To tell my Gp and physio they are wrong?

[Iwannabeacrocodilehunter]

I started suffering with plantar fasciitis early in the year, and as unpleasant as it was, it was generally bearable after the first few minutes in the morning, or after being sat down. I come to know that horrible pain, very very well.

However, the past 6 months, the pain changed to mostly affect the nerves in the bottom of my foot and the nerves that travel up the inside of my ankle. The pain comes on suddenly throughout the day, regardless of what I’m doing (I can be asleep) and it shoots about like I’ve had acid injected, and burns the inside of my foot and ankle. The pain is excruciating.

After doing my own research (yes I know) I have come to the conclusion that I am dealing with ‘Baxter’s Nerve Entrapment’.

However, three GPs and a physio seem to absolute DENY the existence of this condition, and keep telling me it’s PF. One even said ‘I don’t think it’s Bolshers’.

Am I being unreasonable to demand (politely) they look Baxter’s up. Or perhaps take a print off for them? I can’t afford to go private and no one is taking my concern seriously.

Is Baxter’s Nerve Entrapment not a thing in the UK?

Me too. Dr said it wouldn’t possibly be what I thought it was……guess what, it was 🙄

Have you considered whether it could be Morton’s Neuroma or do the symptoms not fit that?

@Claireintheclouds yes I do see the difference. However, my dd had not at that point been diagnosed by an appropriately qualified physician because GP said CAMHS were useless and in any event CAMHS refused their services to a person who was harming by overdoses and cutting.

An appropriately qualified psychiatrist diagnosed the underlying cause which was a neuro-developmental disability, well masked.

A therapist wad not what dd needed when there was no diagnosis and if it was, I needed some guidance as a lay person. There was none. In any event not many therapists will take on an under 18 who is actively harming because they need more specialist support.

I hope that helps you understand the point.

I love it when my GP googles. It means he's listening to me and open to collaboration. Just like when I ask for a referral and he says ' no problem, but can you email in a history as you know them better.'

Most GPs don't, which is why it's no harm in doing some further investigation.

Or would you just get a walking stick, as was suggested to OP?

Much as I appreciate the NHS, sometimes I have found doctors to be arrogant and determined to be right. I was in A& E some years ago because all the skin on my foot suddenly loosened and came off after a minor bit of what looked like athletes foot. The doctor spotted the old injury to my leg-horse stood on it and ripped off part of my calf. I mentioned that I didn’t think the 2 were related and he very pompously told me he’d be the judge of that. Several doctors couldn’t say what was wrong. Dr Google said pompholyx, confirmed by my gp who had to follow up and came to watch the nurse dressing my feet.

Maybe doctors just get fed up of people telling them what Dr Google says! I hope you get it resolved, OP, it sounds horrific.

Even with my dog, I’d ask for a referral to a specialist, there’s no way I’d let my usual vet carry out a major orthopaedic operation such as a TPLO. He just couldn’t do it, because it’s a very specialist procedure.

@mrsjoyfulprizeforraffiawork yes absolutely, that was just how it worked for me but I'm sure it differs from area to area.
I have personally found gps a lot keener to refer for private, if for no other reason than to get a patient out of their hair.

You could try “I’ve come across this condition that sounds exactly like what I have, if you don’t think it is that please can you explain to me why?” Polite, respectful of their knowledge and experience, assertive and fair

@JackTorrance
Yes, I agree about GPs being delighted their patients are going to be sorted out elsewhere, although we do occasionally come across GPs who seem very offended by their patients doing this. I've never been able to understand why, because it certainly saves the NHS money if the patients receive any sort of private medical care even if it is just a specialist consultation.

I haf terrible pf for years. It disappeared 2 weeks after starting hrt.

I would normally give a patient a steroid injection if it's gone on this long. Have you had one?

I had one of these. It was very painful but worked very quickly. Sadly the pf returned after 6 months.

Just a note about the walking stick suggestion. I had a really badly sprained ankle about 15 years ago. I didn't rest it enough and it got very inflamed. A locum orthopaedic chap, very elderly, in the clinic suggested a walking stick and showed me how to use it properly. It took the pressure of the bad ankle and I cannot put into words how helpful it was. Not a permanent solution but it may be worth a try op.

although we do occasionally come across GPs who seem very offended by their patients doing this

I had a GP like this! She seemed really upset when I mentioned a private referral for something. She was generally lovely though, I think she just believed strongly in the principle of free universal healthcare.
This was years ago when the waiting times to be seen were a fraction of what they are now, mind you.

