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Follow up visit with Orthop Dr. today

Posted by Pauline on 7/07/00 at 15:53 (022996)

Well I returned for a follow up visit today. My real reason for going
was to get an extension on my physical therapy which I accomplished.
I get another 6 weeks.

I have had physical therapy for 1 month 3 times a week. The iontophoresis with dexamethasone has really helped bring down my inflammation. I asked the Dr. if he had any concerns about using
this steroid 3 times a week and he said he was not worried because
the concentration was very weak, it was different from getting
cortisone shots.

I asked him about shorter night splints. He has been trying some but
they fell apart so he gave me a perscription for some new ones and
said to look around to see what was available. I'll check tomorrow.
Most of his patient have the same complaint about them. By the
way he said nearly 50% of his patients have PF. Some he has had
to keep off work for 6 months. He said the average time to clear
PF seems to be for him about 8 months. I have a ways to go it's only
my third.

No magic bullet. He gave me a scrip for viscopodic inserts if I want
to try a soft orthotics since I cannot wear my hard ones. He didn't
push it just said to check it out. Has anyone trid this product?
Also renewed my Vioxx. Said to just hang in there as long as I am
doing better no cast. I told him I would never do a cast unless it
was removable. I'd go crazy. It would really depress me and my total recovery would be set back. Besides facing the reconstructive surgery next month would be too upsetting with a cast.

So like the rest of you I wait and continue the program, ice rest,
stretch and physical therapy.


Re: Follow up visit with Orthop Dr. today

Steve P on 7/07/00 at 16:34 (022999)

Sounds good, Pauline. I finished PT & otherwise have the same program as you. I've also been taking Glucosamine the past couple of months & just started Bromelain last week.
The 8 month figure sounds reasonable to me. The important thing is to keep improving along the way!

Re: Pauline, could you tell me more about that treatment... big word I can't even spell.

Beverly on 7/07/00 at 19:08 (023008)

Pauline,

I am not a great speller; so I won't even attempt to respell the name of your latest treatment... the thing that begins with the letter 'i,' but I would like to know more about it. How is it related to Phy Th?
Do you get it while at Ph Th? Does it run the risk of causing a rupture like regular cortizone? Since you said it was a steriod, I'm curious how it is different from cortizone and if I understood you right, it sounds like your doctor believes it is a safer alternative. I know nothing about this particular treatment, but I am interested in knowing more. I've seen the word used on the board, but I didn't know what it was.

Also, what else does your Ph Th. do with you?
Thanks,
Beverly


Re: Follow up visit with Orthop Dr. today -- to Steve

Nancy S. on 7/07/00 at 21:45 (023014)

Steve, I'm trying to learn what to expect at physical therapy, and I just read here that you went through a course of it. I'll be having it for achilles tendonitis, but of course my sort-of recovering PF will no doubt be taken into account too. I'd just like to know what they did for you at PT, and whether the therapist seemed capable of assessing the situation on his or her own (I don't have a PCP referring, just a walk-in clinic doctor who didn't otherwise know me or my case). I know I'll have lots of questions about what to do at home (rest, possible stretching, etc.), and did you find your therapist qualified to address things like this? Also, did you find the therapist to be a good listener, and willing to take things gradually? I'm concerned about too much too soon -- my feet seem sensitive to overstretching and so forth, and I wonder what to be wary of. I mean I don't want to get thrown into an all-out workout that will create setbacks. Thanks, Steve. --Nancy

Re: Follow up visit with Orthop Dr. today -- To Nancy

Pauline on 7/08/00 at 06:38 (023019)

Nancy,
One thing I found out about physical therapy is that all centers and all physical therapist are not created equal. I personally went to
visit different centers before beginning my treatment. Remember
once you give them your perscription for treatment---if you do not
like them or feel that you are not making progress you must go
back to your Dr. for a new perscription for the next place.

Perscriptions do not transfer locations. Ask questions:
Which PT at that site treated plantar fasciitis successfully.
What was the treatment they used.
What was the average time for treatment
How long will your sessions be
Who will work on you
Do they offer water therapy
Do they have all the equipment necessary to treat PF including
exercise equipment, water, iontophoreses, ultrasound
Do you see the same PT each time you visit
What are their aids allowed to do
Add anything you can think of

Some PT locations are not fully equipt, others have you see a different PT each visit (not good). Others leave too much of their
treatment to the aids.

I usually give them 4 weeks to see if I am making any progress. If you do not think things are going well for you (you'll know ) ask the Dr for a new perscription and change facilities.

