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P/F release

Posted by Jay H. on 12/12/00 at 02:44 (034736)

hello,
I have just had the partial release done, and well, it didnt work. I am getting so frustrated. I have all the toys, and have gone to countless doctors and still am having problems. How long is the recovery from the release? It has been about 1 month now since my surgery. What can I expect now?

Now if I do not recover fully, what can I do? Will the shock wave still work? There is a shock wave where I live, but I am not sure what the treatments costs or how many treatments I have to do. You see, the only one in my country in a 4 hour drive away. How many treatments can I expect, and how long is the recovery period? I will take advice from anyone! Please reply ASAP, as I have an appointment soon! Thanks, TTYL!

Jay

Re: P/F release

Karin L. on 12/12/00 at 09:38 (034756)

Jay,
One month is too soon to tell if the surgery was a success or failure. You have to give it about 6 months. The scar tissue is still forming. If after 6 months you still have the same pain, then I would consider the surgery to be a failure. Give it time and give yourself time to heal. I have been where you are. I had surgery 8 months ago and unfortunately, mine failed and am scheduled for the ESWT in 2 weeks. Don't give up and keep up the stretches and all the exercises you were instructed to do. Good luck.
Karin

Re: P/F release

Dr. Z on 12/12/00 at 20:54 (034795)

Good advice. It can take six months for pf releases to heal. If you are in pain then stretching and rest and read Karin L's advice. The same advice for pf release goes for ESWT . Karin good luck .

Re: P/F release

Jay H. on 12/13/00 at 00:36 (034814)

HI again..

Great advice. Maybe I was expecting too much too fast. I never did receive any stretching exercises. Do you recommmend massage or ice? I dont know.. Please tell me what stretches I can do too help the healing process. I live in Taiwan, and the literature is all in Chinese. I am going on a Trans Atlantic flight soon, any reccomendations about flying with hurt feet? Thanks Karin and Dr Z.. I have one more question. I can not dial 800 #'s from here. Is there a way to get your video another way? Thanks for responding so quick, and I hope to hear from one or both again.

Jay

Re: P/F release

Julie F on 12/13/00 at 02:50 (034822)

Jay, take your shoes off when you get on the plane and wear soft slippers to cope with the inevitable swelling of the feet. If you ordinarily wear orthotics or arch supports, you'll probably need to put your shoes on when you go to the toilet, but keep them unlaced and as loose as possible. Ask for an aisle seat so you don't have to climb over people when you need to get up.

I don't think you should stretch. While your feet are recovering from surgery, you need to rest them. Be patient. You can stretch when your recovery is complete.

Re: P/F release

Karin L. on 12/13/00 at 09:09 (034832)

Jay,
Ice is OK, but I didn't find it too helpful. The exercises I found helpful were: with your foot on top of a tennis ball, roll the ball with some pressure, from the heel of your foot to the ball of you foot. Do this for about 3 min. 3 times per day; stand with your toes on a stair, heel hanging over the edge and raise up onto the ball of your foot about 10 times, do this 3 times a day; put your hands on a wall leaning towards it, like you're pushing the wall, put your bad leg in front, feet flat on the floor and bend your knee slightly. You want to feel a slight pull on your heel cord. It's hard to describe, but I guess pretend you are pushing a car, that's the position you want to be in. Finally, with your sock off, put a towel on a hardwood floor and try to scrunch the towel up with your toes. I soaked my foot in a fairly warm jacuzzi, then did the exercises and ended with massage. I hope this helps and that my explanation of the exercises were OK. If I can help further, let me know. Good luck. Oh, for the plane ride, get up and walk frequently, stretching your foot as much as possible. Rise up on your toes helps a lot.
Karin

Re: P/F release

Karin L. on 12/13/00 at 09:14 (034834)

Jay,
I disagree with Julie. Don't take your shoes off!! If your feet swell, & on that long a flight they will, you won't be able to get your shoes back on. After PF release surgery, it is imperitive that you wear shoes with inserts. NEVER EVER go barefoot!! If you do, you aren't giving your feet the support that they need to heel! Ask any Dr. or anyone who has dealt with this problem & they will all say the same thing...BAREFEET IS A NO NO!
I am an Occupational Therapist so not only do I have this PF problem, but medically I know what I'm talking about. Keep your shoes on, just don't tie them tight.
Karin

Re: P/F release

Julie F on 12/13/00 at 09:47 (034838)

I defer to Karin's superior knowledge on the transatlantic flight question. But Jay, I really think you should get the doctors' view on the stretches Karin recommends, especially before trying the heels-hanging-over-the edge of-the-stair stretch. This one is very difficult to control, and I'd have thought it was a no-no while healing from surgery.

