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clarifications & questions, please

Posted by Mary De on 5/30/01 at hrmin (049313)

So, IÕd called my podiatristÕs office today to say that I was still in a lot of pain, although doc promised that my expensive new orthotics would make me pain-free in 2 weeks(!), and no, I really donÕt want cortisone shots, besides IÕm out of money (no insurance), and whatÕs my diagnosis again, plantar what? Then I got on the web. I only meant to take a short break from my work, sometime around 4 p.m.... itÕs now past midnight. Wow. I stumbled onto this site and itÕs amazing. IÕve just read through the sixty-some pages I downloaded. I now have a much better idea of my PF (as you folks say) and how it happened. I know thereÕs more to read, but frankly IÕm a bit overwhelmed. ThereÕs a lot of info, some of it conflicting, some of it unclear. But IÕm also excited about finally figuring out this horrible pain and how to treat it myself. IÕm also relieved to know that IÕm not nuts or a hypochondriac, it does hurt as much as I think it does, IÕm not just being wimpy when I limp like an ancient baboon. And IÕm astonished to see that some (many?) PF patients go on suffering for years -- tell me it ainÕt so!

So, if I can summarize what IÕve gleaned so far and ask for some clarification from both your volunteer doctors and hardcore PF civilians:

Stretching: Good to do, except when itÕs not. Hmmm. I should gently stretch out my heels to the ceiling before arising in the morning, even if I have to pee like hell. I should continue this a few time during the day. In general, calf and leg stretches are good (I think). I should not do the push against the wall calf stretch? How about the little wooden rollers gizmo over the bottoms of the feet? I have a nice, semi-vigorous yoga routine that I plan to start doing more often -- any pointers here? (No, itÕs not Iyengar style -- much gentler.)

Taping: A new concept. IÕll have to study the pictures.

Walking: Bad. Unfortunately, my main, usual exercise & recreation, over the unpaved rural roads where I live. Foot pain has greatly decreased my ability to do anyway. I can eliminate unnecessary walking, but there will still be a fair amount in just living. (And if I thought that I couldnÕt ever take my wonderful long walks again, I really would just roll over and give up.)

Being On My Feet: Bad. A sudden increase in this last winter is a major cause of my developing this problem, I believe. I can reduce, but not eliminate -- and pray that it doesnÕt eliminate me. I know rest is crucial, but itÕs really hard to do.

Barefoot: No-no. This oneÕs hard. I love being barefoot in summer in the house. IÕll look into the Birkenstocks, even though theyÕre ugly as PatootieÕs dog and cost too much. Does one wear oneÕs Birks with or without orthotics?

Inflammation: Bad. I donÕt tolerate ibuprofen or aspirin well, but have to say that my herb anti-inflams havenÕt seemed to help much w/ my PF. Will try some youÕve suggested here. On another web site, a chiropractor (I know, I know, but I used to date one) states: ŌAccording to the summer 1996 newsletter of the American Running and Fitness Association, plantar fasciitis is not an inflammatory problem, but a painful degenerative condition. A better name for it would be 'plantar faciosis' or 'plantar tendinosis'. ... anti-inflammatory medications, both steroidal and non-steroidal, while having short term beneficial effects which may be necessary for serious acute crisis, actually slow healing and have serious side effects. ...The biological goals of treatment include restoration of blood vessel supply for nutrition and tissue production of protein collagen, the Ôhealing glueÕ of the tendon.Ķ Your comments? meaning of suffix Ō-osisĶ? (my dictionaryÕs not very clear).

Ice: Good. Okay, doctor did tell me this before, but I resisted Ôcause I hate having cold feet. IÕve compromised now with cold packs. They do help. When I had horrible, debilitating tendonitis in my hands & wrists a few years ago, alternating extremely hot/ice cold water baths helped a lot. Would that treatment work here?

Weight: Bad. Morally shameful. ItÕs my own fault after all. I was merely slightly overweight before the killer PF hit (about 10 lbs over my ŌbestĶ weight), but in part because of my injury and lack of walking, I gained a lot of weight (25 lbs) over the last 5 months (mainlining chocolate as stress relief). The weight, I see now, has made it worse. IÕll figure this one myself, thanks ...

