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Is the PT working?

Posted by Valerie S on 3/22/01 at hrmin (042252)

I am 2 weeks into my 2 week rx for PT. I continued to work through my first week of PT, have been off work for 4 days. I also got my orthotics back from my pod on Monday (they were being adjusted but still feel terrible) and have been wearing them this week. I was talking to my PT this morning, telling him that I did not feel any improvement, and worry that this is going to be too short to tell if the PT is working. He said you can usually tell within 2 weeks if PT is going to be helpful, and that if I don't show any improvement by next week, it won't be justifiable for me to take more time off work for PT.

My shoes are Birkenstocks with removable insoles (Medford). I took my orthotics out and put the Birk insoles back in today. I played with my 2 year old niece, went outside, even played a little game of hide and seek with her. I spent a couple of hours straight without pain (level 2 maybe), and it was great. My heels hurt a little now, but still not like they have been all week. I wonder if the orthotics are what were causing me that terrible pain all week. I know that I can not judge my recovery on one good day, but I am feeling really under-the-gun to prove that this PT will help me. I really want it to work... is it possible that I am starting to actually get better after a week of rest combined with intensive PT for 2 weeks, or am I just getting false hopes?

I know I have a long way to go, and that my life is going to be changed forever because of this darned PF... just looking for a little ray of hope here...

-Val.

Re: Is the PT working?

Steve P on 3/24/01 at 09:31 (042327)

Val -- I wonder where the heck everyone is this weekend?! I guess I'm the only one around!

It's encouraging that you have gotten some improvement through rest & PT. Of course, that's great. But I have the feeling that your recovery process (like mine) may only tolerate continued rest & moderate use. This is just a hunch......every person is different. But if your progress is as 'hard to come by' as I think it is, I don't see how you can go back to 40 hrs/week on your feet & get away with it.

Understand where I'm coming from. I have been battling PF for a year & am 50% to 60% improved. I have a desk job & I'm only on my feet 10 minutes or so per hour. I cannot tolerate more than that. Progress is precious. I don't want to see you develop a more chronic, long term case like mine. Please be VERY careful when you return to work. Don't sacrifice your feet for your job; I fear there could come a time when your feet are so injured that they no longer improve, even with rest.

Re: Is the PT working?

Julie on 3/24/01 at 10:12 (042328)

Hi Uncle Steve, and no, you're not the only one around. I read Val's post, and was concerned for her for the same reasons you are, but was hoping someone besides me would respond, because I'd already said all I could in response to the one before it. I'm glad you have, because you're the ideal guy! - your experience with PF is a lesson to us all.

Val, please do listen to Steve. He knows what he's talking about. You certainly can't predict recovery on the basis of one good day, and you really are going to have to be patient. It is going to take time. And even when you are no longer in pain, you cannot expect to be able to return to being on your feet all day on hard floors.

Re your orthotics - I recall your saying that your podiatrist had never seen you walk. How did he diagnose you - and how did he cast you? This sounds odd, even suspicious, to me.

Re PT - this sounds odd to me too, as though they are hurrying you through the system (insurance issues again?). I've had no experience of PT, but maybe someone who has could give their view on this. My guess is that you need a prescription for a lot longer than two weeks - but that's just my uneducated guess.

Julie

Re: Is the PT working?

Beverly on 3/24/01 at 14:27 (042338)

Val,

I agree with Steve. Two weeks is not long enough to get off your feet for improvement.

I had months and months of PT. If you have a bad case, I don't see how your therapist can say, 'If you don't see improvement in two weeks, no point to continue?' That sounds like managed care to me! Being rushed.

I was several months into PT before I saw any real improvement. I had a total of six months of PT. The most important component was deep tissue massage. The stretches were also helpful. I learned the hard way through a new injury not to agree to more vigorous stretching that I felt I could handle at any given time. Has your PT measured your flexibility? (Before and now?) That was how my PT justified my continued care even when on the surface it didn't seem like I was making much progress. My flexibility scores showed improvement. (How much you can flex back your foot.)