Re: P/F release

Nancy S. on 12/13/00 at 09:57 (034839)

I too would like the doctors' opinions on the weight-bearing stretches Karin is recommending. They are very aggressive for most people in an acute stage of PF, never mind what I imagine would be appropriate following surgery.
No disrespect to you personally at all, Karin -- but from what I've gathered, these kinds of stretches are to be very gradually worked up to, if done at all. (I will never hang my heels off of stairs, period.)
Drs. B and Z, your input here would be much appreciated.
Nancy

Re: P/F release

Karin L. on 12/13/00 at 11:54 (034849)

Nancy,
When I spoke about the exercises, this is precisely what I was instructed to to do by not only my Dr. but the Physical Therapist as well. If you don't keep things stretched, you are asking for more contractures where the scar tissue has been laid down. I think if not exercising and stretching the foot was called for then Jay would have been either in a hard cast or a cam walker until such time, usually at 5 weeks, stretches would begin. Dr. Z's imput would be helpful here. I can only relate as to what my Dr. & Physical Therapist instructed me to do.
Karin

Re: P/F release -- DRS. Z. AND B., PLEASE HELP HERE

Karin L. on 12/13/00 at 16:10 (034866)

Nancy,
How long have you had PF & when was your surgery? Did your Dr. send you to Physical Therapy? If so, I am curious as to what exercises they recommended & how soon after surgery? I don't mean to sound like a know-it-all, but I have been a rehabilitation therapist for 25 years & have dealt with just about every injury & surgery out there. I deal very closly with PT's & from what I have seen, my exercises & therapy were the rule, not the exception. Do you have to wear inserts or orthotics since your surgery?
Karin

Re: P/F release -- DRS. Z. AND B., PLEASE HELP HERE

Nancy S. on 12/13/00 at 16:55 (034869)

Hi Karin,
No, I haven't had the surgery. I do know people who have, and none of them were told to do any weight-bearing stretching for a long time -- all stretching and exercise was non-weight-bearing for a good while. It seems Dr. Z. here is frequently telling recent post-op people to stay off of their feet.
I've had PF for a year and a half, with some nasty tendonitis on top of it for the past 7 months. The good doctor that I finally found in July put my worse foot in a removable aircast to rest the tendons, but at the same time started me in PT three times a week -- which, along with my home stretching and strengthening program, I wouldn't have been without. All of this was non-weight-bearing, however. I've had two physical therapists, and the emphasis was totally on non-weight-bearing for a good long time, and gentleness was key. It's only recently -- since I got a good pair of orthotics -- that my current therapist has started me on weight-bearing exercise, and for starters it's still pretty minimal. I'm finally getting better.
I tried the against-the-wall stretch several different times last winter, before I'd had any therapy. It only made me worse. Both of my PTs said never to hang my heels off of stairs -- I asked them because at times that subject has come up on the board, and although most people believe it's dangerous (and I'm one of them), a few liked it, so I was curious.
You clearly have a lot of experience, and I in no way mean to minimize that. I have great respect for therapists, based on my own lucky experience. But parts of your stretching advice do seem to go against what my doc and my therapists believe and recommend. That's why I'm hoping to hear from Dr. Z or Dr. B on this.
I do find it hard to believe that that would be a good stretch for a post-surgery patient. I've read a lot -- and experienced more than I want to ever again! -- but I'm not a professional and am not post-surgery, so maybe I'm all wet.
Nancy

Re: P/F release

Julie F on 12/13/00 at 17:16 (034874)

Dr Z, can I second Nancy's request and ask you to clarify your first post to Jay? I know you sometimes leave words out (no offense intended!) but your advice - 'If you are in pain then stretching and rest' seems inconsistent with what I've read of your posts to other recently-post-surgery folk, to whom you've said 'no stretching until healed, and REST'.

