02 September 2010

always listen to your fat pads

I'm wondering if someone reading this can help me.

I have fat in all the wrong places. No, this is not going to be a post about me wanting to lose weight, although I would love to because I am slowing gaining weight due to the subject matter I am about to ask you about.

Every time my lifestyle catches up with me (late night treat sessions in front of a movie with my husband, extra snacking with friends, stress eating in a house of wild boys all day) I listen to the fat collecting around my hips, waist and thighs and hit the road for a long, delicious run.

Running has been my best friend, comfort, source of personal inspiration, therapy, magic mood pill, energizer....etc. for a long time now and increasingly over the last couple of years it has become more and more difficult because of a lack of fat...

on the bottoms of my feet.

A strange, and annoying problem.

As each step pounds the pavement I feel as if a nail or two or sometimes fifty are driving themselves up into the balls and heels of my feet.

I ignored it for a long time, only paying for it dearly when I did long runs like the Great Aloha 8 miler. Having to put my feet up for the next 24 hours after a race seemed like a small price to pay for the endorphins and instant toning that running afforded me.

However, over the last year it has become impossible to even walk barefoot in my own home so I have worn house slippers or even "flip flops" night and day (except for sleeping of course). This is tricky in Hawaii since everyone is expected to remove their shoes no matter what in other peoples homes so I pack around a little pair of house slippers in my purse and look like a weirdo or just limp around trying to not look too pathetic.

I tried taking it easy, not running for like the whole summer, everything I could think of basically and the problem never got better so I decided to ask my PCP for a referral to a Podiatrist and she eagerly recommended someone who was supposed to be really great and he eagerly recommended that all I needed to do was to wear his special ugly-as-sin shoes from his very own shop. When I asked him about my other options if I didn't want to simply wear his brand of shoes for the next 70 years of my life he truly acted like a nerdy adolescent boy who had been turned down at prom or like I had called his mother ugly.

I just really can't imagine that that is the best solution I can rely upon for the rest of my entire life.

Especially since I bought the $70 ugly-as-sin sandals and they didn't feel any better than my regular Reefs. I came home from a kids party whimpering and had to keep my feet up after.... it was worse than before.

The $40 shoe-support inserts from his shop didn't fit in any of my shoes and were the same brand and fit as the sandals.

Both were taken back for a full refund luckily.

I did, however, keep the $130 running shoes and got some mileage out of them, my spirits soaring, feeling like I had at least found one grand solution to my problem..... until all of a sudden I could feel those pesky "nails" again and every crunching bone with each step. If you saw a 26-year-old girl limping home on Kam Hwy sobbing last Saturday.... that was me. Embarrassing. I had been promised by the doctor that I could still run, even long distances, and that it would do no damage to my feet AND that his magic running shoes would solve all my problems.

The podiatrist did help me in the sense that now I know the source of my problem. If you, reading this, are normal then you might have maybe 2 inches of fat on the bottom of your feet cushioning your steps everyday and I, for some reason, have a stretched out 1/3 of an inch or something like that was his guess. It makes sense, but it totally sucks.

Thomas told me very gently on Saturday, when I finally made it home, that I might just have to face the facts that I can't be a runner anymore. All runners won't think me dramatic when I say that this made me sob in a little ball on the end of the couch for a while.

I could face that fact. It's really not the end of the world.... but what about everyday life?

We had a fun family activity on Saturday at the beach and the sand felt great on my feet. Then we got home to rinse off in the yard before heading upstairs and had an impromptu family water fight and I needed it after my morning sob session! It was HILARIOUS and we were all four laughing so hard, but in the middle of all the fun.... I felt my "nails" and suddenly realized I still had to shower, get the boys cleaned up, make dinner, get them ready for bed, dishes, the floors were a wreck...etc. and my feet were KILLING ME.

Thomas felt awful, telling me he could take care of all the parenting and chores that night without me.... but should he have to? For the rest of our lives? Can I get new fat pads?

I have a prescription from my PCP for a couple of pain meds including my favorite, Vicodin, but I really don't want that to be my solution. I haven't ever picked-up the already filled prescriptions because, I'm not gonna lie, I like Vicodin and it just doesn't seem like a great long-term solution. Or even short-term. I can't be all sleepy with two wild babes to look after no matter how bad this hurts.