If you have a PPO, you have every opportunity to change therapists. I discovered that smaller places owned by an individual therapist rather than a big clinic give much better service. There, you are not a number. I switched clinics when the first place treated me like this was no big deal. My next therapist took a totally different approach and said that he didn't try to judge someone's pain level... that only I could judge that.

Have you tried Birk's classic footbed? If the Medford, which is a Footprint style, is helping, the classic line might be even more helpful. (Example: Arizona sandal, Boston Birk, Florida sandal, and others.) In the winter, I wear thick socks and the Boston Birk clog. I have not yet been able to wear the footprint line.

I'm the wrong person to speak on orthodics since my luck with them has not been good. But I do know you have every right to have them adjusted. In the end, I decided that my Birks give me more relief.

Can you file for short-term disability? Do you work for a big outfit that has those kinds of benefits? You may have shared with us what kind of work you do, but I can't remember for sure.

Best wishes,
Beverly

Re: Is the PT working?

Valerie S on 3/24/01 at hrmin (042353)

Thanks everyone for your feedback. I know that 2 weeks is not enough time to experience real improvement, but am really just wondering if this (PT) might actually be working... I see a glimmer of hope.

I went to my PT on Friday, and asked him again how I was doing. He told me that my heels are less swollen and 'thick.' My flexibility is improving, but the tendons are still tight (especially right). He has been doing the tissue massage and ultra sound 4x/week for the last 2 weeks, and each week, he measures my flexibility. When I told him about my good day on Thursday, he told me that it was a promising sign, and warned me to expect to slip back before I go farther forward (then he did an extra deep massage... YOW!).

I really like my Physical Therapist. He runs the place by himself and does give me very personal attention... he really cares and wants to help me.

I have never had PT before, and don't know what to expect... he has told me it takes several weeks to see a real improvement, and didn't know if it was possible to actually have relief be from PT after a week of rest & PT.

I have one week to go, before my PT script is up, and I don't know if that means that the doctor will tell me to go back to work after that, or have me continue the PT. I hope I don't have to go back now.. I will be right back where I started... Is the 3 week rx a test to see whether the patient should continue, or should I expect the doctor to move on to the next treatment (he wants to put me in a cast... please no)? What are my chances of getting an extension on the PT and the medical leave of absence? I will have satisfied the 2 week waiting period for getting short-term disability income. If I don't get an extension, then I won't be able to afford to take time off (start over again)... I am so scared of going back to work.

Thanks for listening...

Val.

Re: Is the PT working?

Julie on 3/24/01 at 17:41 (042359)

Val, you don't HAVE to go back to work. You don't have to do anything. You've already realized that the doctor is unsympathetic and has unreal expectations. If PT is helping you and you need more (I'm sure Bev is right about this) then ask him for another script. If he 'tells' you to go back to work, tell him no and find another doctor.

Inquire about short term disability. Tell your boss what you need. Make the decisions that need to be made. You are in charge here. These are your feet, this is your pain, and your life.

Re: Is the PT working?

Beverly on 3/24/01 at 21:27 (042369)

Valerie,

I second Julie's post. Sounds like you have a good PT. That's a plus. If you think you might file for short-term disability, all the more reason to change doctors. Unless your current doc becomes more sympathetic, he is not going to be very helpful. Part of the key to getting disability is having your doctor on your side.
I have found that orthopedic doctors and even my internist were more sympathetic to me than the three pods I saw first. Dr. Z. and Dr. B are wonderful and very up on all this stuff. But by and large, from what I've seen on this board, more people have gotten sports med. guys to take them seriously. Don't give up. I thought I'd never get my parking permit. I finally got it from my internist. So, if one door closes, look for a different one.
Best wishes,
Beverly

Re: Going back to work (& the shoes)

Valerie S on 3/24/01 at hrmin (042375)

Thanks for the tip, about finding a new doctor; I will try to find an ortho or sports med specialist. My only panic is that I have only 1 week left to find someone. I spent all day calling around last week, and the earliest I could get was 2 weeks out. What do I do if I can't find a new doctor in time? I know I don't HAVE to go back to work, but I have to follow procedures or pay the consequences. I can't afford to lose this job right now... I need it for a little while longer. (and Yes, I DO work for a big corporation - lots of rules along with the benefits - they have very good lawyers.)