Was there, possibly, a 'no' missing? I think Jay needs to know - and Nancy and I, and I'm sure others, would like your casting vote on this question. Particularly on the stair and wall stretches.

Thanks and best wishes, Julie

Re: P/F release

Dr. Zuckerman on 12/13/00 at 19:30 (034886)

I did leave out the most important word if you are in pain rest rest rest
no major stretching no rolling with a ball. The pf was cut don't aggravate it. You can do non-weight bearing stretching for the achilles tendon and extensor tendon. Before you start to walk in the morning if this does cause pain. Sorry about the missing no !! The stretching i am talking about is the use of the personal foot trainer by Mike Wilmott

Re: P/F release

Dr. Zuckerman on 12/13/00 at 19:31 (034887)

Just want to make sure that there is no active stretching of the pf and the intrinic muscles of the foot. The word is No No No . Sorry .

Re: P/F release

Dr. Zuckerman on 12/13/00 at 19:42 (034888)

No Stair . I completley recommend the Mike Wilmont approach to stretching.
No weight bearing and isometic stretching only. So Jay take a look at Mike Wilmott book on stretching.

Re: P/F release

Karin L. on 12/13/00 at 21:16 (034907)

Hi all...I guess everyone differs in the approach to stretches etc. after surgery. I will have to look into the Mike Wilmont approach, at this point I am willing to try anything. I am not opposed to new ideas and new ways to approach the healing process. Thanks for all your helpful input. Jay, good luck. Thanks for a stimulating talk, Nancy & Julie. Will let you all know how my ESWT goes on the 22nd...wish me luck.
Karin

Re: P/F release -- Karin

Julie F on 12/14/00 at 00:42 (034922)

Karin, yes, it was a good and useful discussion. Best of luck from me too. ESWT on 22 December! That should set you up for a very happy Christmas, and I hope you have one.

Jay, I hope you have one too. And back to that long-haul flight - whatever you do about shoes, do get an aisle seat. It saves clambering, which could hurt you. And you can walk around more often, which is good for the circulation, and even, occasionally, surreptitiously, stretch your feet out into the aisle. But watch out for the interminable food/drink/earphone/duty free carts.

All the best, Julie

Re: P/F release

Karin L. on 12/12/00 at 09:38 (034756)

Jay,
One month is too soon to tell if the surgery was a success or failure. You have to give it about 6 months. The scar tissue is still forming. If after 6 months you still have the same pain, then I would consider the surgery to be a failure. Give it time and give yourself time to heal. I have been where you are. I had surgery 8 months ago and unfortunately, mine failed and am scheduled for the ESWT in 2 weeks. Don't give up and keep up the stretches and all the exercises you were instructed to do. Good luck.
Karin

Re: P/F release

Dr. Z on 12/12/00 at 20:54 (034795)

Good advice. It can take six months for pf releases to heal. If you are in pain then stretching and rest and read Karin L's advice. The same advice for pf release goes for ESWT . Karin good luck .

Re: P/F release

Jay H. on 12/13/00 at 00:36 (034814)

HI again..

Great advice. Maybe I was expecting too much too fast. I never did receive any stretching exercises. Do you recommmend massage or ice? I dont know.. Please tell me what stretches I can do too help the healing process. I live in Taiwan, and the literature is all in Chinese. I am going on a Trans Atlantic flight soon, any reccomendations about flying with hurt feet? Thanks Karin and Dr Z.. I have one more question. I can not dial 800 #'s from here. Is there a way to get your video another way? Thanks for responding so quick, and I hope to hear from one or both again.

Jay

Re: P/F release

Julie F on 12/13/00 at 02:50 (034822)

Jay, take your shoes off when you get on the plane and wear soft slippers to cope with the inevitable swelling of the feet. If you ordinarily wear orthotics or arch supports, you'll probably need to put your shoes on when you go to the toilet, but keep them unlaced and as loose as possible. Ask for an aisle seat so you don't have to climb over people when you need to get up.