I want to see another doctor, but now I'm all nervous that the next one will just try to sell me old people shoes that don't actually make my feet feel better and shrug off all the other "more expensive and not as tried and true" solutions. I just don't know who to trust or go to or if anything can really be done about my stupid fat pads... or lack thereof.

So, if you have made it through all my complaining and self-pity I am just wondering.... what should I do?

Do you have this problem? Do you know someone with this problem?

The podiatrist mentioned a new surgery that he was unwilling to explore, but does anyone know about it? I'm feeling sad about this and desperate enough to sound pathetic and ask for your help. I am not even asking to be able to run in the 5k and half marathon I have already paid for.... I just want to function normally for my family without having to buy some ugly shoe from a shoe salesman posing as a doctor for the next 70 years.... because that's a long time and those shoes didn't fix the problem. I really hope I have more options than that. Maybe I don't.

(a common, pathetic sight in our home... me with my aching feet up... did you know you need your feet to do like almost EVERYTHING...)

If anyone knows what I am talking about or knows someone who does can I talk to them please?

Thanks for reading friends.

35 comments:

Megan and Keli'i said...

You definitely know I 100% relate to this post. I have no solution and find myself crying at the end of each day due to killer feet pain. Who'd a thought? Feet pain?

I have no solutions. Please inform me when you find one.

My long distance running days are slowing diminishing, but maybe, you and I can become road biker chick buddies. That's better on your feet than running.

But it's true, there ain't nothing like a good run. Nothing.

I'm depressed now.

Alli said...

I was an avid runner before I went to Russia, where I ruined my running feet by walking all over tarnation in ugly as sin dress shoes. Sadly, I've never reached my pre-mission running state because my heels ache- I too wear slippers or flip flops at all times.
The only thing that helps me is to wear tennis shoes whenever fashionably possible, and try to do other forms of exercise. Swimming is probably the best, though I don't get same thrill out of it and am certainly not as good at it.
It is a very sad thing, admittedly. I feel your pain.

melissa marie said...

steph, i'm so sad about this. i can totally NOT relate because my feet are pretty much balls of fat (even non pregnant), but i'm feeling some sincere empathy for you right now. i'll keep my ears open for any suggestions.

kristi said...

I say go see as many docs as you need to get as many opinions and options out there. I truly feel that 90% of our nations medical staff are crooks. So you gotta search for the honest good smart ones.

My sister has plantar fasciitis and has to wear shoes at all times and has special inserts that she loves. She is a big time runner.

When I run usually the first mile or two kill my feet and shins but pretty sure I have no idea what you experience.

marcus lane said...

both pat (my mom) and mono (my sister) have very similar feet issues. you should ask them.....

you might have to take up biking, that's what pat did.

Kahilau said...

Mike read this book and watched an instructional DVD called "Chi Running" I think you would really like it. It might help, it might not but certainly worth a shot considering the other alternative is giving up on running. BOO HOO! Good luck with that!

Rachel said...

Stephanie, I'm not sure what you should do, but I know doctors can be crazy. I went to two of them when my brother was in his motorcycle accident. It had only been a few weeks and he still couldn't move his toes or foot, so the doctors recommended some awful remote control thing in his butt right away. It made no sense! Give him a chance to heal. Anyway, I'm sure you could see different doctors..maybe you'll find a better one. More importantly, I used to have this horrible shooting pain in my foot. The doctors told me it was Morton's Neuroma (wikipedia it). They told me if a cortisone shot didn't work, I would have to have surgery, so I tried the cortisone shot and the pain went away. Every now and then I feel a little pain, but never as bad as those months where it was terrible. If it ever got bad again, I would just get a cortisone shot. So, maybe those would help you? Cortisone shots and wear special foot inserts and do ballet exercises (the kind that prepare ballerinas for pointe shoes) to your toes and feet and have your husband massage your feet everyday.

