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I have peas size balls in the bottom of my feet

Discussion in 'Ask your questions here' started by nanarozi, Oct 27, 2009.

  1. nanarozi

    nanarozi New Member


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    I have had these pea size balls in the center /bottom / arch area of my feet now for years . The right foot got so bad that it hurt to walk on it. I am on my feet all night at work and it got to the point that my hip was hurting by the end of my shift.

    I went to a local Podiatrist and he preformed surgery on my right foot to remove them. I was off of work for 10 weeks and when I went back for the one of many check ups I told the Doctor that I thought I could feel a ball forming again. I was told it was probably just scar tissue . Before the year was done , they were back again.
    Now two years later , their back and as large as before. The Doctor did say that they could grow back , but I didn't think they'd grow back this fast.

    I never got a clear answer to what they are:confused: ,but I was told I probably got them from an old foot injury. Like when I was running up the steps and would miss the next step and my foot would slip and the edge of the step would slide down the instep of my foot....Very very painful when this happens.:eek:



    Does anyone know what these pea size balls are ? Is having them removed Again worth it if they can come back again ? How many times can surgery be done to remove these each time they regrow?:confused:


    I don't know if going back to the same doctor is wise, I liked him, he was very nice , but I don't see were he helped me.
     
    Last edited: Oct 27, 2009
  2. FootDoc

    FootDoc New Member

    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    If they are Dupuytren's nodules, recurrence after surgical removal is very common and the chances of success not only do not change with multiple attempts, but the scar resultant from the surgery CAN make the situation worse. The recurrences do not necessarily say anything about the doctor's skill. Liking your doctor and thinking him nice is certainly a plus, but not a substitute for getting the information you need. Don't you think that part of what you have paid him for was to give you a clear answer as to what he took out of your foot. Certainly the lumps were sent for histological examination and their identity should be known.
     
  3. nanarozi

    nanarozi New Member

    I called my Doctor this morning with the question of what exactly was removed from my foot. He claims he told me it was plantar fibromatosis. I really don't remember him telling me that, but I guess it's possible I misunderstood him. There was a lot of discussions going back and forth on what could be done for it. Plus I had other issues going on with my feet at the time. Sounds like my Doctor did the right thing, I may go back to him ,because this thing is definitely back.


    After looking online this is what I found,
    Treatment Options

    Many different treatments for plantar fibromatosis have been used and can be divided into two major categories, invasive and noninvasive.
    Invasive treatments include:

    * Corticosteroid injections into the fibroma
    * Surgery - Surgery is currently the most common treatment for plantar fibromatosis. There are two common procedures. One involves the removal of the fibroma only which results in a high recurrence rate and the second involves the complete removal of the plantar fascia which has a long recovery time and can lead to other podiatric problems.

    Non-invasive options include:

    * Transdermal Verapamil 15% Gel
    * Stretching
    * Orthotics
    * Padding
    * Physical therapy

    Most doctors agree that a non-invasive approach to treating plantar fibromatosis should be considered first given the high rate of recurrence from surgery. Invasive treatments and surgery are usually reserved for the most severe cases.


    Here's another


    Medical Care

    * No medical care is effective in plantar fibromatosis, and reported success probably is due to the possible spontaneous involution of superficial plantar fibromatosis. Early treatments have included anti-inflammatory medication, orthotics, and physical therapy. Other modalities have included methotrexate and radiation after surgery.
    * For Ledderhose disease, the intralesional injection of corticosteroids has been tried, but its usefulness is doubtful, and these injections may have some utility at only the initial stage.

    Surgical Care

    * For Ledderhose disease, fasciectomy and excision of the fibrous tissue are the only possible treatments, if needed. Fasciectomy has been shown to reduce the rate of recurrences.10
    * For the other forms of plantar fibromatosis, surgery is the only therapeutic alternative. However, in infantile forms, physicians should evaluate the need for surgery before performing it.11
    * Many juvenile fibromatoses spontaneously regress, and biopsy may be performed to induce their involution.
    o Some lesions can grow, and others can recur after excision that appears complete.
    o Because tumor growth characteristics may be relatively important before surgery, physicians should consider the possibility of an expectant control.
    * Hamartomatous plantar fibromatosis does not regress spontaneously; therefore, surgical removal is appropriate.

