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do I have PF?

Posted by S. Booren on 2/25/00 at 00:00 (016447)

Hi! I am recovering from a 2-year chronic injury to my rectus femoris. Before this, I used to run 4-10 miles/day, never had any foot problems. Now that I am finally back to jogging 5-10 min/every other day, I find my arches of my feet hurt during the jog and the next day. Also pain just in front of my heel, on the bottoms of my feet. I know a friend who had pretty nasty PF whose symptoms in his initial stages were kind of like mine. Help!! Do these symptoms sound like PF? What can I do to prevent furthering of the injury? Should I stop running completley? Thanks.

Re: do I have PF?

alan k on 2/26/00 at 00:00 (016450)

Since you have the experience of injury and rehabilitation behind you already, you are lucky to be able to understand how important it is to do the right thing now. Here are your priorities:


0. Rest. Stop running immediately, at least until you have established a diagnosis and started a treatment (which may prescribe continued rest).

1. Explore heelspurs.com thoroughly

2. Go to a doctor, podiatrist, and/or orthopedic surgeon.

3. Be mindful that they may treat you incompletely or steer you down an unnecessary path of surgery. Read up and/or post messages about any treatment you are going to pursue.

4. try all the conservative treatments immediately which include: Rest, calf stretches, foot strengthening, icing, heating, taping, message, and anti-inflammatories.

It is entirely likely that you have caught this early and will make a full recovery. Those who don't catch it early or don't believe in the dangers may wind up with long-term or (perhaps) permanent disability.
There are other conditions like tarsal tunnel syndrome as well as rheumatism, gout, and others which pretend to be pf, but since you are a runner you are probably on the right track. Runners it seems generally make a good recovery after rest and sometimes custom orthotics, nightsplints, and shots, all of which have mixed reviews. If there is a structural problem with your foot, orthotics may help. Nightsplints are good passive stretching devices. The shots are something that some say help and some say hurt, in ways that vary widely among individuals.

alan k


Re: do I have PF?

S. Booren on 2/26/00 at 00:00 (016459)

Ok, I read the book on this webpage..it answered a lot of questions but now I have some more: (BTW, I made an appt for the doc on Mon)

1) When it says to never go barefoot anywhere, is that anywhere as in 'your feet must never touch the ground without a shoe or sandal underneath them, even in the shower' or is it ok to wander around the house with bare feet?

2) My calves are fairly flexible since I have been stretching 3 hours/day for my rectus problems. Currently I stretch my calves by standing with the ball of my feet on a stair and letting my heels sink downward by force of body weight. Apparently this is quite stressful to the plantar fascia. I should start doing a calf stretch where my heels are supported, right?

3) Is it safe to say that I should avoid any activity where my heel is 'floating' yet my toes are on the ground? Can I still do pushups?


Re: do I have PF?

Mike W on 2/26/00 at 00:00 (016461)

Hello S.Booren,

RE 2) I strongly believe that the standing stair stretch is incorrect and can lead to chronic tearing and damage to the knee, the calf muscles and the flexor digitorum and halcius brevis muscles as well as promote inflammation to the achiles tendon and plantar fascia. Even in healthy people this can cause PF.

Any calf or lower leg stretch that you perform in a weight bearing position is incorrect because these muscles are contracted prior to the stretch. Contracted muscles are inelastic and will place excessive tension on the related tendons that you are trying to heal.
Muscles should be relaxed prior to a stretch.

There are 13 extrinsic muscles located between the knee and ankle. It makes sense to include them too. It is not enough to just stretch you must improve the strength as well. Do a word search on Personal Foot Trainers to learn about correct lower leg stretching and strenghtening or go to the PF Book. You should not have to stretch for 3 hours a day.

Regards,

Mike W


Re: do I have PF?

alan k on 2/27/00 at 00:00 (016473)

1) For best results do not ever, ever go barefoot.

2) I also have very flexible calves and a lot of good that did me. Stretching is a complicated story and everyone has a different theory and also everyone is different-- that makes for many complex permeutations and sometimes someone argues their theory/experience combo as the truth for everyone. The doctors recommend stretching, even that stair stretch you mention. I cringe at the thought of that, as I am in the camp of Mike W below. But in my opinion, if you are finding gentle runner's stretch (lunging toward wall front leg bent back leg straight) helpful you might continue with that. Don't overstretch in weight-bearing positions. Don't stretch if you feel it is making things worse. You can stretch your feet by keeping them out straight and pulling back the toes, pulling back the balls of the feet, bending forward, all this on your butt. Getting into physical therapy is the best way to incorporate stretching into your recovery, but keep an eye on the board here because there may be other factors to consider which the PT does not know. For instance, the doctors and PT's rarely, according to message posters here, ever recommend stregthening the opposing muscles to the flexors that are so invloved in the treading of running and walking. These run the top of the foot and shin and ultimately connected to the psoas. You can begin to exercise them py keeping feet out straight and pushing some long stiff object against them while you flex your feet and toes against it. Also, just simply flexing the feet and toes back (against the resistance of the flexor muscles) is a great way to strengthen those muscles and at the same time provide a healthy stretch to the opposing sole of the foot. This can be done anytime and should be, often. (also see note about push-ups).