I don't think you should stretch. While your feet are recovering from surgery, you need to rest them. Be patient. You can stretch when your recovery is complete.

Re: P/F release

Karin L. on 12/13/00 at 09:09 (034832)

Jay,
Ice is OK, but I didn't find it too helpful. The exercises I found helpful were: with your foot on top of a tennis ball, roll the ball with some pressure, from the heel of your foot to the ball of you foot. Do this for about 3 min. 3 times per day; stand with your toes on a stair, heel hanging over the edge and raise up onto the ball of your foot about 10 times, do this 3 times a day; put your hands on a wall leaning towards it, like you're pushing the wall, put your bad leg in front, feet flat on the floor and bend your knee slightly. You want to feel a slight pull on your heel cord. It's hard to describe, but I guess pretend you are pushing a car, that's the position you want to be in. Finally, with your sock off, put a towel on a hardwood floor and try to scrunch the towel up with your toes. I soaked my foot in a fairly warm jacuzzi, then did the exercises and ended with massage. I hope this helps and that my explanation of the exercises were OK. If I can help further, let me know. Good luck. Oh, for the plane ride, get up and walk frequently, stretching your foot as much as possible. Rise up on your toes helps a lot.
Karin

Re: P/F release

Karin L. on 12/13/00 at 09:14 (034834)

Jay,
I disagree with Julie. Don't take your shoes off!! If your feet swell, & on that long a flight they will, you won't be able to get your shoes back on. After PF release surgery, it is imperitive that you wear shoes with inserts. NEVER EVER go barefoot!! If you do, you aren't giving your feet the support that they need to heel! Ask any Dr. or anyone who has dealt with this problem & they will all say the same thing...BAREFEET IS A NO NO!
I am an Occupational Therapist so not only do I have this PF problem, but medically I know what I'm talking about. Keep your shoes on, just don't tie them tight.
Karin

Re: P/F release

Julie F on 12/13/00 at 09:47 (034838)

I defer to Karin's superior knowledge on the transatlantic flight question. But Jay, I really think you should get the doctors' view on the stretches Karin recommends, especially before trying the heels-hanging-over-the edge of-the-stair stretch. This one is very difficult to control, and I'd have thought it was a no-no while healing from surgery.

Re: P/F release

Nancy S. on 12/13/00 at 09:57 (034839)

I too would like the doctors' opinions on the weight-bearing stretches Karin is recommending. They are very aggressive for most people in an acute stage of PF, never mind what I imagine would be appropriate following surgery.
No disrespect to you personally at all, Karin -- but from what I've gathered, these kinds of stretches are to be very gradually worked up to, if done at all. (I will never hang my heels off of stairs, period.)
Drs. B and Z, your input here would be much appreciated.
Nancy

Re: P/F release

Karin L. on 12/13/00 at 11:54 (034849)

Nancy,
When I spoke about the exercises, this is precisely what I was instructed to to do by not only my Dr. but the Physical Therapist as well. If you don't keep things stretched, you are asking for more contractures where the scar tissue has been laid down. I think if not exercising and stretching the foot was called for then Jay would have been either in a hard cast or a cam walker until such time, usually at 5 weeks, stretches would begin. Dr. Z's imput would be helpful here. I can only relate as to what my Dr. & Physical Therapist instructed me to do.
Karin

Re: P/F release -- DRS. Z. AND B., PLEASE HELP HERE

Karin L. on 12/13/00 at 16:10 (034866)

Nancy,
How long have you had PF & when was your surgery? Did your Dr. send you to Physical Therapy? If so, I am curious as to what exercises they recommended & how soon after surgery? I don't mean to sound like a know-it-all, but I have been a rehabilitation therapist for 25 years & have dealt with just about every injury & surgery out there. I deal very closly with PT's & from what I have seen, my exercises & therapy were the rule, not the exception. Do you have to wear inserts or orthotics since your surgery?
Karin

Re: P/F release -- DRS. Z. AND B., PLEASE HELP HERE

Nancy S. on 12/13/00 at 16:55 (034869)

