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

Is This Normal 1st P.T. Appointment?

Posted by Lisa C. on 5/23/01 at 01:59 (048614)

Just had my 1st physical therapy visit. I was impressed with the time and details. They wrote down alot about the biomechanics of my feet. But... They had me walk barefoot up & down a hall many many times, stand up & down on my tip toes & walk on my heels (I tried but couldn't do this one!)& more. I know that I am not supposed to do any of those things & I hope I have not just pushed back the progress I have made. I told the PT about all the things I was doing & that I got the info from here. She asked me how much better I was since doing the things advised on Heelspurs.com & I thought about it and said easily 50% better. Thanks Heelspurs.com! 1 &1/2 hours, $75.00 and the only therapy was a bit a ultrasound on one of my heels. The rest of the visits should be all therapy from now. Any advice is appreciated as I have never had therapy before. I am having a terrible time with taping. I just read a post where Julie recommends taping with the heel dorsiflexed (I beleive) then she said heel pulled up. Thanks for the lay terms I need them! I will try this as my toes always feel curled and pulled on & looser tape feels ineffective. Many thanks again!

Re: Is This Normal 1st P.T. Appointment?

Denise D. on 5/23/01 at 02:39 (048618)

Hi Lisa,
Good luck on your therapy, I've never had it myself, but at this point I'm willing to try anything. I won't bore you with my foot problem (It's posted under Whats Next????) if you want to read it.
You mentioned taping, what type of trouble did you have? I'm also very confused about that subject, because there seems to be so many ways to tape your foot, I wonder what is the best way? And how long can we go with our foot taped? Also what actually does taping do? Please excuse my ignorance, there is just so much to learn and understand. If anyone reads this post and has the answers maybe it will help us both to understand.
Wish I had the answer to your question about P.T.
Best of Luck to you.

Re: Is This Normal 1st P.T. Appointment?

Julie on 5/23/01 at 02:44 (048619)

Hi Lisa

I can't offer any advice about PT, but I do hope yours goes well.

I'm sorry to hear you're having a terrible time with taping. Your PT ought to be able to help you with it: hands-on help is always better than advice over the internet. But I'll try.

Be careful not to pull the tape too tight. It needs to be 'just right' - tight enough to give support, not so tight that it causes strain or more pain.

Sorry about the technical terms. I try to be clear, but dorsiflexion and plantar flexion are natural to me so they sometimes slip out.

* Plantar flexion = the foot is bending forward at the ankle and the toes are pointing forward

* Dorsiflexion = the foot is bending backward at the ankle and the toes are pointing up

* Neutral = well, neutral - neither one nor the other; the foot is relaxed

I hold my foot in neutral when applying the tape. I pull the tape fairly tightly, and when I stand up it feels right.
If I dorsiflex my foot when applying the tape, it feels painfully tight when I stand up (I've only done this once!)

Several factors are involved - the height of the arch as well as the tightness of the tape and and angle of the foot. So you need to experiment. The tape matters too: if it isn't a good quality tape, it will stretch and loosen after a while so that it no longer gives support.

I also feel that tape should not be kept on for more than one day. (Another reason why I have been so glad that the simple two-strip method worked for me.) Once it has been walked on for a day, and got wet in the shower, it weakens. On the few occasions when I've kept it on overnight and not changed it the next morning, I've noticed the difference, and when I've removed it, it has felt sort of flaccid. Also, the skin needs to recover overnight.

I hope this helps. Good luck with your PT.

Re: Is This Normal 1st P.T. Appointment? Guestion for Julie

Denise D. on 5/23/01 at 03:06 (048620)

Hi Julie,
You are a wealth of information!! I appreciate you so much! I read your post to Lisa and have a question about taping, exactly where is it applied? and how much is used? I also was curious as to what type of foot problems you have.
Thanks
Denise

Re: Is This Normal 1st P.T. Appointment? Guestion for Julie

Julie on 5/23/01 at 03:39 (048624)

Hi Denise

We're having a conversation in real time here, it seems. I've just posted a long message to you in answer to your 'What's next?' post.
You've probably seen it by now if you're still on line, and I hope it made a start in answering your question.