Rachel said...

toe/feet exercises (because, it's two am and what else do I have to do):
1. These two videos are the similar, but one of them is extra funny: http://www.youtube.com/watch?v=qlmTqykUpjs and http://www.youtube.com/watch?v=vzbKXVzCepM&feature=related

2. http://www.youtube.com/watch?v=50Ctg6PubR8&feature=related

3. Now she is just a showoff, but informative http://www.youtube.com/watch?v=gvuWH-TQLhs&feature=related

and there are a million more videos....

As a retired gymnast, I support this message.

melissa marie said...

hey, i just told nate about your plight, and he reminded me about how his feet were killing last year from work (when he was on them all day). we tried a lot different shoes, but then he got some merrill trail shoes and they really helped--fixed the problem actually. so my suggestion is for you to tromp around hawaii in hiking boots all the time.

Mariko said...

Man, that sucks.
I don't have feet problems (knock on wood) despite the fact that I have flat feet.
Did you see Dr. Pitt?

Mainly I would say, see another doctor. See if he or she says the same thing, but I doubt they will.

If sand felt good on your feet, can you run on the sand?

martin said...

call. i have some legit help for you.

star said...

Hey lady, I emailed a friend of mine whose hubby is a podiatrist. I'll let you know if he has any insights for you!

The Prigmore Family said...

Ahh Steph! Have you thought about bone spurs? Also what about Plantar faciitis?

Feeling helpless is the worst. While popping vicodin feels awesome, it feels crappy to be dependent on meds.
That doc is a kook. see a real specialist. Sometimes it takes awhile to diagnose the prob. Don't give up my friend. You will run again.

Diana said...

absolutely the saddest post ever! and that picture! your face! the never failing good sport who's suffering soo much. =( i'm so sorry friend, and have no experience with this. but i do have the utmost hope there is SOME solution.

Diana said...

wait, just read the comments and evidently (s)marty pants has the solution.

modestmuse said...

:( I am so sorry, Stephanie! I have no idea what the problem could be, but I think slippahs might not provide enough cushion for your feet ... people in HI said that (you see how some get "Island Foot" or whatever those spread-out feet are called from wearing slippahs all their lives!). But I think the old-person shoes are too far on the other extreme. I love my Alice Crocs. I know, I know, Crocs. But they're not ugly and they are SUPER comf and waterproof/antimicrobial; good for HI. I hope someone has more specific and helpful suggestions than mine. If it makes you feel any better, as for senseless injuries, I have had two doctors confirm that I have tendonitis, actually "De Quervain's syndrome" in my left wrist -- caused by squeezing the button to adjust the handle on Nile's car seat! Ridiculous! But as you can understand with your feet ... similarly you use your hands for EVERYTHING! It is quite painful ...

Meg said...

My cousins husband is a podiatrist...I will get in touch with him and see what he suggests!

liko said...

i back mariko in talking to brother pitt. he works in the haleiwa health center certain days of the week, or he used to. and i'm hoping he wasn't the one you saw, although it doesn't sound like him. he's a straight-up guy.

i'm sad you're in pain, that's not nice. have you ever tried crocs? i've been wearing them since massage school and they are very comfy. and online you can see all the styles available. some are cuter than others, mine are not cute, but then again i'm not very fashionable. i hope you find relief soon!

Matti said...

So sad...I wish I knew. My sister is a ballet dancer, and I imagine her friends have a range of foot problems. I'll ask her, and have her ask around. I think maybe one of her friends is married to a pediatrist? I would think something else can be worked out. I hear ya on the pain meds. Not my cup-a-tea.

KristenE. said...

Too bad you dont have kaiser! I used to work with the coolest podiatrists. I've never really heard anyone talk about lack of fat pads on the bottoms of their feet though. And you are so right about those orthodics...ugh, they are horrible looking and SUPER expensive (not to mention the weird nasty way they smell when you take them out of the package for the first time). You may wanna ask if there is possibly a steroid shot they can give you. They seemed to work wonders on the patients I used to see in their offices. It might be worth a try! Please get better my friend!