Massage: At least thereÕs some reward for cutting back the chocolate.

TENS w/ vinegar: Really? I actually have a TENS machine, recently acquired. IÕll try it. Where does one attach the electrode stickies?

Anything I missed? And THANKS for all your help.

best, Mary DeDanan
dedanan@value.net

Re: clarifications & questions, please

Cynthia D on 5/30/01 at 06:17 (049315)

Hi Mary, first of all, welcome to heelspurs.com from another pf sufferer. Wow you did stumble into the right place! And so late at night, too.

It looks like you got a lot of good info, so I'll answer a few questions, and let others pick this up, too, I gotta run get the kiddos to school.

The hardest part about discovering this site and realizing how serious foot pain can be is accepting that you are going to have to make some changes and make a committment yourself to help yourself heal.

I'm no doctor, but no walks for now until you try different things and see what works best for you. I'm sure you know to always wear your orthotics 'cause they support your arch. When you can't wear them, wear Birkenstocks if you can (they are too hard for me) to support your arch. The orthotics will not work in them, they have their own arch support. They also make Birkies, a type that can get wet so we use these for shower/pool support. Never go barefoot. I know about the late at night dash for the bathroom!! I had a baby through my pf and had to go urgently about every two hours, but had to massage, stretch and put on my sneakers all nine months!

About your article in American Running and Fitness Assn., there is a prodecure that restores blood flow and the oxygen level to your feet, it's called ESWT, read the info in the home page if you haven't yet.

And most of all, don't be so hard on yourself about the weight gain!! Most of us have been there. There is an interesting thread for you from a couple days ago where we talked about weight gain not being the cause of pf. So don't beat yourself up!

I'm sure we'll 'talk' again, gotta run. Ask more questions on other boards the treatment/symptoms boards are good and ask any social type questions ont the social board. The conversations are not archived in the social section so that helps Scott, our webmaster, keep his archives clear of social stuff.

Best wishes and I hope you can sleep in this morning!

Re: clarifications & questions, please

Laurie R on 5/30/01 at 12:20 (049352)

Hi Mary , Welcome to the board...... Yes just like Cynthia said this is very serious.You are already doing the right thing by reading everything you can.. This is a wonderful site and you will find very compassionate people here that really understand..... I'm not a doctor so I won't answer any of your questions. I just wanted to welcome you.....Laurie R

Re: still have questions

Mary De on 6/03/01 at hrmin (049766)

Thanks, Cynthia and Laurie, for the welcome. I appreciate it. I can see the docs are busy on this board, but I'm still hoping for an answer to the most puzzling of my questions.

I've read in a couple places now (including linis not an inflamation problem, but a degenerative disease. What does this mean in terms of self-care? Should I not bother with anti-inflammatory meds/herbs? What else?

If anyone has any insight -- thank you!

--Mary De

Re: addendum

Mary De on 6/03/01 at hrmin (049768)

The email 'pad' is just a little screwy -- cuts off words. Hmmm. Sentence above should read: 'I've read in a couple places now (including linked articles on this site) that PF is not an inflammation problem, but a degenerative disease.' Hope that's a little clearer. (Regulars, any suggestions on using the email here? Or is it my machine?) Thanks!

--Mary De

Re: to Mary

Julie on 6/03/01 at 15:03 (049771)

Hello Mary

I saw your post yesterday: there was so much in it that I wanted to respond that I left it till today and I'm still not sure I have time to respond to everything. But here goes: just some tidbits from my own experience.

Yes, this site is amazing. And you seem to have swallowed it pretty well whole, so no wonder you're feeling a bit overwhelmed, and, yes, a lot of it is conflicting because different treatment strategies suit different people. But it's good that you're excited, too, and I'm really glad you feel as you do, that you want to get to grips with the situation and be active in your healing.

How long have you had PF? Yes, some people do suffer for years, but usually the ones that start dealing with it quickly do heal within a few months (I'm one of them, and I hope you are too).