See Part 2 of the heel pain book. The section on taping illustrates and describes several methods. I suggest you start with the simplest, two-strip technique. You can see exactly what it looks like in the illustration. I found this technique worked as well (i.e. it was just as supportive) as the much more complicated method my pod used. It has the advantage of being much cheaper, as well as much easier to apply by yourself, and you can (and I firmly believe should) remove it every night and re-apply it every morning.

I explained to Lisa about experimenting to get the right tension, so won't repeat myself.

My foot problems? I have classic plantar fasciitis. It began in August 2000. Fortunately I discovered heelspurs.com almost immediately, and saw a podiatrist at the same time, so I began dealing with it immediately. It took five months of the following:

relative rest (staying off my feet as much as possible)
getting casted for and wearing custom orthotics to deal with over-pronation
wearing only, and always (i.e. never going barefoot) good, supportive, well-cushioned trainers
taping every day
wearing an elastic ankle support (instead of tape or as well as tape if I'm going to be on my feet more than usual)
icing when in pain after too much unavoidable activity
...and appropriate stretching and strengthening exercise

to get it to the stage where I could return to normal activity. Since January I've been able to say that I'm 95% better, but I continue with all the above (apart from icing, which I haven't needed for months as there is no longer any inflammation).

I am aware that the point where the fascia inserts into the heel bone is now a 'weak spot' for me, and that I will always need to be pro-active in avoiding a recurrence. I find this very easy to accept - I've never been under the illusion that once pain-free I can throw away my orthotics, go barefoot, etc. This is ok with me.

I hope this is useful.

All the best, Julie

Re: Is This Normal 1st P.T. Appointment?

Valerie S on 5/23/01 at hrmin (048637)

Hi Lisa.

If there is a 'normal' PT 1st appointment, yours sounds pretty reasonable. I'm a little sorry to hear that they made you walk barefoot, but this is one way for them to really see you walking, so they can make an informed analysis and decide how to treat you.

I went to PT for 5 weeks, and I loved every visit! My PT consisted of stationary bike (to get the blood flowing... some people use hotpacks instead), stretching, ultrasound, massage, more stretching. I found the time that I spent with my PT to be very valuable. It didn't do a lot for my pain level, unfortunately, but it was GREAT therapy... being pampered and cared for. The ultrasound time is a great time to talk, ask questions and opinions... more than PHYSICAL therapy... many psychological benefits, just having a caregiver that listens and spends so much time with you.

Don't lose hope... I really hope that the PT helps you. I found that the one week following the termination of the PT was a very good week, as far as my pain level goes... for me, anyway.

All the best to you, Lisa. I hope that you start to experience some relief soon. PT can help make you feel proactive, as can being here at the message board. There are great, caring and wonderful people here. I have been helped so much-more than I can put into words. Good luck to you.

Keep us posted...
Val.

Re: Is This Normal 1st P.T. Appointment?

ellen w on 5/23/01 at 09:24 (048638)

Lisa,

Sounds a lot like my first visit, except for the walking on heels. The barefoot walking is so the therapist can analyze your gait to see if that's contributing to the problem. Over the last couple of years, I've been through several rounds of pt for both knee and ankle problems. I've always found it helps. Strengthening and flexibility exercises were really big helps to me. So far, it sounds like you've got a good therapist.
ellen

Re: Is This Normal 1st P.T. Appointment?

john h on 5/23/01 at 09:29 (048639)

walking on your toes and heels is a test often done for persons with low back problems to identify possible nerve impingement.

Re: Is This Normal 1st P.T. Appointment?

Jason M on 5/23/01 at hrmin (048644)

Sounds a lot like my 1st PT app. My PTherapist also measured my legs to make sure there wasn't a length difference. I too walked barefoot, etc., and it was painful but necessary I think. PT was fairly beneficial to me because it helped me develop a good stretching routine and it helps to talk to someone about it. Good luck with your PT.
Jason

Re: Is This Normal 1st P.T. Appointment?