Also, about the shoes: I agree about the classic Birk footbed being more comfortable (why is that anyway?), but I got this pair specifically so that I could use the orthotics in them. I have a pair of Bostons and a pair of Arizonas and a pair of Londons. I have been looking at that website in Germany : http://www.birkenstock-cn.com ... the shoes are about 1/2 the cost of retail here, and includes cost of shipping!

Thanks again, you are quickly becoming my best friends!

Val.

Re: Going back to work (& the shoes)

Bill E on 3/25/01 at hrmin (042401)

I am almost embarassed to comment because my PF isn't too bad and my job allows me to stay off my feet as much as required.

Regarding PT. Mine was fantastically successful. I have ultrasound with cortisone cream and then some intermediate massage...not too firm. My PT measured flexibilities and checked my foot out a lot before starting. I started with three visits per week. She said that after 2 weeks she could usually tell if was working. Mine worked after one visit! It was unbelievable. My schedule got weird and I missed one in the first two weeks and then I went on a week vacation. (More about that below) After discussion with the PT I have decided to go once per week to extend the time on my script, though I am sure that my Dr would renew. That seems to be working pretty well. I think that it is a combination of cortisone, massage, and stretching (by the PT) that is so successful for me.

I am a firm believer in stretching even though I don't do as much as I should. There are others here who are more skeptical. I have a suite of non weight bearing stretches that seems to work for me though the weight bearing ones don't bother me either. I believe that each individual can mix and match the best stretches. Just try bending your toes back as far as you can with one hand while massaging the fascia with the other. That is my favorite!!

Re Birks: I just got a pair from Germany. Much quicker than I thought. Mine are Montereys with the soft footbed and I love them. They are the first Birks I have ever worn so I can't comment about the soft footbed. It seems that I will have to learn more about the different styles of footbed before ordering another pair.

Taking time off: My vacation was in the Carribean and I was pretty careful. Wore shoes all of the time! Except swimming! Mostly Birks and running shoes with Spenco insoles. Unfortunately my natural tendency is to be lazy and I didn't stretch enough and walked a lot more than normal But it didn't set me back. I think I was pretty much static. Whereas normally I think I am slowly and steadily improving. So I guess it was worth it for the psyche if not the feet.

I wish you luck...and time off your feet!

Re: Going back to work (& the shoes)

ellen W on 3/26/01 at 08:18 (042494)

In my insurance plan (Blue Cross/Blue Shield PPO) although you need an initial script from the doctor, the physical therapist can justify extending therapy. You may want to call your insurance plan to see if this true under you plan. This may help with getting the treatment you need, though not necessarily the documentation for short-term disability. Good luck, Ellen.

Re: Is the PT working?

Steve P on 3/24/01 at 09:31 (042327)

Val -- I wonder where the heck everyone is this weekend?! I guess I'm the only one around!

It's encouraging that you have gotten some improvement through rest & PT. Of course, that's great. But I have the feeling that your recovery process (like mine) may only tolerate continued rest & moderate use. This is just a hunch......every person is different. But if your progress is as 'hard to come by' as I think it is, I don't see how you can go back to 40 hrs/week on your feet & get away with it.

Understand where I'm coming from. I have been battling PF for a year & am 50% to 60% improved. I have a desk job & I'm only on my feet 10 minutes or so per hour. I cannot tolerate more than that. Progress is precious. I don't want to see you develop a more chronic, long term case like mine. Please be VERY careful when you return to work. Don't sacrifice your feet for your job; I fear there could come a time when your feet are so injured that they no longer improve, even with rest.

Re: Is the PT working?

Julie on 3/24/01 at 10:12 (042328)

Hi Uncle Steve, and no, you're not the only one around. I read Val's post, and was concerned for her for the same reasons you are, but was hoping someone besides me would respond, because I'd already said all I could in response to the one before it. I'm glad you have, because you're the ideal guy! - your experience with PF is a lesson to us all.

Val, please do listen to Steve. He knows what he's talking about. You certainly can't predict recovery on the basis of one good day, and you really are going to have to be patient. It is going to take time. And even when you are no longer in pain, you cannot expect to be able to return to being on your feet all day on hard floors.