    **********************************************

    It doesn't sound like having them removed again is a good idea. Not if they just come back every time and risk the chance of having bigger problems later on. The Doctor all ready made me a $400 set of Orthotics, which now are pushing on the lumps. And I don't understand what Physical therapy and Stretching is going to do for some thing that isn't going to go away.Complete removal of the plantar fascia which has a long recovery time and can lead to other podiatric problems sounds scary to me also.

    The out look seems dim to say the least.
     
  4. FootDoc

    FootDoc New Member

    Plantar fibromatosis is a synonym for Dupuytren's nodules which I mentioned previously. As I had stated, recurrences after excision are common-place.
     
  5. Lakeview

    Lakeview New Member

    Hi, it appears we possibly have the same issue, but I have not opted for surgery as of yet. Did you find a solution to resolve your issue? I can certainly understand you not wanting more surgery (especially if you were off work for 10 weeks following the initial surgery).

    Have you looked into the possibility of Verapamil? My podiatrist says it has had some success (but as of yet has not personally seen it in his practice). I also have heard that some Doctors are using cyrosurgery as an alternative treatment, but haven't completed much research on that option yet, or if it is even available as an option in my area.

    Your situation has me concerned, as apparently Plantar Fibromatosis can be an on going disease process that doesn't always respond well to surgical intervention.

    I am interesting in hearing your thoughts, opinions and suggestions as to how you might proceed (or have done), since this post.

    Thanks

    PS - Foot Doc, do you have any suggestions since as you mentioned, recurrence rates are relatively high?
     
  6. nanarozi

    nanarozi New Member

    Lakeview, I am really at a loss at what to do next.




    Non-invasive options include:

    * Transdermal Verapamil 15% Gel
    * Stretching
    * Orthotics
    * Padding
    * Physical therapy


    As I said I have tried Orthotics and they don't address the problem at all. Non-invasive options , I guess will be my next step although I really do not understand how Stretching and Physical therapy are going to do anything to make these lumps go away. Padding is as useless as the Orthotics are. It is painful to have anything that pushes into the lumps. I NEVER go barefoot anymore because if I step on anything uneven it hurts at the site of the lumps .


    Verapamil is an option . I've been living with these for years now so I am willing to try anything in the hopes of some kind of relief
     
  7. Lakeview

    Lakeview New Member

    I feel your pain (literally). From what I have read (this issue is just new to me, and I haven't opted for the surgery yet). Physical Therapy and Stretching (as well as orthodics) are for the prevention of further damage to the ligaments. This disease is caused by the over production of scar tissue from tears in the ligaments. The more tears, the more scar tissue and the disease is very progressive. So you really might want to consider those treatment options. From what I understand, these treatments won't work to reduce the size of existing tumors, but will prevent additional ones from occurring (which often happens).

    I am using the Verapamil Gel in the hopes that I can get the tumors to shrink enough to live with in order to avoid taking the surgical option (as that sometimes can exaggerate the problem, thus the recurrence rate). I am on a sample given to me by my Podiatrist so haven't ordered it yet, but understand it can be expensive and not covered by insurance. However, if it gives you relief, it certainly may be worth it in your case. If it works treatment usually lasts from 9 months to a year, but re-treatment is not necessary.

    I haven't ordered the orthodics yet, but I really want to avoid surgery, so might put up with them. I, like you, just don't want them to push upon the painful lump. I understand if they are custom made, they can adjust them so that it doesn't, but can't tell you if that is true or not.

    I really wish I had something positive to offer, but like you, am just trying to learn what my options are and how to live with them. I understand there has been some success with cyrosurgery (which lessens the recurrence rate). Also just recently read that after surgery, radiotherapy does seem reduce the recurrence rate (I think it essential kills off any remaining diseased tissue that might remain after surgery in the hopes of preventing recurrence). There also seems to be the option of removing the entire plantar fascitis (sp), but that surgery has a pretty difficult recovery and you lose your arch support, so orthodics are a must afterwards.
     
  8. FootDoc

    FootDoc New Member

    As with most doctors, I have had very limited success with these. Pocketed insoles to off-load pressure on the nodules may often be the best option.
     
  9. nanarozi

    nanarozi New Member

    What is cyrosurgery?
     