3. Exerise question: do all the exercise you can. If the foot is not bearing the brunt of the weight of your body as in push-ups where it is distributed to the hands, then probably it is okay. Listen to your body. Don't jump around and be gentle. In fact the bent toes in push ups can be a good gentle stretch for the fascia. On the other hand, if you point your toes and do push ups on the back of your toes and feet, you will be working those opposing muscles which are so important for runners to develop because of their over-development of the extensors.

Thanks! I never thought of that before! I now have a new exercise to do.

alan k


Re: do I have PF?

S. Booren on 2/27/00 at 00:00 (016511)

Thanks for your replies, guys...I had coaches tell me for years that the weight bearing calf stretch was the way to do it...shows ya that coaches aren't infallible. (wish I knew the benefits of stretching and the RIGHT way to do the stretches back then, then now after 2 yrs of injury...) Anyway, actually I *do* have to stretch for 3 hrs/day or so (1 hour, 3 times)....some of my quadriceps were badly injured and apparently healed in a shortened form. Tried ionto, phono, prednisone, myofascial massage, MRT, etc...but long, diligent stretching is all that has worked!

Re: do I have PF?

alan k on 2/28/00 at 00:00 (016520)

I don't want to create the wrong impression about what I,at least, was saying. I agree with Mike that when there are other options available why sink all that weight onto your fascia in a stair stretch. That doesn't mean I think weight-bearing stretches are bad. You just have to figure out how much, if any, weightbearing stretches to incorporate into your therapy. Your coaches may not be wrong if they are thinking of young healthy athletes. Weight bearing stretches are a part of everyday normal life for all of us. We all load up on muscles and then stretch them in ordinary activities, so there is no reason to completely avoid training them to do that for normal life.

However, its just with the injury that we need to think about, first, the most efficient way to stretch, and then the best time and way to gently re-introduce traditional stretching back into our life.


alan k


Re: do I have PF?

Rick R on 2/28/00 at 00:00 (016526)

You just got some great advise posted below. A long down time recovering from anything that prevents you from running allows the structure of the arches to weaken. You need to come back to activity far more gradually than you would suspect, even if you never had PF or other foot problems. I posted a while back my sugestions on a return to running. If you can't find it I'd be glad to take another stab at it. I too am very cautious of aggressive weight bearing stretching. I am back to about 25 - 35 miles per week after many years and many failed comeback attempts. I still can't/won't go barefoot. I don't even stand in the shower. Sounds like you are in the early stages and with a little care and research you will find a path to a return to good health and runing. Good Luck,

Rick


Re: do I have PF?

alan k on 2/26/00 at 00:00 (016450)

Since you have the experience of injury and rehabilitation behind you already, you are lucky to be able to understand how important it is to do the right thing now. Here are your priorities:


0. Rest. Stop running immediately, at least until you have established a diagnosis and started a treatment (which may prescribe continued rest).

1. Explore heelspurs.com thoroughly

2. Go to a doctor, podiatrist, and/or orthopedic surgeon.

3. Be mindful that they may treat you incompletely or steer you down an unnecessary path of surgery. Read up and/or post messages about any treatment you are going to pursue.

4. try all the conservative treatments immediately which include: Rest, calf stretches, foot strengthening, icing, heating, taping, message, and anti-inflammatories.

It is entirely likely that you have caught this early and will make a full recovery. Those who don't catch it early or don't believe in the dangers may wind up with long-term or (perhaps) permanent disability.
There are other conditions like tarsal tunnel syndrome as well as rheumatism, gout, and others which pretend to be pf, but since you are a runner you are probably on the right track. Runners it seems generally make a good recovery after rest and sometimes custom orthotics, nightsplints, and shots, all of which have mixed reviews. If there is a structural problem with your foot, orthotics may help. Nightsplints are good passive stretching devices. The shots are something that some say help and some say hurt, in ways that vary widely among individuals.

alan k


Re: do I have PF?

S. Booren on 2/26/00 at 00:00 (016459)

Ok, I read the book on this webpage..it answered a lot of questions but now I have some more: (BTW, I made an appt for the doc on Mon)

1) When it says to never go barefoot anywhere, is that anywhere as in 'your feet must never touch the ground without a shoe or sandal underneath them, even in the shower' or is it ok to wander around the house with bare feet?

2) My calves are fairly flexible since I have been stretching 3 hours/day for my rectus problems. Currently I stretch my calves by standing with the ball of my feet on a stair and letting my heels sink downward by force of body weight. Apparently this is quite stressful to the plantar fascia. I should start doing a calf stretch where my heels are supported, right?

3) Is it safe to say that I should avoid any activity where my heel is 'floating' yet my toes are on the ground? Can I still do pushups?


Re: do I have PF?

