CONTACTS
SUBJECTS
Right Foot Injury Pain Plantar Plate Tear Plantarflexion Care Tape L
1503 -
1503 - ..
1504 - Summary/Objective
1505 -
150501 - Follow up ref SDS 90 0000. ref SDS 87 0000.
150502 -
150503 - Met Doctor Thuillier in Orthopedics Department at VAMCSF, ref SDS 0
150504 - HQ5O, to consider treating rising pain in right foot with Supartz,
150505 - which worked well for right knee after 3-injections ending on 170206.
150506 - ref SDS 0 175G Doctor advised there is no clinical trial available at
150507 - VA for treating feet with Supartz. ref SDS 0 D33N Some patients
150508 - report good results experimenting with PRP injections in feet and/or
150509 - knees, but it is not available at the VA. ref SDS 0 VF3J Doctor
150510 - Thuillier indicated Hoka shoe design is favorable for avoiding
150511 - metatarsalgia. ref SDS 0 W44I He diagnosed recent increased pain in
150512 - right foot caused by plantar plate tear. ref SDS 0 I54I He
150513 - demonstrated care with plantarflexion wrap using hospital white tape,
150514 - ref SDS 0 774N, and submitted a letter with a link to video that can
150515 - be displayed with flashplayer showing steps to implement
150516 - plantarflexion care. ref SDS 0 W666 Doctor Thuillier ordered MRI
150517 - radiology study to verify scope of right foot plantar plate injuries,
150518 - and included left foot for comparison. ref SDS 0 OH9L After meeting
150519 - with Doctor Thuillier went to Radiology Schedule Section. Caroline
150520 - will call to advise when MRI is scheduled. ref SDS 0 OH4R
150522 - ..
150523 - [On 170329 1127 received call from Caroline saying MRI
150524 - studies on both feet does not require contrast medium, so
150525 - these studies were both scheduled on 170412 0800.
150526 - ref SDS 91 HQ5O
150528 - ..
150529 - [On 170329 1127 letter notifies Doctor Thuillier that
150530 - Caroline in Radiology planning MRI studies without
150531 - contrast, and some youtube research indicates plantar plate
150532 - tears are dianosed using contrast medium; asking if order
150533 - for MRI requires modification. ref SDS 92 KW62
150534 -
150535 -
150536 -
150538 - ..
1506 -
1507 -
1508 - Background
1509 -
150901 - Meeting Doctor Tang in Podiatry on 140805 1030. ref SDS 36 NU4G
150902 - Progress Notes for meeting on 140805, call for return to clinic after
150903 - receiving FFO. ref SDS 36 IJ4G A few days after meeting on 140805,
150904 - received letter from VA scheduling meeting on 140820 1000.
150906 - ..
150907 - On 140828 meeting with Doctor Kevin Daun and later with Doctor Mihara,
150908 - attending developed solution to blister on inside of big toe on left
150909 - foot, ref SDS 44 W74O, that required stopping 11 mile hike after 8
150910 - miles and calling for a ride home, shown in case study on 120101 0900.
150911 - ref SDS 9 BO6F
150913 - ..
150914 - On 140904 0900 meeting with Doctor Cynthia Lieu and Doctor Tang,
150915 - attending. ref SDS 47 AK6J Doctor Tang said orthotics can be trimed
150916 - to fit a smaller shoe size, if necessary; he has scheduled a meeting
150917 - after orthotics inserts are received. ref SDS 47 4M3H
150919 - ..
150920 - On 150115 0845 meeting with Doctor Tang and Doctor Goodman, the doctor
150921 - ordered a 2nd set of orthotic inserts to recover from and prevent
150922 - recurrance of metatarsalgia. ref SDS 52 BG6I
150924 - ..
150925 - On 151215, met with Doctor Hewitson in Podiary. ref SDS 58 AK6J He
150926 - modified the Prolab orthotic inserts applied with Hoka Stinson Lite
150927 - shoes size 10 worn today, and for the purpose of improving routine
150928 - walking gait. ref SDS 58 9B6I Observation of walking tests, and
150929 - placing the doctor's hands on the patient's hips while standing to
150930 - evaluate body alignment, indicated to Doctor Hewitson that this
150931 - initial modification did not correct defect in walking gait, so he
150932 - removed that modification and instead raised the heel of the left
150933 - orthotic. ref SDS 58 NC7M
150935 - ..
