Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

I saw the osteopathic/sports medicine doctor today/being sent to PT

Posted by Beverly on 7/06/00 at 19:40 (022936)

HI ALL!

I saw the osteopathic/sports medicine doc today. I'm not sure how I feel about him, but I did walk away with a one month perscription for physical therapy that includes: ultrasound, pool therapy, and supervised stretching instructions. Yea!... especially for water therapy!

The downside is that I just didn't feel like he took my pain that seriously. I went in with my x-rays. He didn't mention them, but I think he must have looked at them, because the nurse handed them back to me at the end of the session.

He started showing me stretches, and I'm not talking about gentle passive stretches. He had a Plantar F. brochure that included stretches and exercises. He demonstrated the 'put your foot up wedged against the wall stretch' and a calf stretch that leans into a chair. This seems way too extreme given my pain level... at least for starting out.

He said that most people eventually get over this but it takes time. (Duh!) He acknowledged how frustrating it is. He said that stretching is essential to getting better. (He said that he has never done surgery on this.) I also appreciated him pointing out the risks of cortizone when he offered that as an option. As many of you know, I have already ruled out cortizone, but unlike the pods I saw, at least he pointed out the risk of a rupture.

He was not particularly interested in my shoe choices. He said, 'Find three pairs of shoes you like and rotate them.' But the particular shoe did not matter to him. Right now, my Birk Arizona's are the only really comfy shoes I have. My Chaco river shoes would come in second. I am still looking for a pair of athletic type walking/running shoes that will feel good. He didn't say a word about orthodics or inserts. (Guess I'm on my own there.) Oh, and I also have a pair of Dansko sandals that are perfect for when I need to wear a dress or skirt but the arch and heel are both a bit high for everyday wear.

So, overall I was not especially impressed, but I am grateful to have the physical therapy script and the water therapy.

He poked around on my foot and ankle. He said he thinks I have 'garden variety' Plantar Fascitis. He wrote 'Bilateral Plantar Fascitis' on my physical therapy script. In otherwords, he doesn't think I have anything else going on. I asked about my ankles, and he said what several of you have said, that PF will throw off our gait and make the ankles and calves hurt, but I guess it wasn't bad enough to alarm him.

I still don't have my MRI. He said, I could have one in a few weeks if I'm still not better. Once again, he didn't think that was critical.
I asked about a tear (to be detected on MRI), and he said that even with tears, he trys to get people stretching as soon as possible.

So, I don't know what to think, but I'm willing to give supervised PT stretching a try. I'm no longer the 'go along with anything' patient; so we will definitely have to start out with some pretty gentle/passive stuff. So, now three pods and one osteopath later, two say stretch, two say dont stretch. I guess I just have to follow my gut at this point.

I see from a post below that many of you are in PT or have done it for your foot. What type of stretches were you given and how did you respond? I'm a PT veteran of the upperbody but a novice for the feet.
Also, I told the doc that stretching has hurt when I have tried it the last couple of months, and he said it will hurt at first.

Thanks,
Beverly


Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Laurie R on 7/06/00 at 19:57 (022940)

Hi Beverly,
To me I think some doctors just don't take this very seriously and don't understand the pain .I am sure he is a very good doctor ,maybe he was to busy today.

My opinion is if you have pain than stop stretching,I don't think you have pain first and than it will go away after you stretch.Let your feet tell you how much you should do.My Pod told me if I have pain than stop.

I think it was a good idea you went today ,I think the more doctors the better so you can get different opinions. I have had 6 doctors so far and they all have said the same thing.

Beverly how is your pain level been?My very best to you. Laurie R


Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Dr. Zuckerman on 7/06/00 at 20:05 (022942)

I just received information about about a computerized Diathermy System that is FDA approved and being used at HealthSouth Sports Medicine and Rehabilitation Center in Birmgham, Ala. Diathermy is an old physical therapy device which does the following

1. Relieves pain

2. Moves fluid out of the area ( swelling

3. Bring Fluid in to the area ( increase circulation

4. Stimulates muscle tissue to heal things such as the plantar facia and other muscles and tendon of the foot.

So if you are in the Birmingham , Ala area it may be worth looking into this treatment.