Stretching. Good to do, yes, as long as you do the right things FOR YOU. Most people here have come to grief with the weight-bearing stretches, including the famous, oft-prescribed wall stretch. I would keep clear of these if I were you. Yes, stretch in bed before you get up, even when you have to pee. You don't have to stretch your heels towards the ceiling, you can stretch them out along the bed. Try curling and stretching your toes several times, then bending your feet backwards and forwards at the ankles, then circling them at the ankles. This should avoid or diminish the 'first steps' pain.

Taping - try it. Try the simplest two-strip technique first. It has worked well for me. It is a way of resting the fascia by replacing the support it is supposed to give the arch, but can no longer give because it has torn, and elongated. It should also relieve the pain.

Walking. You WILL be able to do your long walks again. But not right now. Walking through the pain is the worst thing you could do, so do get as much 'relative rest' as possible. If you're used to walking a lot, just giving that up will be 90% of the battle. Stay off your feet as much as you can for as long as it takes, and be hopeful for the future. (See my 'story' on the 'success stories' board: I was exactly like you, loving long walks but having to give them up. It took just five months, not really so long, for me to be able to return to walking about as much as before.)

Barefoot. NO. Really. No.

Birkenstocks are NOT ugly. I object! The basic sandals are - I think - a nice shape. I love mine. When you've been fitted properly and know your size and the styles you like, you can order them on line from http://www.birkenstock-cn.de for half the price you would pay in the States. But get fitted first, in a specialist store where they know what they're doing.

Inflammation. I can't comment on the article you read: I don't know. But whatever PF is, inflammation, which is a symptom, accompanies it, so NSAIDs can help. In the beginning I tried to steer clear of them because of their pain-killing attributes: I felt it was important not to mask the symptoms, but to be aware of when I was hurting. So I took them only very occasionally. And now I don't need them. But others swear by them. ('itis' refers to inflammation, 'osis' to degeneration - viz: arthritis/arthrosis - the latter a more correct term for osteoarthritis, which is a degenerative disease).

I used ice a lot (a gel pack) when I was at my worst, in the first few months. It does help to reduce inflammation. Dr Zuckerman here recommends cold and hot, as you did for your hands. Try it and see.

No, don't feel guilty about the weight: that just makes you reach for more chocolate. If you are really worried about it, try Weight Watchers. It's a very helpful programme: just having to be write down all you eat, and attending the weekly weigh-in, was useful and supportive for me. But weight may not be a crucial factor in acquiring PF or making it worse: views on this differ. And 25 pounds isn't much. Relax about that, and you'll find it easier to go slow on the chocolate.

Yoga. I've practised yoga for 31 years and have taught it for 14. It will help you in more ways than just the physical. Avoid standing postures, especially one-leg balances. Do lots of floor work and seated work. And plenty of relaxation.

I hope these sketchy comments help. Keep in touch: this is a good place to be.

All the best, Julie

Re: to Mary - wrong link

Julie on 6/03/01 at 15:12 (049774)

I was relying on a faulty memory. The correct link for the German Birkenstock site is

http://www.birkenstock-cn.com

Re: still have questions

Dr. Zuckerman on 6/03/01 at 19:58 (049795)

Yes it can be a degenerative disease this depends on the stage of this vey painful condition. In the beginning is is an inflamatory condition . Down the road it is degenerative which means that the fibers aren't healing. This is what ESWT does created an inflamatory reaction to restart the healing process. again

Does this answer your question.

Re: still have questions

Mary De on 6/04/01 at hrmin (049924)

Thank you, Dr. Zuckerman!!

--Mary D

Re: to Mary

Mary De on 6/04/01 at hrmin (049929)

Thank you, Julie, for your detailed answer. I appreciate your help. I've already started some new things (morning foot stretches) that've helped a bit. Patience will be the hardest part! When I have time, I've been checking into the site via searches. My search on 'yoga' brought up some interesting stuff -- is Alan K still onboard? Yesterday I did my first session of yoga without standing. Felt strange, but a: how can I stretch THAT when I can't do THIS ... My deepest gratitude to everyone who's put this site & BBS together and keeps it running. I can see it's quite a job, all the newbies asking the same questions, shocked that they're in pain. But you are all doing a great service to humanity -- that sounds kinda pompous, but it's really true. I won't be able to check in that often and be a 'regular,' but will surely pop in now and then.