150936 - Doctor Hewitson said to bring in the other pair of orthotic inserts on
150937 - the next meeting in Podiatry for adding modifications that make both
150938 - pair the same. ref SDS 58 1J98
150940 - ..
150941 - On 151215 1000 Progress Notes explain modifications to orthotics -
150942 - Improved gait by decreasing early heel off L, increased L knee
150943 - extension, and decreased R recurvatum. ref SDS 59 ZA9I
150945 - ..
150946 - On 151215, Doctor Hewitson and his team made molds of the feet to make
150947 - new orthodic inserts. They will be shipped in a few weeks. When new
150948 - orthotics are received, notify VA to schedule follow with Doctor
150949 - Hewitson to review effectiveness, and to make modifications as needed,
150950 - and as done on 151215.
150952 - ..
150953 - On 151215 1000 Progress Notes confirm follow up meeting will occur
150954 - after receiving orthotic inserts. ref SDS 59 PK6L
150956 - ..
150957 - On 140101 0600 case study reporting on 151222, developed new blister
150958 - on left side little toe left foot, possibly related to changed
150959 - orthotics. ref SDS 15 IE9O
150961 - ..
150962 - On 160202 1540 reported injury to right knee, very painful; Doctor
150963 - Tang recommended not using adjusted orthotic inserts, until meeting
150964 - with Doctor Hewitson in Podiatry Biomechanics can evaluate adjustments
150965 - to avoid right knee injury. ref SDS 66 WG59
150967 - ..
150968 - On 160325 0443 letter to VA notifies Doctor Tang that orthotic inserts
150969 - ordered by Doctor Hewitson on 151215, have been received, so meeting
150970 - can be scheduled for Doctor Hewitson to configure the new inserts,
150971 - ref SDS 67 AK6J, as planned by the doctor during the prior meeting on
150972 - 151215. ref SDS 58 HM8J
150974 - ..
150975 - On 160503 1130 encountered Doctor Hewitson in the cafeteria; he agreed
150976 - to provide care after lunch at 1300 in Podiatry. 160503 1256,
150977 - ref SDS 70 9A34
150979 - ..
150980 - On 160503 1300 meeting Doctor Hewitson in Podiatry. Since this
150981 - meeting was ad hoc, we did not have the 3 sets of orthotic inserts
150982 - which he planned to modify, shown in the record on 151215 1000.
150983 - ref SDS 58 1J98 Scheduled another meeting on 160516, for Doctor
150984 - Hewitson to improve alignment of ankles, knees and hips. 160503 1256,
150985 - ref SDS 70 TN94
150987 - ..
150988 - On 161212 meeting with Doctor Alexis Dang in Orthopedics, the doctor
150989 - recommended review by Podiatry to correct Tailor's Bunion. ref SDS 73
150990 - OG4N
150992 - ..
150993 - On 161219 2208 wrote letter to Doctor Tang and Doctor Hewitson,
150994 - ref SDS 75 V13J, requesting care for Tailor's Bunion, ref SDS 75 X659,
150995 - and prescription for liquid Naproxen. ref SDS 75 X65V
150997 - ..
150998 - On 161220 0927 Doctor Tang offered prescription for diclofenac gel to
150999 - replace Naproxen to control inflammaton to feet and joints from
151000 - hiking. ref SDS 76 0657 Letter to Doctor Tang requested prescription.
151001 - ref SDS 76 J99T The doctor notified that he ordered diclofenac gel,
151002 - and can pick it up at Pharmacy today. ref SDS 76 L668
151004 - ..
151005 - On 161221 0730 xray both feet evaluate Tailor's Bunion, and other
151006 - injuries to feet. ref SDS 77 JT6G
151008 - ..
151009 - On 161221 0822 received prescription from VAMCSF Pharmacy for
151010 - diclofenac gel to replace Naproxen to control inflammation during
151011 - hikes. ref SDS 78 Z38F
151013 - ..