  10. Lakeview

    Lakeview New Member



    The newest treatment for Plantar Fibroma is Cryoanalgesia (Cryosurgery or cryo). This is performed through a small 3mm incision just to the side of the mass. The cryoprobe is directed using a Digital Diagnostic Ultrasound to several sites within the lesion and the procedure is performed like a typical cryo procedure. There is no cutting of the ligament as in the Conventional Plantar Fasciectomy, which can usually lead to functional instability of the entire foot. This procedure is performed in the office under local anesthesia. It typically takes 20-30 minutes. The pain from the lesion is typically decreased dramatically within 2-3 days and the lump is visibly decreased in size within a few days to weeks. It gradually continues to decrease in size over the next few months as the pain stays gone for 3 months or more. By that time, the mass is essentially gone and so is the pain
     
  11. Lakeview

    Lakeview New Member

    QUOTE=FootDoc;23967]As with most doctors, I have had very limited success with these. Pocketed insoles to off-load pressure on the nodules may often be the best option.[/QUOTE]

    So is your opinion that Orthodics are the best solution for this issue? I know we all want an immediate fix (or at least I did until I came to understand the issue). Would you suggest these be custom made in order to avoid pressure on the lumps? I have used over the counter (modified by me :confused:) , and have found the same issue as others, they just make the problem worse. I understand if they are custom made, they will not press on the sore area. Has that been your opinion in practice?
     
  12. nanarozi

    nanarozi New Member

    Cryosurgery sounds like a great option ! What are the side affects if any? Is this covered by Insurance ? Is there a recurrence with this? If so, how many times can this procedure be done in the same area?
     
  13. Lakeview

    Lakeview New Member


    I guess this kind of answers the question as to the use of orthodics. Appears it may be the best treatment option (other than maybe Cyrosurgery).

    " Conservative treatment options

    Common conservative treatments for Plantar Fibroma
    -Changes in shoes to include more supportive sport/walking shoes that have a softer footbed.
    -Oral anti-inflammatories including over-the-counter meds such as Advil, Motrin and Aleve may help acute flare-ups.
    -Prescription-strength anti-inflammatories prescribed by a Physician.
    -Anti-inflammatory injections (cortisone-type medications) into the mass and the surrounding areas to decrease the inflammation.
    -Stretching exercises-this may worsen the problem as it stretches the area of tear.
    -Massage including tennis ball or frozen water bottle massage of the arch-as with stretching, this may worsen the problem.
    -Taping or strapping of the foot/arch/ankle to take the pull off the Plantar Fascia is a very good diagnostic tool.
    -Longterm conservative treatment should include custom molded functional orthotics. When this device has an accommodation for the mass, this is the best conservative treatment for Plantar Fibroma."

    Currently my Podiatrist has my foot taped. I am not sure how that is useful as a diagonistic tool, but will continue down this path until we get Orthodics made.
     
    Last edited: Nov 4, 2009
  14. Lakeview

    Lakeview New Member

    Have only just started to look into the options, so can't answer your questions (especially about the insurance aspect). But it appears worth checking out. Try a google search for more info. Here is one of many website answers:



    http://azcryo.com/?q=node/48

    When we use Cryoanalgesia (cryo) for the treatment of Plantar Fibroma, there is also a chance of recurrence. In the more than 40 procedures Dr. Rampertab has performed at azcryo specifically for Plantar Fibroma, we have seen a recurrence rate of 25% or less than half of the recurrence rate seen with Conventional Plantar Fasciectomy. It must be noted that this is a fairly small sample to consider. It should also be noted that we have only been using the procedure for this problem for a little over 4 years. Otherwise, it should be further noted that there is minimal scar tissue formation with cryo of the lesion. In addition, this procedure is repeatable as many times as we need to perform it without any discernible increase in scar tissue.

    Inherent in the Cryosurgical approach to treatment of Plantar Fibroma is the softening of the lesion during the freezing process. The established strong collagen cross bonds of the mass are broken during the freeze-thaw process. Because of this process, the softer, more pliable lesion is seen immediately after the procedure. In addition, the inflamed nerves underlying the mass are treated simultaneously as we perform the procedure, so the pain is decreased almost immediately.

    Post-operatively, patients relate similar results as with patients who have the Cryo procedure for Plantar Fasciitis. 80% of those patients related an 80% decrease in the original pain/discomfort level within days of the procedure. In those patients that had the problem in the other foot treated with Conventional Plantar Fasciectomy and were treated with Cryo in the second foot, they related a much faster healing course and much less lost time from work. They responded favorably to Cryo and would have the procedure done again if necessary.