They gave me alot of scientific information to read but it in German again. The name of the company is called Meditherm Corporation
Web site is http://www.rismed.com/meditherm.htm . I will take a look at the web site. Their e-mail is (email removed)


Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

JudyS on 7/06/00 at 22:30 (022946)

Hi Beverly.......I apologize in advance if I'm about to sound a little harsh but......it sort of seems like this new Doc is as disinterested as so many we've all had are. Seems like his advice is the very same advice we all got on our very first visit to a Pod or an Ortho......a couple of hundred years ago. I remember that my Pod(s) didn't go on with x-rays, custom inserts, casts, etc. until several more months/vists went by. Do you suppose he thinks you just haven't suffered long enough for him to be more aggressive? Did he know that you've already seen a couple of Pods? What sort of exercises are in that brochure? Can you see on the back of it what company produced it? I had PT for several months but I can't honestly say it was beneficial- but then I was being stupid and continuing to play ball and stay on my feet during it. My PT had mostly strengthing stuff - no stretching. Funny, now that I think about it, neither my Pod nor my PT actually insisted that I quit my activities. She also did Ionis-something....whatever that is.....treatments 3X week. All that was over a year ago. Can't say it helped at the time but then, like I said, I was being stupid. I've done measurably better since I prescribed my own plan of treatment which includes, rest, ibuprofen, gently stretching, ice, massage, patience (which, after 2 years, I'm becoming quite short of!)

Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Beverly on 7/06/00 at 23:03 (022947)

Laurie, Dr. Z, and Judy,

Yes, it is very frustrating when doctors don't take this pain seriously. Some days, I think Dr. Z. is the only doctor who does take our pain seriously! Dr Z., I don't live anywhere near Alabama, about four states away, but I will keep my eye posted for any info on that treatment. Let us know what you find out. By the way, Dr. Z., do you usually start people on at least some kind of gentle stretching even while the pain is still present? In my case, I usually don't hurt much when I'm off my feet, but I don't have to walk far at all for the pain to come back. Around the house or just out to dinner, I'd rate my pain a 2-4, but put me in a grocery store or other large place, and if I don't ride that cart, I'll be a 10+ by the time I leave and will hurt/barely be able to walk for days afterwards.

Laurie, my pain level is not nearly as bad as it was a month ago when I came home from my failed vacation. Then, every step I took was agony. It still hurts but not nearly as much as it did, and I'm doing pretty well just around the house on days of great rest. At the moment, my worst pain is in my arches. My ankles are having a better day! I just don't understand why it is so hard to get an MRI. I have a PPO. So, that should make it easier, but I've not found that to be the case thus far. I guess I should be grateful for the PT script. It took several doctors to get that. Laurie, now that you are in PT, how are you doing with their stretches? I'm game for trying very gentle passive/brief stretching.
But I don't want to make myself worse; so as I said, I will be cautious.

Judy, the PF exercise brochure was made by Roche Laboratories.
The exercises in the brochure are: towel curls (scrunching the towel with your toes), shin curls (running the injured foot slowly up and down the shin of your other leg as you try to grab the shin with your toes), and a calf stretch that leans into a sturdy table. These seem more like strengthening exercises than stretches to me.(And I have heard a number of people on the board write that calf stretches made their PF worse; so I'm confused.) Then, the doctor added passive toe pulls and that wedge your foot against the wall thing. There is NO WAY I could do these calf stretches or that wall wedge thing. It hurts just thinking about it! I am trying to keep an open mind to gentle passive stretching. But I sure can't do it as many times a day as he wrote. Unbelievable! He wrote '6x a day.' That is when I said, 'Could I have a script for PT? I'm open to this stretching business, but I want it supervised and planned by a physical therapist.' Thus, I walked out with my script. I also had to ask for pool therapy. He was happy to write the script for both of these things, but I had to ask for them. Moral is: If you want extra perks like PT from the doctor, ask for it; in this age of managed care, most aren't going to offer it without being asked.