151014 - On 161222 1519 Doctor Tang called and reported xray found no evidence
151015 - of Tailor's Bunion, nor other severe injury to feet. ref SDS 81 HQ5O
151017 - ..
151018 - On 170315 1146 submitted letter to Doctor Tang in Podiatry, thanking
151019 - the VA for timely care, and asking for the name of the treatment that
151020 - may be offered in clinical trial for metatarsalgia. ref SDS 88 F64G
151022 - ..
151023 - On 170317 0847 letter to Gina who gave Supartz injections, ending on
151024 - 170206, and requesting meeting for few minutes, ref SDS 89 H84K, also,
151025 - called and left message for Gina on meeting, purpose is to request
151026 - assistance expediting meeting on Supartz treatment for metatarsalgia.
151027 - ref SDS 89 F97H
151029 - ..
151030 - On 170318 1113 received call from Moses in VA Orthopedics; scheduled
151031 - meeting with Doctor Thuillier to consider treatment in clinical trial
151032 - for using Supartz in right foot. ref SDS 90 HQ5O
151034 - ..
151035 - On 170327 1430 meeting with Doctor Dan Thuillier in Orthopedics,
151036 - ref SDS 0 HQ5O; doctor advised VA does not support clinical trial
151037 - applying Supartz for metatarsalgia. ref SDS 0 D33N; Doctor Thuillier
151038 - explained shoes with stiffer forefoot, like Hoka Stinson 3, help
151039 - prevent metatarsalgia injuries. ref SDS 0 W44I Doctor Thuillier
151040 - diagnosed possible plantar plate tear, ref SDS 0 I54I, and
151041 - demonstrated Plantarflexion taping to prevent further injury during
151042 - hiking, and he submitted a letter with a video showing procedure for
151043 - plantarflexion taping. ref SDS 0 774N
151044 -
151045 -
151046 -
151047 -
151048 -
151049 -
151051 - ..
1511 -
1512 -
1513 - Progress
1514 -
151401 - Arrived at VA and checked in OA 1230.
151402 -
151403 - Meeting today, with Doctor Daniel Thuillier in Orthopedics to consider
151404 - experimental injection treatment for metatarsalgia in both feet. foot.
151406 - ..
151407 - The meeting today, was scheduled by Moses on 170318 1113. ref SDS 90
151408 - HQ5O
151410 - ..
151411 - The doctor is listed on the staff at UCSF...
151412 -
151413 - https://www.ucsfhealth.org/daniel.thuillier
151414 -
151415 - Graduated medical school at UCSF in 2007.
151416 - Completed residencies at UCSF 2013.
151418 - ..
151419 - Orthopaedic Surgery
151420 - Assistant Professor in Residence
151421 -
151422 - http://orthosurg.ucsf.edu/home/faculty/biography/daniel-thuillier-md/
151424 - ..
151425 - Business Address
151427 - ..
151428 - MISSION BAY
151429 - ORTHOPAEDIC INSTITUTE
151430 - 1500 Owens Street
151431 - San Francisco, CA 94158
151432 - Phone: 415-353-2808
151434 - ..
151435 - This implements referral by Doctor Tang for getting "experimental
151436 - injection" treatment to resolve severe metatarsalgia pain from hiking
151437 - to raise HDL for treating atherosclerosis, reported on 170314 0930.
151438 - ref SDS 87 SG3J
151440 - ..
151441 - Leading up to 170310, comparitively had done practially no hiking due
151442 - to pain in right knee, until Supartz injections completed on 170206.
151444 - ..
151445 - After hike yesterday, considered possibility that sudden increase in
151446 - severe pain to right foot long toe, may arise from injury, e.g., a
151447 - break or fracture, suffered lifting 90 pound box upstairs on 170309
151448 - 1910. ref SDS 85 1E4F The case study reporting daily exercise, diet,
151449 - meds and vitals, lists possible injury to toe explaining
151450 - significantly greater pain in right foot than left foot, where as the
151451 - left foot always hurt worse than the right, until recently.
151453 - ..
151454 - Would like to get MRI radiology study to determine precise injuries to
151455 - right foot compared with left foot.
151457 - ..