Remember it's your money and you can pay for good treatment or bad treatment. My choice has always been only to pay for good and walk out on the others.


Re: Follow up visit with Orthop Dr. today -- To Beverly

Pauline on 7/08/00 at 07:02 (023021)

I have been getting iontophoresis 3 times a week now for 4 weeks in add1tion to other therapy. It involves driving a solution of dexamethasone through the skin using electrodes. The reason the Dr said he was not worried about this is because the dexamethasone solution used is a weak solution and since it must first go through the outer layer of your foot, if any dammage was going on the outer layer would be the first to show the problem.

An injection on cortisone on the other hand is serious medication
that is injected directly into the foot. It carries with it
the possiblity of causing the tendons to rupture. Most Orthos know this. Although there is this risk, I personally feel as long as you are aware of it and the Dr. has informed you but still recommends ONE I would take it. Ask if it is the long acting or short acting and the amount he is injecting and what can you expect as a result and for how long. I have found that doctors do not inject the same amount. Some want to use only long acting and some want to use 3 shorting acting and some inject a little of each. So find out ahead what are they doing. I am surprised that most of the time when people get injections of any kind they never ask what it is , what it will do and how much is being injected. To me this if very important. If I have a reaction I want to know what went in and how much. Since we know the risk because of being educated on this board, I simply begin asking questions and telling him/her that because of the risk that it carries where I draw the line. When you act in an intelligent manner they respond with more reservation.

At my PT sessions I found out that ultra sound which helped last time actually cause more inflammation this time. Thus we opted for
the iontophoresis. Will it last, can't say but for now my inflammation has finally started to subside. I do however still incorporate all the other things on this board. Lots of rest, ice, some exercise, etc. What I really needed was a jump start to getting my inflammation down. I think I have achieved that so I can now continue the other treatment.

Someday I hope there will be a magic bullet for this problem. If we could discover it we would be rich.


Re: Follow up visit with Orthop Dr. today -- To Beverly

Br. Biehler on 7/08/00 at 07:59 (023023)

I would just like to mention that I have had a lot of success with streching exercises in relieving pf. The foot needs to be able to come up 15 degrees in relation to the leg for the body to pass over it while ambulating. If the 15 degrees of movement is already there, then the streching is no going to help the problem. I also have has good results with ulta sound if the pf is recent. If the pf has been around lnger that 6 months the problem might be more of a destrucitve nature and not inflamatory. This the physical therapist can treat with electrotherapy ( high -valtage galvanis stimulation). Usually the same machine that does the ultra sound treatment can also do the electrotherapy treatment. Streching in this case is still good but is used to help produce collagen for repair, not to lenghthen the muscles. Dr. Biehler

Re: To Nancy ---- PT answers

Steve P on 7/08/00 at 10:06 (023027)

Nancy --- I went to 4 weeks of PT twice a week. Sessions lasted about an hour & 15 minutes. The first session was an evaluation only, no treatment. My therapist was the 'foot specialist' of this PT center, which included 6 therapists total. He seemed to be very familiar with PF & said he had treated many patients. In the evaluation session he measured the angles of movement of my feet & pushed/pressed on different parts of my feet (i.e., the usual 'where does it hurt?' routine that we all know so well). We discussed how the injury had happened, what time of day & under what conditions it hurt the most, what I was already doing for treatment, etc. I appreciated the fact that he devoted an entire session to evaluation rather than just plunging into treatment.
My treatment sessions began with electric stimulation of both feet in a foot bath for about 10 minutes. I felt a tingling sensation (not unpleasant) in my arches. Next I lay on the table & he applied ultrasound for about 5 minutes per foot followed by a gentle massage for another 5 minutes. Then, with me lying face down, he manipulated each foot for a couple of minutes (reminded me of a chiropractor). This was followed by stretches on a ProStretch, which he ended up modifying after the first couple of times because they hurt. His statement about stretching was: 'I want you to feel tightness but not pain. In each stretch, go UP TO, but do not reach, the threshold of pain.'
I discontinued PT after 4 weeks because I felt at that point that I had gotten all the info I needed & that my home program would be more important from then on. I do feel that he was a pretty good listener & tried his best to answer all my questions. I think he did a good job setting me up with my home program, including a night splint, & that was probably the best contribution he made to my recovery.
I'm not sure whether the ultrasound & electric stim did any good. But since the exercises & massage were something I could obviously do myself, that became the basis for my decision not to continue PT.
I don't know how they'll treat your AT/PF combination, but I understand your concern about 'too much too soon'. Therapists generally like exercise & stretching, but of course this varies greatly among individual therapists, the same as among doctors.
My e-mail address is (email removed) if you would like to discuss further offline. Feel free to mail me.
Hope this helps.........Steve