PS -- figured out the email problem -- I can't just add/correct things, like a word processing program. I have to delete up to the error and retype. Aha.

best, Mary

Re: clarifications & questions, please

Cynthia D on 5/30/01 at 06:17 (049315)

Hi Mary, first of all, welcome to heelspurs.com from another pf sufferer. Wow you did stumble into the right place! And so late at night, too.

It looks like you got a lot of good info, so I'll answer a few questions, and let others pick this up, too, I gotta run get the kiddos to school.

The hardest part about discovering this site and realizing how serious foot pain can be is accepting that you are going to have to make some changes and make a committment yourself to help yourself heal.

I'm no doctor, but no walks for now until you try different things and see what works best for you. I'm sure you know to always wear your orthotics 'cause they support your arch. When you can't wear them, wear Birkenstocks if you can (they are too hard for me) to support your arch. The orthotics will not work in them, they have their own arch support. They also make Birkies, a type that can get wet so we use these for shower/pool support. Never go barefoot. I know about the late at night dash for the bathroom!! I had a baby through my pf and had to go urgently about every two hours, but had to massage, stretch and put on my sneakers all nine months!

About your article in American Running and Fitness Assn., there is a prodecure that restores blood flow and the oxygen level to your feet, it's called ESWT, read the info in the home page if you haven't yet.

And most of all, don't be so hard on yourself about the weight gain!! Most of us have been there. There is an interesting thread for you from a couple days ago where we talked about weight gain not being the cause of pf. So don't beat yourself up!

I'm sure we'll 'talk' again, gotta run. Ask more questions on other boards the treatment/symptoms boards are good and ask any social type questions ont the social board. The conversations are not archived in the social section so that helps Scott, our webmaster, keep his archives clear of social stuff.

Best wishes and I hope you can sleep in this morning!

Re: clarifications & questions, please

Laurie R on 5/30/01 at 12:20 (049352)

Hi Mary , Welcome to the board...... Yes just like Cynthia said this is very serious.You are already doing the right thing by reading everything you can.. This is a wonderful site and you will find very compassionate people here that really understand..... I'm not a doctor so I won't answer any of your questions. I just wanted to welcome you.....Laurie R

Re: still have questions

Mary De on 6/03/01 at hrmin (049766)

Thanks, Cynthia and Laurie, for the welcome. I appreciate it. I can see the docs are busy on this board, but I'm still hoping for an answer to the most puzzling of my questions.

I've read in a couple places now (including linis not an inflamation problem, but a degenerative disease. What does this mean in terms of self-care? Should I not bother with anti-inflammatory meds/herbs? What else?

If anyone has any insight -- thank you!

--Mary De

Re: addendum

Mary De on 6/03/01 at hrmin (049768)

The email 'pad' is just a little screwy -- cuts off words. Hmmm. Sentence above should read: 'I've read in a couple places now (including linked articles on this site) that PF is not an inflammation problem, but a degenerative disease.' Hope that's a little clearer. (Regulars, any suggestions on using the email here? Or is it my machine?) Thanks!

--Mary De

Re: to Mary

Julie on 6/03/01 at 15:03 (049771)

Hello Mary

I saw your post yesterday: there was so much in it that I wanted to respond that I left it till today and I'm still not sure I have time to respond to everything. But here goes: just some tidbits from my own experience.

Yes, this site is amazing. And you seem to have swallowed it pretty well whole, so no wonder you're feeling a bit overwhelmed, and, yes, a lot of it is conflicting because different treatment strategies suit different people. But it's good that you're excited, too, and I'm really glad you feel as you do, that you want to get to grips with the situation and be active in your healing.

How long have you had PF? Yes, some people do suffer for years, but usually the ones that start dealing with it quickly do heal within a few months (I'm one of them, and I hope you are too).

Stretching. Good to do, yes, as long as you do the right things FOR YOU. Most people here have come to grief with the weight-bearing stretches, including the famous, oft-prescribed wall stretch. I would keep clear of these if I were you. Yes, stretch in bed before you get up, even when you have to pee. You don't have to stretch your heels towards the ceiling, you can stretch them out along the bed. Try curling and stretching your toes several times, then bending your feet backwards and forwards at the ankles, then circling them at the ankles. This should avoid or diminish the 'first steps' pain.