151458 - Left foot orthopedic care with inserts seems to control metatarsalgia
151459 - so normal hiking can occur, expecially using treatment with Diclofenac
151460 - gel, prescribed by Doctor Tang on 161220 0927. ref SDS 76 0657
151462 - ..
151463 - Doctor Thuillier advised there is no clinical trial at the VA for any
151464 - experimental injection treatment for patients to recover from
151465 - metatarsalgia feet pain from hiking extended miles.
151467 - ..
151468 - Reviewed Doctor Tang made referral to Orthopedics to consider trying
151469 - "experimental" treatment, reported on 170314 0930. ref SDS 87 SG3J
151471 - ..
151472 - Mentioned my cousin, Robin, had orthopedic injection treatment in her
151473 - knee many years ago which she called prolotherapy. It has been
151474 - effective, but now years later she needs additional treatments. She
151475 - and my step-father are visiting Doctor Darrow in Los Angeles about a
151476 - newer PRP injection therapy, reported on 161204 0127. ref SDS 72 LK53
151478 - ..
151479 - Dan said some patients are experimenting with PRP, and report good
151480 - results treating feet and knee injuries, but it is not available at
151481 - the VA. He encouraged independent research outside the VA, saying
151482 - there is a lot going on in the field of orthopedics, and noted PRP is
151483 - getting some attention in the news lately.
151484 -
151485 - [On 170630 1044 letter to Doctor Thuillier confirms
151486 - planning to investigate orthopedic injection treatments
151487 - with PRP. ref SDS 97 P278
151489 - ..
151490 - [On 170726 1600 Doctor Tucker performed experimental PRP
151491 - injection treatments in feet and left knee. ref SDS 98 0001
151493 - ..
151494 - The doctor was familiar with Hoka shoes. He explained the stiff
151495 - forefoot helps prevent pain from metatarsalgia occurring in this case.
151497 - ..
151498 - Explained difficulties with Hoka Stinson 3 shoes changing the design
151499 - about 18 months ago required switching to another shoe, because Hoka
151500 - narrowed the Stinson 3 models. This squeezed the toes causing further
151501 - injury. Hoka does not provide variable widths, so had to switch to
151502 - Brooks Ghost with variable width.
151504 - ..
151505 - Dan was not familiar with Brooks Ghost. Advised these shoes have
151506 - softer forefoot, and so may contribute to recent increase in
151507 - metatarsalgia pain, however, they are available in wider forefoot that
151508 - prevents squeezing toes together, especially wearing 2 pair socks.
151510 - ..
151511 - The doctor asked why double socks?
151513 - ..
151514 - Second pair of socks increases cushioning, but more importantly
151515 - prevents the left heel from bunching above the shoe line during a hike
151516 - after 2 or 3 miles, and then causing severe blisters.
151518 - ..
151519 - Wore Brooks Ghost size 10 width 2E and 2 pair socks hiking Half Dome
151520 - on 160914. This worked well. But in October metatarsalgia pain
151521 - increased, so switched to size 11 to reduce squeezing the toes
151522 - wearing 2 pair socks.
151524 - ..
151525 - Dan also recommended trying "Alta" shoes in place of Hoka and Brooks
151526 - Ghost shoes.
151527 -
151529 - ..
151530 - Plantar Plate Tear
151531 -
151532 - The doctor explained recent severe pain on right forefoot below the
151533 - long toe may occur from a tear or failure of the Plantar Plate, which
151534 - is stressed when running and hiking, or by traumatic event, as
151535 - discussed today, shown above. ref SDS 0 T95L
151536 -
151537 - [On 170330 1419 got suggestion to investigate KT tape for
151538 - hiking with plantar plate tear, so it will not worsen and
151539 - can heal. ref SDS 93 GE6G
151541 - ..
151542 - [On 170412 0800 MRI both feet found right foot long toe
151543 - compatible with chronic tears, and further, "degeneration
151544 - without discrete tear". ref SDS 95 JI37
151546 - ..
151547 - Today, during the meeting the doctor wrapped the right foot long toe
151548 - with 1/2" white tape to demonstrate a procedure for Plantarflexion
151549 - care that protects against Plantar Plate tear injuries during heavy
151550 - exercise, in this case hiking 11 - 15 miles per day.