JudyS on 5/23/01 at 11:06 (048649)

Denise - Julie has done such a thorough job describing taping so I'll just add a couple of thoughts....
Don't be afraid to experiment with different methods. As with all other PF treatments, taping is individualized. A number of us have found that the simplest methods are also the most effective - those using just one or two strips. I was happiest with the one-strip 'omega/figure eight' design on Scott's taping page.
I know it'll be frustrating the first few times but believe me, you'll get the hang of it and it'll be as easy and routine as putting on your socks!
The other great thing about the simple methods is that you can do it every day which gives you fresh support every day and doesn't use up too much tape.
What taping is meant to do is to take stress off of the Plantar tendon which, theoretically, helps it heal. Taking stress off the Plantar (ie; resting) is just the same as not using any other inflammed tendon - it's just in a much more used/stressed spot!
Some pods, if they find you have relief from the tape, will then have you use orthotics - at least mine did!

Re: Is This Normal 1st P.T. Appointment?

Denise D. on 5/24/01 at 02:22 (048735)

Hello Judy,
Thanks for the great advise. I have a couple of questions, what type of tape do you use? And can the tape be worn along with wearing an ankle brace?
Denise

Re: OOPS!!!!!!

Denise D. on 5/24/01 at 02:28 (048736)

Sorry, didn't mean for that message to be posted twice! I get in the habit of DOUBLE CLICKING sometimes.

Re: Is This Normal 1st P.T. Appointment?

JudyS on 5/24/01 at 11:33 (048781)

Denise - I just went to the pharmacy and bought 1 inch wide tape of what I thought might be 'better' quality adhesive tape. I think it was waterproof also. I think Julie and John have some good information about certain kinds/brands of tape.
I never used an ankle brace in addition to tape so, I'm sorry :( - I can't answer that question!

Re: Is This Normal 1st P.T. Appointment?

Julie on 5/25/01 at 01:46 (048838)

Denise, the tape I use is Leuko tape. John posted a link to a website that sells it on line a while ago.

I use an elastic ankle brace with tape. It gives additional support. Often it's enough by itself, but if I'm going to be out and on myfeet all day, I adhere to the 'belt and braces' philosophy and use both.

Re: Is This Normal 1st P.T. Appointment? bit of humour

Lisa C. on 5/26/01 at 01:42 (048940)

First I hope that I am using this board correctly. (let me know if not) Thank you for the responses! Thanks you for your detailed answer Julie and my intial welcome! I think you should be the official greeter because you have such a nice way and it feels so good to get that first welcome response! If laughter is the best medicine here is a small dose: At this first visit the Phyisical Therapist asked me if I ever lost urine upon exertion, coughing... I freaked out and said DON'T TELL ME THAT CAN HAPPEN FROM PF!!!! Apparently it would have meant back trouble! (Forgive me if that was too risque or in poor potty humour taste) Once I found out that it was not something else to worry about happening with this PF, I thought it was kind of funny! Enjoy the week end and take care of those feet & backs!

Re: Is This Normal 1st P.T. Appointment?

Denise D. on 5/23/01 at 02:39 (048618)

Hi Lisa,
Good luck on your therapy, I've never had it myself, but at this point I'm willing to try anything. I won't bore you with my foot problem (It's posted under Whats Next????) if you want to read it.
You mentioned taping, what type of trouble did you have? I'm also very confused about that subject, because there seems to be so many ways to tape your foot, I wonder what is the best way? And how long can we go with our foot taped? Also what actually does taping do? Please excuse my ignorance, there is just so much to learn and understand. If anyone reads this post and has the answers maybe it will help us both to understand.
Wish I had the answer to your question about P.T.
Best of Luck to you.

Re: Is This Normal 1st P.T. Appointment?

Julie on 5/23/01 at 02:44 (048619)

Hi Lisa

I can't offer any advice about PT, but I do hope yours goes well.

I'm sorry to hear you're having a terrible time with taping. Your PT ought to be able to help you with it: hands-on help is always better than advice over the internet. But I'll try.

Be careful not to pull the tape too tight. It needs to be 'just right' - tight enough to give support, not so tight that it causes strain or more pain.

Sorry about the technical terms. I try to be clear, but dorsiflexion and plantar flexion are natural to me so they sometimes slip out.

* Plantar flexion = the foot is bending forward at the ankle and the toes are pointing forward

* Dorsiflexion = the foot is bending backward at the ankle and the toes are pointing up

* Neutral = well, neutral - neither one nor the other; the foot is relaxed

I hold my foot in neutral when applying the tape. I pull the tape fairly tightly, and when I stand up it feels right.
If I dorsiflex my foot when applying the tape, it feels painfully tight when I stand up (I've only done this once!)