Taping - try it. Try the simplest two-strip technique first. It has worked well for me. It is a way of resting the fascia by replacing the support it is supposed to give the arch, but can no longer give because it has torn, and elongated. It should also relieve the pain.

Walking. You WILL be able to do your long walks again. But not right now. Walking through the pain is the worst thing you could do, so do get as much 'relative rest' as possible. If you're used to walking a lot, just giving that up will be 90% of the battle. Stay off your feet as much as you can for as long as it takes, and be hopeful for the future. (See my 'story' on the 'success stories' board: I was exactly like you, loving long walks but having to give them up. It took just five months, not really so long, for me to be able to return to walking about as much as before.)

Barefoot. NO. Really. No.

Birkenstocks are NOT ugly. I object! The basic sandals are - I think - a nice shape. I love mine. When you've been fitted properly and know your size and the styles you like, you can order them on line from http://www.birkenstock-cn.de for half the price you would pay in the States. But get fitted first, in a specialist store where they know what they're doing.

Inflammation. I can't comment on the article you read: I don't know. But whatever PF is, inflammation, which is a symptom, accompanies it, so NSAIDs can help. In the beginning I tried to steer clear of them because of their pain-killing attributes: I felt it was important not to mask the symptoms, but to be aware of when I was hurting. So I took them only very occasionally. And now I don't need them. But others swear by them. ('itis' refers to inflammation, 'osis' to degeneration - viz: arthritis/arthrosis - the latter a more correct term for osteoarthritis, which is a degenerative disease).

I used ice a lot (a gel pack) when I was at my worst, in the first few months. It does help to reduce inflammation. Dr Zuckerman here recommends cold and hot, as you did for your hands. Try it and see.

No, don't feel guilty about the weight: that just makes you reach for more chocolate. If you are really worried about it, try Weight Watchers. It's a very helpful programme: just having to be write down all you eat, and attending the weekly weigh-in, was useful and supportive for me. But weight may not be a crucial factor in acquiring PF or making it worse: views on this differ. And 25 pounds isn't much. Relax about that, and you'll find it easier to go slow on the chocolate.

Yoga. I've practised yoga for 31 years and have taught it for 14. It will help you in more ways than just the physical. Avoid standing postures, especially one-leg balances. Do lots of floor work and seated work. And plenty of relaxation.

I hope these sketchy comments help. Keep in touch: this is a good place to be.

All the best, Julie

Re: to Mary - wrong link

Julie on 6/03/01 at 15:12 (049774)

I was relying on a faulty memory. The correct link for the German Birkenstock site is

http://www.birkenstock-cn.com

Re: still have questions

Dr. Zuckerman on 6/03/01 at 19:58 (049795)

Yes it can be a degenerative disease this depends on the stage of this vey painful condition. In the beginning is is an inflamatory condition . Down the road it is degenerative which means that the fibers aren't healing. This is what ESWT does created an inflamatory reaction to restart the healing process. again

Does this answer your question.

Re: still have questions

Mary De on 6/04/01 at hrmin (049924)

Thank you, Dr. Zuckerman!!

--Mary D

Re: to Mary

Mary De on 6/04/01 at hrmin (049929)

Thank you, Julie, for your detailed answer. I appreciate your help. I've already started some new things (morning foot stretches) that've helped a bit. Patience will be the hardest part! When I have time, I've been checking into the site via searches. My search on 'yoga' brought up some interesting stuff -- is Alan K still onboard? Yesterday I did my first session of yoga without standing. Felt strange, but a: how can I stretch THAT when I can't do THIS ... My deepest gratitude to everyone who's put this site & BBS together and keeps it running. I can see it's quite a job, all the newbies asking the same questions, shocked that they're in pain. But you are all doing a great service to humanity -- that sounds kinda pompous, but it's really true. I won't be able to check in that often and be a 'regular,' but will surely pop in now and then.

PS -- figured out the email problem -- I can't just add/correct things, like a word processing program. I have to delete up to the error and retype. Aha.

best, Mary