Mike W on 2/26/00 at 00:00 (016461)

Hello S.Booren,

RE 2) I strongly believe that the standing stair stretch is incorrect and can lead to chronic tearing and damage to the knee, the calf muscles and the flexor digitorum and halcius brevis muscles as well as promote inflammation to the achiles tendon and plantar fascia. Even in healthy people this can cause PF.

Any calf or lower leg stretch that you perform in a weight bearing position is incorrect because these muscles are contracted prior to the stretch. Contracted muscles are inelastic and will place excessive tension on the related tendons that you are trying to heal.
Muscles should be relaxed prior to a stretch.

There are 13 extrinsic muscles located between the knee and ankle. It makes sense to include them too. It is not enough to just stretch you must improve the strength as well. Do a word search on Personal Foot Trainers to learn about correct lower leg stretching and strenghtening or go to the PF Book. You should not have to stretch for 3 hours a day.

Regards,

Mike W


Re: do I have PF?

alan k on 2/27/00 at 00:00 (016473)

1) For best results do not ever, ever go barefoot.

2) I also have very flexible calves and a lot of good that did me. Stretching is a complicated story and everyone has a different theory and also everyone is different-- that makes for many complex permeutations and sometimes someone argues their theory/experience combo as the truth for everyone. The doctors recommend stretching, even that stair stretch you mention. I cringe at the thought of that, as I am in the camp of Mike W below. But in my opinion, if you are finding gentle runner's stretch (lunging toward wall front leg bent back leg straight) helpful you might continue with that. Don't overstretch in weight-bearing positions. Don't stretch if you feel it is making things worse. You can stretch your feet by keeping them out straight and pulling back the toes, pulling back the balls of the feet, bending forward, all this on your butt. Getting into physical therapy is the best way to incorporate stretching into your recovery, but keep an eye on the board here because there may be other factors to consider which the PT does not know. For instance, the doctors and PT's rarely, according to message posters here, ever recommend stregthening the opposing muscles to the flexors that are so invloved in the treading of running and walking. These run the top of the foot and shin and ultimately connected to the psoas. You can begin to exercise them py keeping feet out straight and pushing some long stiff object against them while you flex your feet and toes against it. Also, just simply flexing the feet and toes back (against the resistance of the flexor muscles) is a great way to strengthen those muscles and at the same time provide a healthy stretch to the opposing sole of the foot. This can be done anytime and should be, often. (also see note about push-ups).

3. Exerise question: do all the exercise you can. If the foot is not bearing the brunt of the weight of your body as in push-ups where it is distributed to the hands, then probably it is okay. Listen to your body. Don't jump around and be gentle. In fact the bent toes in push ups can be a good gentle stretch for the fascia. On the other hand, if you point your toes and do push ups on the back of your toes and feet, you will be working those opposing muscles which are so important for runners to develop because of their over-development of the extensors.

Thanks! I never thought of that before! I now have a new exercise to do.

alan k


Re: do I have PF?

S. Booren on 2/27/00 at 00:00 (016511)

Thanks for your replies, guys...I had coaches tell me for years that the weight bearing calf stretch was the way to do it...shows ya that coaches aren't infallible. (wish I knew the benefits of stretching and the RIGHT way to do the stretches back then, then now after 2 yrs of injury...) Anyway, actually I *do* have to stretch for 3 hrs/day or so (1 hour, 3 times)....some of my quadriceps were badly injured and apparently healed in a shortened form. Tried ionto, phono, prednisone, myofascial massage, MRT, etc...but long, diligent stretching is all that has worked!

Re: do I have PF?

alan k on 2/28/00 at 00:00 (016520)

I don't want to create the wrong impression about what I,at least, was saying. I agree with Mike that when there are other options available why sink all that weight onto your fascia in a stair stretch. That doesn't mean I think weight-bearing stretches are bad. You just have to figure out how much, if any, weightbearing stretches to incorporate into your therapy. Your coaches may not be wrong if they are thinking of young healthy athletes. Weight bearing stretches are a part of everyday normal life for all of us. We all load up on muscles and then stretch them in ordinary activities, so there is no reason to completely avoid training them to do that for normal life.

However, its just with the injury that we need to think about, first, the most efficient way to stretch, and then the best time and way to gently re-introduce traditional stretching back into our life.


alan k


Re: do I have PF?

Rick R on 2/28/00 at 00:00 (016526)

You just got some great advise posted below. A long down time recovering from anything that prevents you from running allows the structure of the arches to weaken. You need to come back to activity far more gradually than you would suspect, even if you never had PF or other foot problems. I posted a while back my sugestions on a return to running. If you can't find it I'd be glad to take another stab at it. I too am very cautious of aggressive weight bearing stretching. I am back to about 25 - 35 miles per week after many years and many failed comeback attempts. I still can't/won't go barefoot. I don't even stand in the shower. Sounds like you are in the early stages and with a little care and research you will find a path to a return to good health and runing. Good Luck,

Rick