151552 - ..
151553 - Asked how often taping should be changed?
151555 - ..
151556 - Doctor Thuillier said to change the tape daily for common white tape
151557 - used today. He advised there are types of tape that can stay for up
151558 - to 4 days, and are compatible with showering. The VA does not supply
151559 - these longer lasting taping materials.
151560 -
151561 - [On 170417 1330 Doctor Thuillier advised that
151562 - plantarflexion care for right foot long toe will protect
151563 - plantar plate from further injury and enable healing during
151564 - heavy exercise, ref SDS 96 I45H, and despite mild pain < 5
151565 - during hiking. ref SDS 96 8A6N
151567 - ..
151568 - He seemed to say that athletic tape would also be helpful.
151570 - ..
151571 - The wrapping method is complicated.
151573 - ..
151574 - Asked the doctor to check on Youtube for this procedure, since just
151575 - seeing it once was not enough to remember the complex lacing of the
151576 - toe wrap.
151578 - ..
151579 - The doctor found a Youtube video demonstrating the steps. He sent
151580 - a letter saying...
151581 -
151582 - 1. Subject: Youtube taping video
151583 - Date: 2017-03-27 15:02
151586 -
151587 - https://m.youtube.com/watch?v=meUFV2UQyf8
151589 - ..
151590 - 2. Altra shoes
151592 - ..
151593 - 3. Dan
151594 -
151595 -
151597 - ..
151598 - Knees Supartz Injection Treatment Complement PRP Injections
151599 - Supartz Injection Treatment Both Knees and/or PRP Injections
151600 - PRP Injections and/or Supartz Injection Treatment Both Knees
151601 -
151602 - Dan next looked at the MRI of both knees performed on 160805. He
151603 - observed the left knee is much worse than the right knee. This aligns
151604 - with Doctor Dang's comments during the meeting on 161212 1632.
151605 - ref SDS 73 OP5J
151607 - ..
151608 - He will contact Gina about adding 2 injections for the right knee, and
151609 - possibly doing 3 injection treatment for left knee, as previously done
151610 - on the right knee, ending on 170206 1240. ref SDS 82 0234
151612 - ..
151613 - The doctor suggested independent investigation for PRP injections in
151614 - the knees, per above. ref SDS 0 VF3J
151615 -
151616 -
151617 -
151618 -
151620 - ..
151621 - Feet MRI Studies Ordered Evaluate Plantar Plate Tear
151622 -
151623 - The doctor ordered MRI studies on both left and right feet to
151624 - evaluate scope of metatarsalgia injuries, and including Plantar Plate
151625 - Tear on 2nd toe.
151627 - ..
151628 - Thanked Dan for productive meeting.
151630 - ..
151631 - Later research found another Youtube video
151632 -
151633 - Second Toe Pain and Plantar Plate Tears
151634 -
151635 - https://www.youtube.com/watch?v=9grk2Y3_KZE#t=234.502458
151636 -
151637 - Doctor Larry Huppin
151639 - ..
151640 - The last 3rd of the video, the doctor says in part...
151642 - ..
151643 - Arthurgram MRI dye is put into the joint. If the MRI shows
151644 - the dye leaks out of the joint, this diagnoses Plantar Plate
151645 - Tear.
151647 - ..
151648 - The doctor in the video says to visit a biomechanics
151649 - specialist to provide conservative solutions.
151651 - ..
151652 - Another source on the Internet...
151653 -
151654 - The Running Institute San Diego
151655 - 8525 Gibbs Dr, Ste 205
151656 - San Diego, CA 92123
151657 - 858 268 8525
151658 - Email drrunco@sdri.net
151659 -
151660 - https://www.sdri.net/2012/11/plantar-plate-sprains-and-plantar-plate-tears/
151662 - ..