I don't know whether it is worth messing with, but since I didn't know which osteopath I'd like best, I made an appointment with both of the lower body osteopath/sports med. guys in town. I have an appointment with the other guy next week. I have not decided whether to go or not.

Beverly


Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Robin B. on 7/07/00 at 04:57 (022949)

Forgive me for sounding casual, but I think you got a standard prescription from a very standard doctor. The premise that someone actually knows: 1)What he is doing; 2) More than you do about PF -- simply because he has some kind of degree has proven -- right on this board -- to be in error.

If it were me, I would be very cautious about stretching. Stretching does not necessarily make PF better, and I am living proof -- since I am better and quit stretching after about 6 months of PF.

My vote is -- follow your gut.


Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Nancy S. on 7/07/00 at 07:31 (022952)

Hi Beverly -- I have to agree with everyone that this doc sounds quite blase'. But I guess you've already figured that out: I don't read the board for just one evening and whole waves have passed me by!
It does seem that for many of us, like Judy and Robin, in the end it comes down to gathering information from this site and then figuring out what works best for each of us as an individual, listening to our feet, and following our own instincts. There seems to be little help out there in the medical profession for those of us whose foot problems last longer than 3-6 months -- I mean the interest just isn't there.
At least this doc did prescribe PT after you asked him; the podiatrist I saw for 6 months wouldn't do it, even after I asked for it.
When do you start PT? I'm eager for it and nervous about it at the same time. Like you, I don't want any standard acrobatics going on with no account taken of my particular situation. So I plan to go in there with a mind of my own and I'm going to speak it.
--Nancy

Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Dr. Zuckerman on 7/07/00 at 07:40 (022953)

So the pain increases the more you are on you feet.???. There is not
typical morning pain when first getting up. The stretching should only be done if it's not causing pain.!!!!. Only do stretching non-weight bearing such as personal trainers.

Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Pauline on 7/07/00 at 08:04 (022956)

Beverly,
From my experience with Orthopedic Drs. your experience is typical. They never get excited about PF. It is 'heel pain' to them. They
like the more adventureous bone problems. Its like acne to a skin
specialist who treats major skin cancers. The kind where an entire
nose is removed. The don't give a second thought to the teens self immage, after all it's just acne and it will go away in time.

I had one Orthopedic Dr. say to me ' Well no one I know has ever died
from Plantar Fasciitis' His sympathic care about my 'heel pain'.
I wish more of them would get it, then maybe more treatment ideas
might arise.

I agree with Dr. Z that stretches should not cause pain. Everytime
I did them and it hurt, I got more inflammation. I now do my
wall stretches in the shower. I plug the drain, allow the warm
water to relax my feet, then do gentle wall stretches. I don't feel
any pain and feel that this works for me besides doing the other stretches recommended on this board.

I see my Ortho today for a follow up. I'm not expecting anything new
but I want a renewal on my physical therapy because it has helped
to get my inflammation down.


Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

john h on 7/07/00 at 08:51 (022964)

i have been to two sports medicine physicians. my experience is that an orthopedic surgeon who has a fellowship in foot an ankle surgery is much more experienced with PF. I also think that most Poditrist are more experienced than sport medicine physicians in treating this problem.

Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Rock on 7/07/00 at 09:06 (022969)

Once again, My experience is that calf stretches caused excessive strain on my PF and prevented healing. Nothing else was more important.

Example one day (Late May 2000) while watching my son at a long, long track meet, I did a bunch of calf stretched on the bleachers (dropped heel style). The next day, I could barely walk. I quit those stretches and that was the last flare up I had.

By contrast, two weeks later, I ran 57 miles in a mountain trail ultra-marathon and had no PF pain during or after ! Go figure.