Hi Karin,
No, I haven't had the surgery. I do know people who have, and none of them were told to do any weight-bearing stretching for a long time -- all stretching and exercise was non-weight-bearing for a good while. It seems Dr. Z. here is frequently telling recent post-op people to stay off of their feet.
I've had PF for a year and a half, with some nasty tendonitis on top of it for the past 7 months. The good doctor that I finally found in July put my worse foot in a removable aircast to rest the tendons, but at the same time started me in PT three times a week -- which, along with my home stretching and strengthening program, I wouldn't have been without. All of this was non-weight-bearing, however. I've had two physical therapists, and the emphasis was totally on non-weight-bearing for a good long time, and gentleness was key. It's only recently -- since I got a good pair of orthotics -- that my current therapist has started me on weight-bearing exercise, and for starters it's still pretty minimal. I'm finally getting better.
I tried the against-the-wall stretch several different times last winter, before I'd had any therapy. It only made me worse. Both of my PTs said never to hang my heels off of stairs -- I asked them because at times that subject has come up on the board, and although most people believe it's dangerous (and I'm one of them), a few liked it, so I was curious.
You clearly have a lot of experience, and I in no way mean to minimize that. I have great respect for therapists, based on my own lucky experience. But parts of your stretching advice do seem to go against what my doc and my therapists believe and recommend. That's why I'm hoping to hear from Dr. Z or Dr. B on this.
I do find it hard to believe that that would be a good stretch for a post-surgery patient. I've read a lot -- and experienced more than I want to ever again! -- but I'm not a professional and am not post-surgery, so maybe I'm all wet.
Nancy

Re: P/F release

Julie F on 12/13/00 at 17:16 (034874)

Dr Z, can I second Nancy's request and ask you to clarify your first post to Jay? I know you sometimes leave words out (no offense intended!) but your advice - 'If you are in pain then stretching and rest' seems inconsistent with what I've read of your posts to other recently-post-surgery folk, to whom you've said 'no stretching until healed, and REST'.

Was there, possibly, a 'no' missing? I think Jay needs to know - and Nancy and I, and I'm sure others, would like your casting vote on this question. Particularly on the stair and wall stretches.

Thanks and best wishes, Julie

Re: P/F release

Dr. Zuckerman on 12/13/00 at 19:30 (034886)

I did leave out the most important word if you are in pain rest rest rest
no major stretching no rolling with a ball. The pf was cut don't aggravate it. You can do non-weight bearing stretching for the achilles tendon and extensor tendon. Before you start to walk in the morning if this does cause pain. Sorry about the missing no !! The stretching i am talking about is the use of the personal foot trainer by Mike Wilmott

Re: P/F release

Dr. Zuckerman on 12/13/00 at 19:31 (034887)

Just want to make sure that there is no active stretching of the pf and the intrinic muscles of the foot. The word is No No No . Sorry .

Re: P/F release

Dr. Zuckerman on 12/13/00 at 19:42 (034888)

No Stair . I completley recommend the Mike Wilmont approach to stretching.
No weight bearing and isometic stretching only. So Jay take a look at Mike Wilmott book on stretching.

Re: P/F release

Karin L. on 12/13/00 at 21:16 (034907)

Hi all...I guess everyone differs in the approach to stretches etc. after surgery. I will have to look into the Mike Wilmont approach, at this point I am willing to try anything. I am not opposed to new ideas and new ways to approach the healing process. Thanks for all your helpful input. Jay, good luck. Thanks for a stimulating talk, Nancy & Julie. Will let you all know how my ESWT goes on the 22nd...wish me luck.
Karin

Re: P/F release -- Karin

Julie F on 12/14/00 at 00:42 (034922)

Karin, yes, it was a good and useful discussion. Best of luck from me too. ESWT on 22 December! That should set you up for a very happy Christmas, and I hope you have one.

Jay, I hope you have one too. And back to that long-haul flight - whatever you do about shoes, do get an aisle seat. It saves clambering, which could hurt you. And you can walk around more often, which is good for the circulation, and even, occasionally, surreptitiously, stretch your feet out into the aisle. But watch out for the interminable food/drink/earphone/duty free carts.

All the best, Julie