Re: To Nancy ---- PT answers

Nancy S. on 7/08/00 at 19:42 (023042)

Steve and Pauline, thank you very much for your descriptions and advice about physical therapy. I'm feeling well prepared as a result, and the less-than-a-week wait I have now will be much less full of neurotic imaginings. (Who, me?) I guess I consider myself lucky that I never had a problem requiring physical therapy before, this is my first one -- that's why I've had so many questions -- I appreciate your help. --Nancy

Re: Follow up visit with Orthop Dr. today

Steve P on 7/07/00 at 16:34 (022999)

Sounds good, Pauline. I finished PT & otherwise have the same program as you. I've also been taking Glucosamine the past couple of months & just started Bromelain last week.
The 8 month figure sounds reasonable to me. The important thing is to keep improving along the way!

Re: Pauline, could you tell me more about that treatment... big word I can't even spell.

Beverly on 7/07/00 at 19:08 (023008)

Pauline,

I am not a great speller; so I won't even attempt to respell the name of your latest treatment... the thing that begins with the letter 'i,' but I would like to know more about it. How is it related to Phy Th?
Do you get it while at Ph Th? Does it run the risk of causing a rupture like regular cortizone? Since you said it was a steriod, I'm curious how it is different from cortizone and if I understood you right, it sounds like your doctor believes it is a safer alternative. I know nothing about this particular treatment, but I am interested in knowing more. I've seen the word used on the board, but I didn't know what it was.

Also, what else does your Ph Th. do with you?
Thanks,
Beverly


Re: Follow up visit with Orthop Dr. today -- to Steve

Nancy S. on 7/07/00 at 21:45 (023014)

Steve, I'm trying to learn what to expect at physical therapy, and I just read here that you went through a course of it. I'll be having it for achilles tendonitis, but of course my sort-of recovering PF will no doubt be taken into account too. I'd just like to know what they did for you at PT, and whether the therapist seemed capable of assessing the situation on his or her own (I don't have a PCP referring, just a walk-in clinic doctor who didn't otherwise know me or my case). I know I'll have lots of questions about what to do at home (rest, possible stretching, etc.), and did you find your therapist qualified to address things like this? Also, did you find the therapist to be a good listener, and willing to take things gradually? I'm concerned about too much too soon -- my feet seem sensitive to overstretching and so forth, and I wonder what to be wary of. I mean I don't want to get thrown into an all-out workout that will create setbacks. Thanks, Steve. --Nancy

Re: Follow up visit with Orthop Dr. today -- To Nancy

Pauline on 7/08/00 at 06:38 (023019)

Nancy,
One thing I found out about physical therapy is that all centers and all physical therapist are not created equal. I personally went to
visit different centers before beginning my treatment. Remember
once you give them your perscription for treatment---if you do not
like them or feel that you are not making progress you must go
back to your Dr. for a new perscription for the next place.

Perscriptions do not transfer locations. Ask questions:
Which PT at that site treated plantar fasciitis successfully.
What was the treatment they used.
What was the average time for treatment
How long will your sessions be
Who will work on you
Do they offer water therapy
Do they have all the equipment necessary to treat PF including
exercise equipment, water, iontophoreses, ultrasound
Do you see the same PT each time you visit
What are their aids allowed to do
Add anything you can think of

Some PT locations are not fully equipt, others have you see a different PT each visit (not good). Others leave too much of their
treatment to the aids.

I usually give them 4 weeks to see if I am making any progress. If you do not think things are going well for you (you'll know ) ask the Dr for a new perscription and change facilities.

Remember it's your money and you can pay for good treatment or bad treatment. My choice has always been only to pay for good and walk out on the others.


Re: Follow up visit with Orthop Dr. today -- To Beverly

Pauline on 7/08/00 at 07:02 (023021)

I have been getting iontophoresis 3 times a week now for 4 weeks in add1tion to other therapy. It involves driving a solution of dexamethasone through the skin using electrodes. The reason the Dr said he was not worried about this is because the dexamethasone solution used is a weak solution and since it must first go through the outer layer of your foot, if any dammage was going on the outer layer would be the first to show the problem.