Bunka's said...

have you ever tried looking at homeopathic doctors? they have helped me with problems MOST medical doctors have not been able to even DIAGNOSE! best of luck....

martin said...

steph, maybe while you're still motivated you can do some reading here:

http://www.ncbi.nlm.nih.gov/pubmed

searching plantar fat pad atrophy.


i'll get back to you soon...

Lisse Brox said...

Thatt is the SADDEST, Steph. Looks like the best solutions are more dramatic; instead of shoes or painkillers, you can now get plastic surgery and get inserts put into your feet that give them the needed padding. That actually sounds genius to me. Less dramatic are injectable collagens and DermaFillers that give you the needed padding. (some last over a year). You may think those sound a little crazy, but I personally think it sounds really smart. Good luck, friend!

Patria said...

oh Steph- my feet hurt with sympathy pain for a minute when i read that. because i understand how good running can feel, the loss of it hurts. i'm nursing an injury right now that impedes running. i think you should keep going with the doctors until you get a solution- surgical fat pads, if promising, is something i think is totally worth it! i don't know if all of our bodies are really built for long term running (at least that's what i worry about my body) so i think about options like swimming and biking. but you're talking about the activities of daily living so keep going- i know there is a doctor here (or even on the mainland) who can help!

Carrie said...

Ben and I echo the others who said keep shopping for doctors until you find a solution. There really are as many opinions as there are doctors, and a lot of dumb people have made it into the medical profession. Someone, however, is smart and can help you.

Ben mentioned (from his little knowledge of feet--- med students don't study feet too much since podiatrists go to a separate school) that if you can get an MRI you will be able to rule out hairline fractures and tendonitis and such, which is what he would push for if you can. Don't give up! I'm so sorry for you!

Anonymous said...

Hi there. I do not know you, but I am the husband of someone you know, and I am a DPM (doctor of podiatric medicine) currently doing a podiatric surgical residency in Portland, OR. As much as I hate to say it there are good and bad people in every profession in life, and podiatry is not immune to that. There are really bad podiatrists out there who make a lot of money by offering a solution to patients that is not bad, but also not the best possible treatment. Luckily, there are also some really good podiatric surgeons out there who treat people in an evidence based manner, meaning that scientific literature supports all of the decisions they make, and accordingly money does not impact their decision making. Don't let one guy give you a bad flavor for podiatrists, they really are the authorities on foot and ankle issues like the one you are experiencing. Now that I have defended the better doctors in my profession, let me offer you some suggestions:

While your problem may be simply a wear and tear issue, the fat pad can atrophy in relation to several systemic conditions. Atrophy of the fat pad in someone your age is not that common. My suspicion is that there may be more to it than just wear and tear, which would require additional workup in cooperation with your primary care doctor. I would shy away from anyone who offers a corticosteroid injection as a solution. While they are great at reducing inflammation which is often the cause of pain, they also cause atrophy and weakening of soft tissue by reducing inflammation which is part of the body's early response to injury in order to stimulate healing. So, steroids are definitely not the right solution for your situation.

Along another line, I have nothing against holistic doctors and their treatments, many people find relief to their ailments via that avenue. That being said, in every aspect of a patient's healthcare I encourage them to make sure that there is some evidence behind whatever a provider offers you as treatment, that is the safest way to avoid inadvertent disasters.

There are some podiatric surgeons who are injecting collagen fillers and silicone based products for people in your situation, I have heard several lectures on this and it may be a good solution, but it is not yet a mainstream treatment and seems to be slightly unpredictable. I do like the suggestions above for CROCS. There are a variety of conditions in the foot that respond well to the soft cushioning effect provided by their shoes, this is really an external way to provide an effect similar to the injections. I believe that is what your podiatrist has attempted so far with the shoes he has set you up with. The frustration you have is probably partially due to the fact that they are only a temporary fix, and are not at all attractive. I am a junkie for cool shoes, so I don't blame you for not liking their appearance. (continued)

Anonymous said...

I believe there is a better solution for you than just changes in shoes. Without examining your feet and being able to order any labs or imaging it is hard to offer you precise suggestions, but there may be underlying problems with the bony architecture of your feet and the way this impacts functional movement of the foot causing increased stress to the fat pad. If that is the case there is likely a surgical solution. But every good surgeon will tell you to exhaust all non-surgical treatments before even considering surgery. If there is an underlying systemic condition then there may be medical/pharmacological treatments to address the root of the problem.

