The Evil Podiatrist (evilpodiatrist) wrote,
The Evil Podiatrist

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Chapter One

'It is well known that nerve conduction velocity studies are unreliable in the diagnosis of peripheral nerve entrapments in the lower extremity,' said the Evil Podiatrist as he slapped a kitten.

'Mew?' said the kitten.

'In my experience,' bellowed the Evil Podiatrist in a movie theater during a quiet moment in the film, 'one may have approximately a 50 percent chance of getting a false negative finding in the face of an overwhelming clinical presentation.'

'Shut the fuck up!' shouted someone sitting in front of the Evil Podiatrist.

'Some have advocated making therapeutic decisions for carpal tunnel syndrome in patients with diabetic peripheral neuropathy without the use of electrodiagnostic studies,' shrieked the Evil Podiatrist as he removed his own grandmother's head, 'as these diagnostic modalities cannot distinguish those with the syndrome. No nerve in the lower extremity even comes close to the median nerve when it comes to the reliability of electrodiagnostic testing. Not only does neurosensory testing with the PSSD modality give the clinician a higher degree of sensitivity, it also allows testing of nerves such as the medial calcaneal nerve which one cannot test with standard electrodiagnostic studies.'

'Urk,' said the grandmother.

'While the algorithm and heel pain scoring questionnaire have not been prospectively validated on a large population of patients,' said the Evil Podiatrist as he wore white after Labor Day, 'these diagnostic tools can give the clinician a good frame of reference for an orderly and stepwise workup of the patient with heel pain. It is critical to take a careful and detailed history in order to determine the true etiology of heel pain.'

'Holy shit,' said everyone.

'In many cases, one can further confirm the diagnosis of a neurogenic etiology via the process of elimination with highly reliable modalities such as musculoskeletal sonography. While a normal sonogram of the plantar fascia can eliminate plantar fasciosis as a potential cause, positive sonographic findings of plantar fasciosis cannot rule out a concomitant neural etiology. However, it is very helpful in managing the longstanding patient who has been misdiagnosed and unsuccessfully treated. It can also eliminate fasciosis as a component or contributing factor to the patient’s heel pain,' whispered the Evil Podiatrist as he played with his own nipples outside the schoolyard.

Next: Grains, Nuts and Veggies All Rolled Into One Scrumptious Burger

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