Rock.
(99% over PF, but still cautious)


Re: So how did you all deal with the PT's exercises?

Beverly on 7/07/00 at 09:21 (022972)

Sounds like good imput from you all. My question is, How did you deal with the physical therapist's stretches while getting PT? You say PT helped get inflammation down. Are you just talking about the feel good stuff like ultrasound and the whirlpool or did this include their stretches? Also, how is the wall stretch gentle? It seems like it would be more intense than a gentle, quick, passive toe pull.
I think the other osteopath is the one with a Fellowship in the foot and ankle... gotta check; if so, he may be worth going to see.
I'm going to give my feet one more week of rest before starting PT. This is the first week I see some real improvement in my ablility to get around and do errands, see a movie, ect since coming home from my dreaded vacation. Thus, I want to give my feet another week. What I am thinking about doing is laying it on the level with the physical therapist and saying that before I can even consider doing 'land' stretches, I need to start with the water therapy and see how I do with that.
The only soft tissue stuff on my script is ultrasound but if the PT thinks I need something else, perhaps he can get the doc to add it.

Oh, the other reason I felt like this doctor was disinterested was, because when I asked him how his patients with PF did... did they get over it, he said, 'They either got over it or they went to another doctor.' In otherwords, he didn't really know what happened to many of them. Did they get better, go to another doctor, give up on doc's altogether. He didn't seem to know what happened to them.

Thanks for all your feedback,
Beverly


Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Laurie R on 7/06/00 at 19:57 (022940)

Hi Beverly,
To me I think some doctors just don't take this very seriously and don't understand the pain .I am sure he is a very good doctor ,maybe he was to busy today.

My opinion is if you have pain than stop stretching,I don't think you have pain first and than it will go away after you stretch.Let your feet tell you how much you should do.My Pod told me if I have pain than stop.

I think it was a good idea you went today ,I think the more doctors the better so you can get different opinions. I have had 6 doctors so far and they all have said the same thing.

Beverly how is your pain level been?My very best to you. Laurie R


Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Dr. Zuckerman on 7/06/00 at 20:05 (022942)

I just received information about about a computerized Diathermy System that is FDA approved and being used at HealthSouth Sports Medicine and Rehabilitation Center in Birmgham, Ala. Diathermy is an old physical therapy device which does the following

1. Relieves pain

2. Moves fluid out of the area ( swelling

3. Bring Fluid in to the area ( increase circulation

4. Stimulates muscle tissue to heal things such as the plantar facia and other muscles and tendon of the foot.

So if you are in the Birmingham , Ala area it may be worth looking into this treatment.

They gave me alot of scientific information to read but it in German again. The name of the company is called Meditherm Corporation
Web site is http://www.rismed.com/meditherm.htm . I will take a look at the web site. Their e-mail is (email removed)


Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

JudyS on 7/06/00 at 22:30 (022946)

Hi Beverly.......I apologize in advance if I'm about to sound a little harsh but......it sort of seems like this new Doc is as disinterested as so many we've all had are. Seems like his advice is the very same advice we all got on our very first visit to a Pod or an Ortho......a couple of hundred years ago. I remember that my Pod(s) didn't go on with x-rays, custom inserts, casts, etc. until several more months/vists went by. Do you suppose he thinks you just haven't suffered long enough for him to be more aggressive? Did he know that you've already seen a couple of Pods? What sort of exercises are in that brochure? Can you see on the back of it what company produced it? I had PT for several months but I can't honestly say it was beneficial- but then I was being stupid and continuing to play ball and stay on my feet during it. My PT had mostly strengthing stuff - no stretching. Funny, now that I think about it, neither my Pod nor my PT actually insisted that I quit my activities. She also did Ionis-something....whatever that is.....treatments 3X week. All that was over a year ago. Can't say it helped at the time but then, like I said, I was being stupid. I've done measurably better since I prescribed my own plan of treatment which includes, rest, ibuprofen, gently stretching, ice, massage, patience (which, after 2 years, I'm becoming quite short of!)

Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Beverly on 7/06/00 at 23:03 (022947)

Laurie, Dr. Z, and Judy,

Yes, it is very frustrating when doctors don't take this pain seriously. Some days, I think Dr. Z. is the only doctor who does take our pain seriously! Dr Z., I don't live anywhere near Alabama, about four states away, but I will keep my eye posted for any info on that treatment. Let us know what you find out. By the way, Dr. Z., do you usually start people on at least some kind of gentle stretching even while the pain is still present? In my case, I usually don't hurt much when I'm off my feet, but I don't have to walk far at all for the pain to come back. Around the house or just out to dinner, I'd rate my pain a 2-4, but put me in a grocery store or other large place, and if I don't ride that cart, I'll be a 10+ by the time I leave and will hurt/barely be able to walk for days afterwards.

Laurie, my pain level is not nearly as bad as it was a month ago when I came home from my failed vacation. Then, every step I took was agony. It still hurts but not nearly as much as it did, and I'm doing pretty well just around the house on days of great rest. At the moment, my worst pain is in my arches. My ankles are having a better day! I just don't understand why it is so hard to get an MRI. I have a PPO. So, that should make it easier, but I've not found that to be the case thus far. I guess I should be grateful for the PT script. It took several doctors to get that. Laurie, now that you are in PT, how are you doing with their stretches? I'm game for trying very gentle passive/brief stretching.
But I don't want to make myself worse; so as I said, I will be cautious.

Judy, the PF exercise brochure was made by Roche Laboratories.
The exercises in the brochure are: towel curls (scrunching the towel with your toes), shin curls (running the injured foot slowly up and down the shin of your other leg as you try to grab the shin with your toes), and a calf stretch that leans into a sturdy table. These seem more like strengthening exercises than stretches to me.(And I have heard a number of people on the board write that calf stretches made their PF worse; so I'm confused.) Then, the doctor added passive toe pulls and that wedge your foot against the wall thing. There is NO WAY I could do these calf stretches or that wall wedge thing. It hurts just thinking about it! I am trying to keep an open mind to gentle passive stretching. But I sure can't do it as many times a day as he wrote. Unbelievable! He wrote '6x a day.' That is when I said, 'Could I have a script for PT? I'm open to this stretching business, but I want it supervised and planned by a physical therapist.' Thus, I walked out with my script. I also had to ask for pool therapy. He was happy to write the script for both of these things, but I had to ask for them. Moral is: If you want extra perks like PT from the doctor, ask for it; in this age of managed care, most aren't going to offer it without being asked.

I don't know whether it is worth messing with, but since I didn't know which osteopath I'd like best, I made an appointment with both of the lower body osteopath/sports med. guys in town. I have an appointment with the other guy next week. I have not decided whether to go or not.

Beverly


Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Robin B. on 7/07/00 at 04:57 (022949)

Forgive me for sounding casual, but I think you got a standard prescription from a very standard doctor. The premise that someone actually knows: 1)What he is doing; 2) More than you do about PF -- simply because he has some kind of degree has proven -- right on this board -- to be in error.

If it were me, I would be very cautious about stretching. Stretching does not necessarily make PF better, and I am living proof -- since I am better and quit stretching after about 6 months of PF.

My vote is -- follow your gut.


Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Nancy S. on 7/07/00 at 07:31 (022952)

Hi Beverly -- I have to agree with everyone that this doc sounds quite blase'. But I guess you've already figured that out: I don't read the board for just one evening and whole waves have passed me by!
It does seem that for many of us, like Judy and Robin, in the end it comes down to gathering information from this site and then figuring out what works best for each of us as an individual, listening to our feet, and following our own instincts. There seems to be little help out there in the medical profession for those of us whose foot problems last longer than 3-6 months -- I mean the interest just isn't there.
At least this doc did prescribe PT after you asked him; the podiatrist I saw for 6 months wouldn't do it, even after I asked for it.
When do you start PT? I'm eager for it and nervous about it at the same time. Like you, I don't want any standard acrobatics going on with no account taken of my particular situation. So I plan to go in there with a mind of my own and I'm going to speak it.
--Nancy

Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Dr. Zuckerman on 7/07/00 at 07:40 (022953)

So the pain increases the more you are on you feet.???. There is not
typical morning pain when first getting up. The stretching should only be done if it's not causing pain.!!!!. Only do stretching non-weight bearing such as personal trainers.

Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Pauline on 7/07/00 at 08:04 (022956)

Beverly,
From my experience with Orthopedic Drs. your experience is typical. They never get excited about PF. It is 'heel pain' to them. They
like the more adventureous bone problems. Its like acne to a skin
specialist who treats major skin cancers. The kind where an entire
nose is removed. The don't give a second thought to the teens self immage, after all it's just acne and it will go away in time.

I had one Orthopedic Dr. say to me ' Well no one I know has ever died
from Plantar Fasciitis' His sympathic care about my 'heel pain'.
I wish more of them would get it, then maybe more treatment ideas
might arise.

I agree with Dr. Z that stretches should not cause pain. Everytime
I did them and it hurt, I got more inflammation. I now do my
wall stretches in the shower. I plug the drain, allow the warm
water to relax my feet, then do gentle wall stretches. I don't feel
any pain and feel that this works for me besides doing the other stretches recommended on this board.

I see my Ortho today for a follow up. I'm not expecting anything new
but I want a renewal on my physical therapy because it has helped
to get my inflammation down.


Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

john h on 7/07/00 at 08:51 (022964)

i have been to two sports medicine physicians. my experience is that an orthopedic surgeon who has a fellowship in foot an ankle surgery is much more experienced with PF. I also think that most Poditrist are more experienced than sport medicine physicians in treating this problem.

Re: I saw the osteopathic/sports medicine doctor today/being sent to PT

Rock on 7/07/00 at 09:06 (022969)

Once again, My experience is that calf stretches caused excessive strain on my PF and prevented healing. Nothing else was more important.

Example one day (Late May 2000) while watching my son at a long, long track meet, I did a bunch of calf stretched on the bleachers (dropped heel style). The next day, I could barely walk. I quit those stretches and that was the last flare up I had.

By contrast, two weeks later, I ran 57 miles in a mountain trail ultra-marathon and had no PF pain during or after ! Go figure.

Rock.
(99% over PF, but still cautious)


Re: So how did you all deal with the PT's exercises?

Beverly on 7/07/00 at 09:21 (022972)

Sounds like good imput from you all. My question is, How did you deal with the physical therapist's stretches while getting PT? You say PT helped get inflammation down. Are you just talking about the feel good stuff like ultrasound and the whirlpool or did this include their stretches? Also, how is the wall stretch gentle? It seems like it would be more intense than a gentle, quick, passive toe pull.
I think the other osteopath is the one with a Fellowship in the foot and ankle... gotta check; if so, he may be worth going to see.
I'm going to give my feet one more week of rest before starting PT. This is the first week I see some real improvement in my ablility to get around and do errands, see a movie, ect since coming home from my dreaded vacation. Thus, I want to give my feet another week. What I am thinking about doing is laying it on the level with the physical therapist and saying that before I can even consider doing 'land' stretches, I need to start with the water therapy and see how I do with that.
The only soft tissue stuff on my script is ultrasound but if the PT thinks I need something else, perhaps he can get the doc to add it.

Oh, the other reason I felt like this doctor was disinterested was, because when I asked him how his patients with PF did... did they get over it, he said, 'They either got over it or they went to another doctor.' In otherwords, he didn't really know what happened to many of them. Did they get better, go to another doctor, give up on doc's altogether. He didn't seem to know what happened to them.

Thanks for all your feedback,
Beverly