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Does physical therapy work on PF and arch pain?

Posted by Kathy on 6/23/01 at 09:12 (051333)

I already posted a message earlier this week but now, after reading so many of the other postings, I'd like to ask your collective opinion. My problems started 5 years ago with severe pain on the sole of my foot below my toes. Went to the podiotrist- seemed like a neuroma, but not classic. (in the wrong place - not responsive enough to cortisone shots - pain in other parts of my feet as well). He gave me blue inserts, restricted me to running shoes, and eventually I ended up getting cortisone shots every 4 or 5 months, for a while. He wouldn't give them to me after a period of time (I should have kept a diary - can't remember what happened when!) because of danger of weakening the joint, damaging the tissue, etc. I also used ice, massage (bless my husband!) and anti-inflammatories. The pain was liveable for a few years then began to worsen. I got a pair of custom-made Birks - they were comfortable but caused lower back pain. (I have back problems, too.) He had the heels raised by 3/8' and they are currently having another 3/8' raise put in them, since the negative heel is probably causing the back pain.

Eventually, last October, I got a pair of orthotics (from the doctor). The pain in the upper foot - toe area disappeared! However, pain and terrible burning in my arches began. Then I developed what I called 'muscle spasms' in my calves. I can't stand for any period of time without pain - I can't walk for any period of time without pain. When I sit, it takes a while (sometimes all night) for the burning in the arches to dissipate. The doctor diagnosed it as PF and I am started physical therapy 2 1/2 weeks ago. They are doing massage, ultra sound, whirlpool and exercises to strengthen my feet and ankles. They showed me stretching exercises for my calves and the pain is much less since I've started them. So far, they have made the pain in my arches and feet worse. In fact, I am developing pains in my feet where I never had them! However, I believe that's because the muscles are indeed weak and I may experience pain while I strengthen them. But when they massaged, they made the pain under my toes reappear. I called the doctor and he called them and said to stop touching that area since they wouldn't listen to me! The PT told me that I will have to continue to come for 8 more weeks so that will be a total of 10 weeks of PT. They are nice but treat me kind of like I'm a wimp or neurotic since I'm not responding the way they think I should. We all say it, but honest to god, I have a high pain threshold and I'm not a wimp and I really want to get my life back!!! I'm not looking for no-pain just liveable pain. Since I have absolutely no heel pain and my pain is hardly present when I get up in the morning, I guess I don't have classic PF. X-rays show no arthritis and a screen showed no rheumitoid arthritis.

After all this rambling, I guess my main question is - does physical therapy help? I have an appointment on July 9 with the doctor and I have great faith and respect for him and will be greatly guided by his advice, but I just wonder what others have found.

Once again, I thank you for a wonderful place to get advice and vent my frustrations! Knowing I'm not alone is so comforting.

Re: Does physical therapy work on PF and arch pain?

bg cped on 6/23/01 at 09:31 (051336)

Sometimes too much pt can aggravate the heck out of it. You said it does not hurt upon rising but after you have been on them all day. You should have your orthotics checked, possible lower the arch, sounds like they are too high or lack rearfoot control. If you have a high arch or cavus foot it would be worse. I would try wearing a good running shoe or cross trainer without the orthotics for a few days, if you get some relief during the day the orthotics are prob causing it, plus it sounds like pt is beating the heck out of your feet. Tight heel cords can cause many foot problems, but cranking on the fascia like that can really irritate it

Re: Does physical therapy work on PF and arch pain?

Helene M on 6/23/01 at 10:26 (051343)

Kathy,
I also have long-term, 'atypical' PF (arch pain, no heel pain) as well as neromas, also not in the classic spot; and also unresponsive to cortisone.
Although physical therapy has helped many of the people on this board, it just inflamed my arches even more. If you still want to give PT a try, I would suggest you try a new therapist. In the midst of your pain, you certainly don't need someone implying that you are a wimp. Just let them have PF for one week and see how 'wimpy' they will become. I have also found that all the orthotics I've had in the past caused my high arches to burn and swell. I agree you should try wearing a good shoe without the orthotics for a while, as bg suggests; and see if your symptoms improve. Gentle stretching is important but stretching too hard just caused more foot pain for me, and set me back quite a bit. It's all trial and error to find out how much stretching actually helps and how much is too much. As far as the neuromas pain, I understand that the latest treatment is not cortisone, but sclerosing the nerve with 4% alcohol injections.I may look into that in the future.

Having tried almost every conservative method for this, I am currently having Active Release Technique and I am hopeful that this may be the remedy (I hesitate to say 'cure') for my chronic PF. My arches and calves already do feel much softer and more flexible. The chiropractor performing the ART feels he can eliminate my neuroma pain, too, but that remains to be seen.

I hope I've helped you in some way.

Re: Does physical therapy work on PF and arch pain?

Steve P on 6/23/01 at 10:30 (051344)

Kathy --- I can relate to much of what you say.

If you click on 'Our Surveys' at the top of this page, you'll get a lot of info on what treatments people think did/did not help, etc. Many posters have said that PT was of some help, but I think most would say it was only part of an overall treatment program......i.e., no silver bullet!

I did feel that PT helped me somewhat, but I didn't extend beyond the original period because I also felt that my home program was more important at that time.

best...........Steve

Re: Does physical therapy work on PF and arch pain?