Several factors are involved - the height of the arch as well as the tightness of the tape and and angle of the foot. So you need to experiment. The tape matters too: if it isn't a good quality tape, it will stretch and loosen after a while so that it no longer gives support.

I also feel that tape should not be kept on for more than one day. (Another reason why I have been so glad that the simple two-strip method worked for me.) Once it has been walked on for a day, and got wet in the shower, it weakens. On the few occasions when I've kept it on overnight and not changed it the next morning, I've noticed the difference, and when I've removed it, it has felt sort of flaccid. Also, the skin needs to recover overnight.

I hope this helps. Good luck with your PT.

Re: Is This Normal 1st P.T. Appointment? Guestion for Julie

Denise D. on 5/23/01 at 03:06 (048620)

Hi Julie,
You are a wealth of information!! I appreciate you so much! I read your post to Lisa and have a question about taping, exactly where is it applied? and how much is used? I also was curious as to what type of foot problems you have.
Thanks
Denise

Re: Is This Normal 1st P.T. Appointment? Guestion for Julie

Julie on 5/23/01 at 03:39 (048624)

Hi Denise

We're having a conversation in real time here, it seems. I've just posted a long message to you in answer to your 'What's next?' post.
You've probably seen it by now if you're still on line, and I hope it made a start in answering your question.

See Part 2 of the heel pain book. The section on taping illustrates and describes several methods. I suggest you start with the simplest, two-strip technique. You can see exactly what it looks like in the illustration. I found this technique worked as well (i.e. it was just as supportive) as the much more complicated method my pod used. It has the advantage of being much cheaper, as well as much easier to apply by yourself, and you can (and I firmly believe should) remove it every night and re-apply it every morning.

I explained to Lisa about experimenting to get the right tension, so won't repeat myself.

My foot problems? I have classic plantar fasciitis. It began in August 2000. Fortunately I discovered heelspurs.com almost immediately, and saw a podiatrist at the same time, so I began dealing with it immediately. It took five months of the following:

relative rest (staying off my feet as much as possible)
getting casted for and wearing custom orthotics to deal with over-pronation
wearing only, and always (i.e. never going barefoot) good, supportive, well-cushioned trainers
taping every day
wearing an elastic ankle support (instead of tape or as well as tape if I'm going to be on my feet more than usual)
icing when in pain after too much unavoidable activity
...and appropriate stretching and strengthening exercise

to get it to the stage where I could return to normal activity. Since January I've been able to say that I'm 95% better, but I continue with all the above (apart from icing, which I haven't needed for months as there is no longer any inflammation).

I am aware that the point where the fascia inserts into the heel bone is now a 'weak spot' for me, and that I will always need to be pro-active in avoiding a recurrence. I find this very easy to accept - I've never been under the illusion that once pain-free I can throw away my orthotics, go barefoot, etc. This is ok with me.

I hope this is useful.

All the best, Julie

Re: Is This Normal 1st P.T. Appointment?

Valerie S on 5/23/01 at hrmin (048637)

Hi Lisa.

If there is a 'normal' PT 1st appointment, yours sounds pretty reasonable. I'm a little sorry to hear that they made you walk barefoot, but this is one way for them to really see you walking, so they can make an informed analysis and decide how to treat you.

I went to PT for 5 weeks, and I loved every visit! My PT consisted of stationary bike (to get the blood flowing... some people use hotpacks instead), stretching, ultrasound, massage, more stretching. I found the time that I spent with my PT to be very valuable. It didn't do a lot for my pain level, unfortunately, but it was GREAT therapy... being pampered and cared for. The ultrasound time is a great time to talk, ask questions and opinions... more than PHYSICAL therapy... many psychological benefits, just having a caregiver that listens and spends so much time with you.

Don't lose hope... I really hope that the PT helps you. I found that the one week following the termination of the PT was a very good week, as far as my pain level goes... for me, anyway.

All the best to you, Lisa. I hope that you start to experience some relief soon. PT can help make you feel proactive, as can being here at the message board. There are great, caring and wonderful people here. I have been helped so much-more than I can put into words. Good luck to you.