Re your orthotics - I recall your saying that your podiatrist had never seen you walk. How did he diagnose you - and how did he cast you? This sounds odd, even suspicious, to me.

Re PT - this sounds odd to me too, as though they are hurrying you through the system (insurance issues again?). I've had no experience of PT, but maybe someone who has could give their view on this. My guess is that you need a prescription for a lot longer than two weeks - but that's just my uneducated guess.

Julie

Re: Is the PT working?

Beverly on 3/24/01 at 14:27 (042338)

Val,

I agree with Steve. Two weeks is not long enough to get off your feet for improvement.

I had months and months of PT. If you have a bad case, I don't see how your therapist can say, 'If you don't see improvement in two weeks, no point to continue?' That sounds like managed care to me! Being rushed.

I was several months into PT before I saw any real improvement. I had a total of six months of PT. The most important component was deep tissue massage. The stretches were also helpful. I learned the hard way through a new injury not to agree to more vigorous stretching that I felt I could handle at any given time. Has your PT measured your flexibility? (Before and now?) That was how my PT justified my continued care even when on the surface it didn't seem like I was making much progress. My flexibility scores showed improvement. (How much you can flex back your foot.)

If you have a PPO, you have every opportunity to change therapists. I discovered that smaller places owned by an individual therapist rather than a big clinic give much better service. There, you are not a number. I switched clinics when the first place treated me like this was no big deal. My next therapist took a totally different approach and said that he didn't try to judge someone's pain level... that only I could judge that.

Have you tried Birk's classic footbed? If the Medford, which is a Footprint style, is helping, the classic line might be even more helpful. (Example: Arizona sandal, Boston Birk, Florida sandal, and others.) In the winter, I wear thick socks and the Boston Birk clog. I have not yet been able to wear the footprint line.

I'm the wrong person to speak on orthodics since my luck with them has not been good. But I do know you have every right to have them adjusted. In the end, I decided that my Birks give me more relief.

Can you file for short-term disability? Do you work for a big outfit that has those kinds of benefits? You may have shared with us what kind of work you do, but I can't remember for sure.

Best wishes,
Beverly

Re: Is the PT working?

Valerie S on 3/24/01 at hrmin (042353)

Thanks everyone for your feedback. I know that 2 weeks is not enough time to experience real improvement, but am really just wondering if this (PT) might actually be working... I see a glimmer of hope.

I went to my PT on Friday, and asked him again how I was doing. He told me that my heels are less swollen and 'thick.' My flexibility is improving, but the tendons are still tight (especially right). He has been doing the tissue massage and ultra sound 4x/week for the last 2 weeks, and each week, he measures my flexibility. When I told him about my good day on Thursday, he told me that it was a promising sign, and warned me to expect to slip back before I go farther forward (then he did an extra deep massage... YOW!).

I really like my Physical Therapist. He runs the place by himself and does give me very personal attention... he really cares and wants to help me.

I have never had PT before, and don't know what to expect... he has told me it takes several weeks to see a real improvement, and didn't know if it was possible to actually have relief be from PT after a week of rest & PT.

I have one week to go, before my PT script is up, and I don't know if that means that the doctor will tell me to go back to work after that, or have me continue the PT. I hope I don't have to go back now.. I will be right back where I started... Is the 3 week rx a test to see whether the patient should continue, or should I expect the doctor to move on to the next treatment (he wants to put me in a cast... please no)? What are my chances of getting an extension on the PT and the medical leave of absence? I will have satisfied the 2 week waiting period for getting short-term disability income. If I don't get an extension, then I won't be able to afford to take time off (start over again)... I am so scared of going back to work.

Thanks for listening...

Val.

Re: Is the PT working?

Julie on 3/24/01 at 17:41 (042359)

Val, you don't HAVE to go back to work. You don't have to do anything. You've already realized that the doctor is unsympathetic and has unreal expectations. If PT is helping you and you need more (I'm sure Bev is right about this) then ask him for another script. If he 'tells' you to go back to work, tell him no and find another doctor.