151663 - Plantar Plate Tear Heals 6 - 12 Weeks
151664 -
151665 - If all of the correct procedures are followed there is no
151666 - reason to expect anything less than 100% resolution of the
151667 - condition. By supporting and/or immobilizing the Plantar
151668 - Plate, usually for a period of 6 weeks to 3 months, the
151669 - ligament will heal by forming new tissue know as Fibrin. The
151670 - new fibrotic tissue will essentially from a patch over the
151671 - damaged area of the Plantar Plate. This new fibrotic tissue
151672 - will at first be stiffer and may result in feelings of
151673 - tightness beneath the Metatarsals. Over the period of the
151674 - next few months, even up to a year, the feelings of stiffness
151675 - and tightness will lessen due to specialized cells in your body
151676 - called Macrophages. These cells will reshape and reorganize
151677 - the fibrotic tissue molding it as close to perfect as possible.
151678 - It is my experience that making custom insoles with Plantar
151679 - Plate supports provides additional protection to the area while
151680 - it undergoes remodeling and strengthening and are a viable
151681 - addition in the prevention of future reoccurrences.
151683 - ..
151684 - Helpful to know stiffness will accompany healing, and so signal this
151685 - is occurring. If "stiffness" explained here is similar to feeling of
151686 - swelled tissue at long toe, then this is already occuring, because it
151687 - feels like slight swelling.
151689 - ..
151690 - There is a youtube video at...
151691 -
151692 - https://youtu.be/_mgqGS-zF5k
151694 - ..
151695 - Proposes "protective boot or walking boot.
151697 - ..
151698 - How does this "protective boot" relate to wrapping long toe using
151699 - plantarflexion taping scheme with Rocktape?
151701 - ..
151702 - Is a "portective boot" simply an orthotic insert, with the area for
151703 - the long toe through the forefoot cut out to distribut the load to
151704 - adjacent metatarsals?
151706 - ..
151707 - Video seems to say use both walking boot and taping. Video further
151708 - maintains that plantar plate injury is not simply an aspect of
151709 - metatarsalgia.
151711 - ..
151712 - Video further indicates physical therapy treatments complement walking
151713 - boot and taping.
151715 - ..
151716 - This organization offers consultation for $67.
151718 - ..
151719 - [On 170329 1127 received call from Caroline saying MRI
151720 - studies on both feet do not require contrast medium, so
151721 - these studies were both scheduled on 170412 0800.
151722 - ref SDS 91 HQ5O
151724 - ..
151725 - [On 170329 1127 letter notifies Doctor Thuillier that
151726 - Caroline in Radiology planning MRI studies without
151727 - contrast, and some youtube research indicates plantar plate
151728 - tears are dianosed using contrast medium; asking if order
151729 - for MRI requires modification. ref SDS 92 KW62
151731 - ..
151732 - [On 170411 1040 Doctor Hewitson in Podiatry Biomechanics
151733 - seemed to advise that MRI studies to diagnose Plantar
151734 - Plate Tear afflictions, requires contrast medium.
151735 - ref SDS 94 2J6J
151736 -
151737 -
151738 -
151740 - ..
1518 -
1519 -
1520 - 1513
1521 -
152101 - Radiology Schedule MRI Feet on 170412
152102 - MRI Feet Schedule on 170412 Radiology
152103 -
152104 - After meeting with Doctor Thuillier in Orthopedics Clinic at Module
152105 - 2, went upstairs to Radiology on 2nd floor.
152107 - ..
152108 - Caroline was at her desk. She investigated scheduling MRI's ordered
152109 - by Doctor Thuillier for either 170411 or 170412, the days meeting
152110 - Doctor Stewart and then Doctor Simpson.
152112 - ..
152113 - Caroline said there are complications entering this schedule due to
152114 - extensive preparation work prior to the doing the scan. She will call
152115 - later in the week after doing investigation to workout a specific
152116 - schedule.
152117 -
152118 - [On 170329 1127 received call from Caroline saying MRI
152119 - studies on both feet does not require contrast medium, so
152120 - these studies were both scheduled on 170412 0800.
152121 - ref SDS 91 HQ5O
152123 - ..
152124 - [On 170329 1127 letter notifies Doctor Thuillier that
152125 - Caroline in Radiology planning MRI studies without
152126 - contrast, and some youtube research indicates plantar plate
152127 - tears are dianosed using contrast medium; asking if order
152128 - for MRI requires modification. ref SDS 92 KW62
152130 - ..
152131 - Evidently, Bella is visiting family in the Phillipines, and so may
152132 - not be available for this MRI study.
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1522 -