Keep us posted...
Val.

Re: Is This Normal 1st P.T. Appointment?

ellen w on 5/23/01 at 09:24 (048638)

Lisa,

Sounds a lot like my first visit, except for the walking on heels. The barefoot walking is so the therapist can analyze your gait to see if that's contributing to the problem. Over the last couple of years, I've been through several rounds of pt for both knee and ankle problems. I've always found it helps. Strengthening and flexibility exercises were really big helps to me. So far, it sounds like you've got a good therapist.
ellen

Re: Is This Normal 1st P.T. Appointment?

john h on 5/23/01 at 09:29 (048639)

walking on your toes and heels is a test often done for persons with low back problems to identify possible nerve impingement.

Re: Is This Normal 1st P.T. Appointment?

Jason M on 5/23/01 at hrmin (048644)

Sounds a lot like my 1st PT app. My PTherapist also measured my legs to make sure there wasn't a length difference. I too walked barefoot, etc., and it was painful but necessary I think. PT was fairly beneficial to me because it helped me develop a good stretching routine and it helps to talk to someone about it. Good luck with your PT.
Jason

Re: Is This Normal 1st P.T. Appointment?

JudyS on 5/23/01 at 11:06 (048649)

Denise - Julie has done such a thorough job describing taping so I'll just add a couple of thoughts....
Don't be afraid to experiment with different methods. As with all other PF treatments, taping is individualized. A number of us have found that the simplest methods are also the most effective - those using just one or two strips. I was happiest with the one-strip 'omega/figure eight' design on Scott's taping page.
I know it'll be frustrating the first few times but believe me, you'll get the hang of it and it'll be as easy and routine as putting on your socks!
The other great thing about the simple methods is that you can do it every day which gives you fresh support every day and doesn't use up too much tape.
What taping is meant to do is to take stress off of the Plantar tendon which, theoretically, helps it heal. Taking stress off the Plantar (ie; resting) is just the same as not using any other inflammed tendon - it's just in a much more used/stressed spot!
Some pods, if they find you have relief from the tape, will then have you use orthotics - at least mine did!

Re: Is This Normal 1st P.T. Appointment?

Denise D. on 5/24/01 at 02:22 (048735)

Hello Judy,
Thanks for the great advise. I have a couple of questions, what type of tape do you use? And can the tape be worn along with wearing an ankle brace?
Denise

Re: OOPS!!!!!!

Denise D. on 5/24/01 at 02:28 (048736)

Sorry, didn't mean for that message to be posted twice! I get in the habit of DOUBLE CLICKING sometimes.

Re: Is This Normal 1st P.T. Appointment?

JudyS on 5/24/01 at 11:33 (048781)

Denise - I just went to the pharmacy and bought 1 inch wide tape of what I thought might be 'better' quality adhesive tape. I think it was waterproof also. I think Julie and John have some good information about certain kinds/brands of tape.
I never used an ankle brace in addition to tape so, I'm sorry :( - I can't answer that question!

Re: Is This Normal 1st P.T. Appointment?

Julie on 5/25/01 at 01:46 (048838)

Denise, the tape I use is Leuko tape. John posted a link to a website that sells it on line a while ago.

I use an elastic ankle brace with tape. It gives additional support. Often it's enough by itself, but if I'm going to be out and on myfeet all day, I adhere to the 'belt and braces' philosophy and use both.

Re: Is This Normal 1st P.T. Appointment? bit of humour

Lisa C. on 5/26/01 at 01:42 (048940)

First I hope that I am using this board correctly. (let me know if not) Thank you for the responses! Thanks you for your detailed answer Julie and my intial welcome! I think you should be the official greeter because you have such a nice way and it feels so good to get that first welcome response! If laughter is the best medicine here is a small dose: At this first visit the Phyisical Therapist asked me if I ever lost urine upon exertion, coughing... I freaked out and said DON'T TELL ME THAT CAN HAPPEN FROM PF!!!! Apparently it would have meant back trouble! (Forgive me if that was too risque or in poor potty humour taste) Once I found out that it was not something else to worry about happening with this PF, I thought it was kind of funny! Enjoy the week end and take care of those feet & backs!