Inquire about short term disability. Tell your boss what you need. Make the decisions that need to be made. You are in charge here. These are your feet, this is your pain, and your life.

Re: Is the PT working?

Beverly on 3/24/01 at 21:27 (042369)

Valerie,

I second Julie's post. Sounds like you have a good PT. That's a plus. If you think you might file for short-term disability, all the more reason to change doctors. Unless your current doc becomes more sympathetic, he is not going to be very helpful. Part of the key to getting disability is having your doctor on your side.
I have found that orthopedic doctors and even my internist were more sympathetic to me than the three pods I saw first. Dr. Z. and Dr. B are wonderful and very up on all this stuff. But by and large, from what I've seen on this board, more people have gotten sports med. guys to take them seriously. Don't give up. I thought I'd never get my parking permit. I finally got it from my internist. So, if one door closes, look for a different one.
Best wishes,
Beverly

Re: Going back to work (& the shoes)

Valerie S on 3/24/01 at hrmin (042375)

Thanks for the tip, about finding a new doctor; I will try to find an ortho or sports med specialist. My only panic is that I have only 1 week left to find someone. I spent all day calling around last week, and the earliest I could get was 2 weeks out. What do I do if I can't find a new doctor in time? I know I don't HAVE to go back to work, but I have to follow procedures or pay the consequences. I can't afford to lose this job right now... I need it for a little while longer. (and Yes, I DO work for a big corporation - lots of rules along with the benefits - they have very good lawyers.)

Also, about the shoes: I agree about the classic Birk footbed being more comfortable (why is that anyway?), but I got this pair specifically so that I could use the orthotics in them. I have a pair of Bostons and a pair of Arizonas and a pair of Londons. I have been looking at that website in Germany : http://www.birkenstock-cn.com ... the shoes are about 1/2 the cost of retail here, and includes cost of shipping!

Thanks again, you are quickly becoming my best friends!

Val.

Re: Going back to work (& the shoes)

Bill E on 3/25/01 at hrmin (042401)

I am almost embarassed to comment because my PF isn't too bad and my job allows me to stay off my feet as much as required.

Regarding PT. Mine was fantastically successful. I have ultrasound with cortisone cream and then some intermediate massage...not too firm. My PT measured flexibilities and checked my foot out a lot before starting. I started with three visits per week. She said that after 2 weeks she could usually tell if was working. Mine worked after one visit! It was unbelievable. My schedule got weird and I missed one in the first two weeks and then I went on a week vacation. (More about that below) After discussion with the PT I have decided to go once per week to extend the time on my script, though I am sure that my Dr would renew. That seems to be working pretty well. I think that it is a combination of cortisone, massage, and stretching (by the PT) that is so successful for me.

I am a firm believer in stretching even though I don't do as much as I should. There are others here who are more skeptical. I have a suite of non weight bearing stretches that seems to work for me though the weight bearing ones don't bother me either. I believe that each individual can mix and match the best stretches. Just try bending your toes back as far as you can with one hand while massaging the fascia with the other. That is my favorite!!

Re Birks: I just got a pair from Germany. Much quicker than I thought. Mine are Montereys with the soft footbed and I love them. They are the first Birks I have ever worn so I can't comment about the soft footbed. It seems that I will have to learn more about the different styles of footbed before ordering another pair.

Taking time off: My vacation was in the Carribean and I was pretty careful. Wore shoes all of the time! Except swimming! Mostly Birks and running shoes with Spenco insoles. Unfortunately my natural tendency is to be lazy and I didn't stretch enough and walked a lot more than normal But it didn't set me back. I think I was pretty much static. Whereas normally I think I am slowly and steadily improving. So I guess it was worth it for the psyche if not the feet.

I wish you luck...and time off your feet!

Re: Going back to work (& the shoes)

ellen W on 3/26/01 at 08:18 (042494)

In my insurance plan (Blue Cross/Blue Shield PPO) although you need an initial script from the doctor, the physical therapist can justify extending therapy. You may want to call your insurance plan to see if this true under you plan. This may help with getting the treatment you need, though not necessarily the documentation for short-term disability. Good luck, Ellen.