Two months ago I’d have said the doctors know what they are doing and have better medical training than you BUT after multiple trips to the doctor about a problem I had they couldn’t agree what was wrong and it was very stressful. I went private and the doctor diagnosed me what what I thought almost straight away. I’d say if you can afford to have a private consultation where you will be listened too because your paying them too!

No, I haven’t been offered one.

GP 1 prescribed cocoadamol and Naproxen and told me to self refer for physio.

GP 2 prescribed Volterol gel and took me off Naproxen

GP 3 prescribed Amytriptline and put me back on Naproxen

Physio gave me an elastic band for strengthening exercises and a list of local swimming pools.

I honestly just want someone to listen.

If you know better than your GP and Physio leave them to work it out. You’re clearly way superior to folk who spent years at university training specifically.

I’m not at all saying I’m superior, but I do feel my symptoms are being ignored in favour of an assumption that if it involves the heel, it’s plantar fasciitis.

If someone had pressed on my foot a bit, tested out where the pain was coming from; asked about the type of pain or the times it came on, I would feel just a little bit more accepting of the diagnosis.

Following being told it was plantar fasciitis, I researched this to see how to take care of myself and that’s when I thought - nope. This isn’t what I’m dealing with. I’ve had PF before and this isn’t it.

My second and third appointments were over the phone. How can anyone tell anything from that?

I’m a GP.

I’ll be honest, I don’t know a lot about Baxter’s nerve entrapment.

I wouldn’t mind you suggesting a diagnosis at all or a possible treatment plan. Makes my life easier - and you will have spent far more time thinking about your problem than I can with the best will in the world so sometimes at least you’re going to know more about it than I do. If patients suggest something and I think there’s a decent chance they’re right I’ll probably do it (unless it’s outside guidelines etc). If I don’t know enough I’ll do some of my own research be that reading or discussing it with colleagues. If I think they’re wrong I’m quite happy to explain why and discuss. It’s helpful to know what patients are thinking anyway.

I probably wouldn’t start off the consultation by saying “I think you’re wrong” though! We’re only human and that might make me feel a bit more irritable than “I’ve been reading and wondered if it might be….”

Yes, definitely question, I did some research about my condition and treatment as I felt that I wasn't being recommended the right route. I presented recently changed guidance and research papers to my NHS consultants who just ignored them. I paid for an opinion from a consultant from the national centre of excellence on my condition who agreed with me and wrote a letter saying the same but my local NHS consultants are still disagreeing because I think they're working from old guidance. I'm not convinced they've even read the letter. It's frustrating but at least now I have good information in order to make my own decision.

Not sure your GP did you any favours there. I suffered terribly with PF and the injection cured it completely.
The injection wasn't too bad at all compared to the pain I was in anyway.

I think you need a referral to a podiatrist - a really top notch one. After years of seeing doctors and physios for various foot related pain my podiatrist did a foot assessment that took over an hour. I then had custom orthotics made and over a few months my 20+ years of foot and leg pain was over.

Took me 10 years to get a diagnosis for one ongoing illness despite having the typical symptoms and family history. Took 3 different GP surgeries and several GPs to be referred to the correct place. One surgery later and my life was completely changed. As soon as I said 'I think it is x illness' they completely shut me down. Thankfully one Dr listened and referred me to the correct dept who put me on the waiting list for exploratory surgery that day.

I'm also asthmatic and my GP kept prescribing me an inhaler that wasn't working for like 3 years. It was only when I ended up in hospital that i was referred to the asthma nurse that regularly holds clinics at the GP surgery. She was shocked when I told her that I had told the GP I can't go outside when it's cold as it hurts to breath, and I was just told to take my current inhaler before going outside and to keep warm!

There is a very big difference between expecting a GP to know everything, and expecting a GP to do a referral to the correct people when the problem is beyond their knowledge!

I’m a healthcare professional (a podiatrist, actually). I don’t mind at all if people have self diagnosed or googled, it gives me additional insight.

For example, the OP thinks it might be Baxter’s entrapment because it shoots and burns up into her foot and ankle. That already gives me some clues for differential diagnoses. Also, she is scared about permanent nerve damage, which tells me something about her worries and values.

Allied health professionals are in a unique position, in that we generally have mote Time than GPs to listen to the patient’s story.