An injection on cortisone on the other hand is serious medication
that is injected directly into the foot. It carries with it
the possiblity of causing the tendons to rupture. Most Orthos know this. Although there is this risk, I personally feel as long as you are aware of it and the Dr. has informed you but still recommends ONE I would take it. Ask if it is the long acting or short acting and the amount he is injecting and what can you expect as a result and for how long. I have found that doctors do not inject the same amount. Some want to use only long acting and some want to use 3 shorting acting and some inject a little of each. So find out ahead what are they doing. I am surprised that most of the time when people get injections of any kind they never ask what it is , what it will do and how much is being injected. To me this if very important. If I have a reaction I want to know what went in and how much. Since we know the risk because of being educated on this board, I simply begin asking questions and telling him/her that because of the risk that it carries where I draw the line. When you act in an intelligent manner they respond with more reservation.

At my PT sessions I found out that ultra sound which helped last time actually cause more inflammation this time. Thus we opted for
the iontophoresis. Will it last, can't say but for now my inflammation has finally started to subside. I do however still incorporate all the other things on this board. Lots of rest, ice, some exercise, etc. What I really needed was a jump start to getting my inflammation down. I think I have achieved that so I can now continue the other treatment.

Someday I hope there will be a magic bullet for this problem. If we could discover it we would be rich.


Re: Follow up visit with Orthop Dr. today -- To Beverly

Br. Biehler on 7/08/00 at 07:59 (023023)

I would just like to mention that I have had a lot of success with streching exercises in relieving pf. The foot needs to be able to come up 15 degrees in relation to the leg for the body to pass over it while ambulating. If the 15 degrees of movement is already there, then the streching is no going to help the problem. I also have has good results with ulta sound if the pf is recent. If the pf has been around lnger that 6 months the problem might be more of a destrucitve nature and not inflamatory. This the physical therapist can treat with electrotherapy ( high -valtage galvanis stimulation). Usually the same machine that does the ultra sound treatment can also do the electrotherapy treatment. Streching in this case is still good but is used to help produce collagen for repair, not to lenghthen the muscles. Dr. Biehler

Re: To Nancy ---- PT answers

Steve P on 7/08/00 at 10:06 (023027)

Nancy --- I went to 4 weeks of PT twice a week. Sessions lasted about an hour & 15 minutes. The first session was an evaluation only, no treatment. My therapist was the 'foot specialist' of this PT center, which included 6 therapists total. He seemed to be very familiar with PF & said he had treated many patients. In the evaluation session he measured the angles of movement of my feet & pushed/pressed on different parts of my feet (i.e., the usual 'where does it hurt?' routine that we all know so well). We discussed how the injury had happened, what time of day & under what conditions it hurt the most, what I was already doing for treatment, etc. I appreciated the fact that he devoted an entire session to evaluation rather than just plunging into treatment.
My treatment sessions began with electric stimulation of both feet in a foot bath for about 10 minutes. I felt a tingling sensation (not unpleasant) in my arches. Next I lay on the table & he applied ultrasound for about 5 minutes per foot followed by a gentle massage for another 5 minutes. Then, with me lying face down, he manipulated each foot for a couple of minutes (reminded me of a chiropractor). This was followed by stretches on a ProStretch, which he ended up modifying after the first couple of times because they hurt. His statement about stretching was: 'I want you to feel tightness but not pain. In each stretch, go UP TO, but do not reach, the threshold of pain.'
I discontinued PT after 4 weeks because I felt at that point that I had gotten all the info I needed & that my home program would be more important from then on. I do feel that he was a pretty good listener & tried his best to answer all my questions. I think he did a good job setting me up with my home program, including a night splint, & that was probably the best contribution he made to my recovery.
I'm not sure whether the ultrasound & electric stim did any good. But since the exercises & massage were something I could obviously do myself, that became the basis for my decision not to continue PT.
I don't know how they'll treat your AT/PF combination, but I understand your concern about 'too much too soon'. Therapists generally like exercise & stretching, but of course this varies greatly among individual therapists, the same as among doctors.
My e-mail address is (email removed) if you would like to discuss further offline. Feel free to mail me.
Hope this helps.........Steve

Re: To Nancy ---- PT answers

Nancy S. on 7/08/00 at 19:42 (023042)

Steve and Pauline, thank you very much for your descriptions and advice about physical therapy. I'm feeling well prepared as a result, and the less-than-a-week wait I have now will be much less full of neurotic imaginings. (Who, me?) I guess I consider myself lucky that I never had a problem requiring physical therapy before, this is my first one -- that's why I've had so many questions -- I appreciate your help. --Nancy