So it really comes down to seeing the right doctor/surgeon. The American College of Foot and Ankle Surgeons runs a website that will help you find a podiatric surgeon who is certified in the organization (carries the acronym FACFAS after their name). I can't make any guarantees that these one of these docs will have the solution for you, but it would be a good place to start if you are exploring other options for foot and ankle care providers. Here is the link:

http://www.foothealthfacts.org/

I will try to keep up on your blog and would be happy to arrange further communication via email at some point if you are interested. I wish you the best and hope you can start to find some real solutions very soon.

Alicia said...

My Dr. Husband says it sounds like Plantar Fasciitis. He recommends going to a place like Runner's World where they have a mat you can walk on that will tell you what kind of shoes you need to support your type of gait. I know that doesn't sound very professional... but he is just giving his two cents worth from the short Reader's Digest/Cliff Notes version I gave him of your post. I agree with the others who have said to keep searching for a doctor/podiatrist that can help you. I have learned that not all doctors are created equal. Good luck! I'm so sorry you're in pain. I know how it feels to miss that runner's high!

Alicia said...

Oh, and another thing he said to do is to stretch your feet a few times a day using a towel to pull your toes up toward your body. And he said to get a really cold can of soda (or whatever) and roll your feet on it to ice it at least 3 times a day, and especially after any kind of exercise. You may also need to get some orthotics (shoe inserts for flat feet). Back off of running for a month or so and if it isn't feeling 100% better, you may need a steroid shot. Good luck, Steph! I hope it helps!

Melissa said...

I would say you definitely need to ask for a referral to a different doctor! Don't give up, I will keep my eyes out for anything or anyone that may know of a solution!

Melanie said...

Hey Stephanie! It's been a long time... remember me? I had LOTS of foot pain for a long while... all different spots... don't know if it's the same for you or not... my doc recommended motion control shoes... look for the dark sole area around the arch... or ask a running store... they should know. However, if that doesn't work and you need custom orthotics... be sure to put them in a neutral shoe... ya. learned that one the hard way... if you put custom orthotics in a motion control shoe, you'll stress the problem the other way... still pain. good luck. I'm hoping it all worked out... much aloha! miss you!

Karen Niner said...

Not sure if my post went through. I have the very same problem as you have. Went to a podiatrist without relief. Gave up and went to see orthopedic podiatry surgeon. He said fat pad atrophy. He ordered soft orthotics with deep heel cup and metatarsal pad to keep pressure off toes and heels. Also ordered physical therapy. This helped and I am taking antidepressant for the pain. I suggest you follow this same path. Good luck!

Karen Niner said...

Not sure if my post went through. I have the very same problem as you have. Went to a podiatrist without relief. Gave up and went to see orthopedic podiatry surgeon. He said fat pad atrophy. He ordered soft orthotics with deep heel cup and metatarsal pad to keep pressure off toes and heels. Also ordered physical therapy. This helped and I am taking antidepressant for the pain. I suggest you follow this same path. Good luck!

Karen Niner said...

Not sure if my post went through. I have the very same problem as you have. Went to a podiatrist without relief. Gave up and went to see orthopedic podiatry surgeon. He said fat pad atrophy. He ordered soft orthotics with deep heel cup and metatarsal pad to keep pressure off toes and heels. Also ordered physical therapy. This helped and I am taking antidepressant for the pain. I suggest you follow this same path. Good luck!

C. M. said...

i am dealing with this right now. 2 months after having my 2 baby at 42 years old, all of the sudden it seemed, i couldnt walk barefoot. it started off as a neuroma on my left foot but then progressed into feeling my met heads on both feet. long story short, i wear flip flops in the shower even. I cannot be without them, i just ordered 12 more from old navy in all different colors. i also bought some silicone pads for the balls of my feet and injinji socks to wear with my new pair of LEMS b/c of the large toe box. and lets not forget the trusty crocs...i have2 pairs now. i hate it but what r u gonna do.