    » Login or register to post comments
     
  15. Lakeview

    Lakeview New Member

  16. FootDoc

    FootDoc New Member


    DISCLAIMER:
    THE FOLLOWING IS OFFERED GRATIS AS GENERAL INFORMATION ONLY, AND, AS SUCH, MAY NOT BE APPLICABLE TO THE SPECIFIC QUESTIONER AND/OR HIS/HER PROBLEM. IT IS CLEARLY NOT BASED ON ACTUAL KNOWLEDGE AND/OR EXAMINATION OF THE QUESTIONER OR HIS/HER MEDICAL HISTORY, AND IT CAN NOT AND SHOULD NOT BE RELIED UPON AS DEFINITIVE MEDICAL OPINION OR ADVICE. ONLY THROUGH HANDS-ON PHYSICAL CONTACT WITH THE ACTUAL PATIENT CAN ACCURATE MEDICAL DIAGNOSIS BE ESTABLISHED AND SPECIFIC ADVICE BE GIVEN. NO DOCTOR/PATIENT RELATIONSHIP IS CREATED OR ESTABLISHED OR MAY BE INFERRED. THE QUESTIONER AND/OR READER IS INSTRUCTED TO CONSULT HIS OR HER OWN DOCTOR BEFORE PROCEEDING WITH ANY SUGGESTIONS CONTAINED HEREIN, AND TO ACT ONLY UPON HIS/HER OWN DOCTOR’S ORDERS AND RECOMMENDATIONS. BY THE READING OF MY POSTING WHICH FOLLOWS, THE READER STIPULATES AND CONFIRMS THAT HE/SHE FULLY UNDERSTANDS THIS DISCLAIMER AND HOLDS HARMLESS THIS WRITER. IF THIS IS NOT FULLY AGREEABLE TO YOU, THE READER, AND/OR YOU HAVE NOT ATTAINED THE AGE OF 18 YEARS, YOU HEREBY ARE ADMONISHED TO READ NO FURTHER.
    ***********************************************************
    No, I didn't mention orthotics. The term "orthotics" is frequently misused, but when that term came into the lexicon of podiatry, it was meant to describe generally hard in-shoe devices fabricated on casts of the feet intended to accommodate biomechanical problems . . . generally restricting excessive pronation or accommodating forefoot or rearfoot varus or valgus. What I was talking about is a cushioned insole of some depth with pockets to accommodate the nodules. The BEST form of treatment would be permanent removal of the nodules, but unfortunately that is often unsuccessful and very often they recur and with scar tissue from the procedure which sometimes makes it worse than before.
     
    Last edited: Nov 4, 2009
  17. Lakeview

    Lakeview New Member

    Thank you for the clarification, I had assumed they were one and the same (Orthodics = specially built shoes or inserts) so I really misspoke. Are these soft insoles custom made to accommodate your particular nodules by your podiatrist? That would certainly seem to make more sense than trying to work with over the counter insoles and getting them correctly pocketed to your particular problem.
     
    Last edited: Nov 4, 2009
  18. nanarozi

    nanarozi New Member

    My Doctor made me the Orthodics that you mentioned . He made cast of my feet and it was something my insurance wouldn't pay for. After reading your post it makes me wonder why my Doctor went with these Orthodics when it sounds like the cushioned insole of some depth with pockets to accommodate the nodules would have been more of what I needed or need. See I have these nodules on both feet.

    Thank God my Doctor talked me out of having both feet done at the same time.

    I am interested in trying these cushioned insoles, is this something I have to get from the Doctor? If not can you tell me how to make them myself? How thick are they?

    I see Lakeview and I have asked the same question here. Sorry.
     
  19. Foot Doc

    Foot Doc Guest

    Have your podiatrist check with Bergmann Orthotic Laboratory in Northfield Illinois. I have used their soft diabetic pocketed insole. I indicate on the cast where I want the pockets. They ARE far more thick than standard biomechanical orthotics and may require a larger shoe.


    FOOT DOC
     
  20. nanarozi

    nanarozi New Member

    I am having pain in the same foot that I had surgery on in Jan of 08' The Doctor gave me Naproxen to take for it back then. I still have some pills left and I think I'm going to start taken them again. It feels like the nodules are growing bigger and I feel more now.

    What cushions would you suggest that I could cut holes in so I can stay working until I decide to go back to my Doctor.
     
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