Nancy N on 6/23/01 at 13:53 (051356)

Kathy--

Your PT experience sounds like mine. I went in the first night, and they did the whirlpool, marbles, towel scrunches, showed me some stretches, and then did some massage. I thought it was going to be pretty quick (per visit) and easy. But the next time, it was a totally different ballgame. They had me doing total gym, biking, hip patterns with weights, and the massage hurt like hell. As I progressed, they also added stair stepping with weights and had me doing the calf raises with weights. I would feel worse going out than I did coming in, but I figured that PT was not supposed to feel good, so I didn't worry about it until about the third month, when I realized I wasn't getting any better (and they had of course realized this, too). I did everything they asked without question (probably the mistake, right there) and didn't even call my doc to see if this was a good program for me or not--the idea never occurred to me. It wasn't until I read about some others' PT experiences here that I realized that the PT program probably really was keeping me from healing, if not actually making it worse.

So, my advice to you would be to go over everything in the PT with your doctor and make sure that it sounds OK to him. TELL SOMEONE if you hurt, and if they therapist says that it's OK to hurt while doing something, get in touch with your doc about it to be sure. (They had me doing wall stretches and using the Pro Stretch, which I could feel pulling on the problem spot, and they said that was OK. I didn't start to feel better until long after my PT, when I stopped doing weight-bearing stretches, so do beware of those).

That's my long-winded response! Let us know if you need more details/suggestions.

Re: Does physical therapy work on PF and arch pain?

Beverly on 6/24/01 at 13:28 (051418)

I've had both good and bad PT experiences. They have been both the best and worst part of my PF treatment. As others have said, PT's tend to push too hard too fast. I learned the hard way to speak up when something was too much for me and to speak up right away. I've dumped PT's who implied that I was wimpy or just did not seem supportive. There is a PT clinic on almost every corner... no reason to put up with someone who is not helping. I did best with gentle nonweightbearing stretches and increasing the reps at a very slow pace. I also like the massage. Can't handle weightbearing stretches.
At the present, I am not in PT. I get more from a total body massage. I still do some of the stretches I learned in PT. (Some proved to be too much for me.) I like the total body massage, because I tend to be tight all the way up to my neck. What the massage therapist relaxes in my butt sometimes helps my feet and ankles. My main complain about PT's besides the pace at which some push you is that the massage is so targeted to the injury site. I found I needed a massage that took in a broader amount of my body.
Best wishes,
Beverly

Re: Does physical therapy work on PF and arch pain?

Kathy on 6/25/01 at 07:58 (051455)

Thank you all for your responses which have been so helpful! I have an appointment with my doctor and he said he was going to re-evaluate the orthotics and have them re-engineered in hopes of alleviating some of the arch pain. My appointment is in two weeks and I guess I'll go to PT today, but I am going to be firm about what I can and can't do. If all else fails (and I don't mess up the insurance), I'll just suspend PT until I am able to see the doctor. He is, unfortunately for me, currently on vacation. Can't imagine the nerve of these doctors, thinking they can go on vacation!!!

Re: Does physical therapy work on PF and arch pain?

bg cped on 6/23/01 at 09:31 (051336)

Sometimes too much pt can aggravate the heck out of it. You said it does not hurt upon rising but after you have been on them all day. You should have your orthotics checked, possible lower the arch, sounds like they are too high or lack rearfoot control. If you have a high arch or cavus foot it would be worse. I would try wearing a good running shoe or cross trainer without the orthotics for a few days, if you get some relief during the day the orthotics are prob causing it, plus it sounds like pt is beating the heck out of your feet. Tight heel cords can cause many foot problems, but cranking on the fascia like that can really irritate it

Re: Does physical therapy work on PF and arch pain?

Helene M on 6/23/01 at 10:26 (051343)

Kathy,
I also have long-term, 'atypical' PF (arch pain, no heel pain) as well as neromas, also not in the classic spot; and also unresponsive to cortisone.
Although physical therapy has helped many of the people on this board, it just inflamed my arches even more. If you still want to give PT a try, I would suggest you try a new therapist. In the midst of your pain, you certainly don't need someone implying that you are a wimp. Just let them have PF for one week and see how 'wimpy' they will become. I have also found that all the orthotics I've had in the past caused my high arches to burn and swell. I agree you should try wearing a good shoe without the orthotics for a while, as bg suggests; and see if your symptoms improve. Gentle stretching is important but stretching too hard just caused more foot pain for me, and set me back quite a bit. It's all trial and error to find out how much stretching actually helps and how much is too much. As far as the neuromas pain, I understand that the latest treatment is not cortisone, but sclerosing the nerve with 4% alcohol injections.I may look into that in the future.

Having tried almost every conservative method for this, I am currently having Active Release Technique and I am hopeful that this may be the remedy (I hesitate to say 'cure') for my chronic PF. My arches and calves already do feel much softer and more flexible. The chiropractor performing the ART feels he can eliminate my neuroma pain, too, but that remains to be seen.

I hope I've helped you in some way.

Re: Does physical therapy work on PF and arch pain?

Steve P on 6/23/01 at 10:30 (051344)

Kathy --- I can relate to much of what you say.

If you click on 'Our Surveys' at the top of this page, you'll get a lot of info on what treatments people think did/did not help, etc. Many posters have said that PT was of some help, but I think most would say it was only part of an overall treatment program......i.e., no silver bullet!

I did feel that PT helped me somewhat, but I didn't extend beyond the original period because I also felt that my home program was more important at that time.

best...........Steve

Re: Does physical therapy work on PF and arch pain?

Nancy N on 6/23/01 at 13:53 (051356)

Kathy--

Your PT experience sounds like mine. I went in the first night, and they did the whirlpool, marbles, towel scrunches, showed me some stretches, and then did some massage. I thought it was going to be pretty quick (per visit) and easy. But the next time, it was a totally different ballgame. They had me doing total gym, biking, hip patterns with weights, and the massage hurt like hell. As I progressed, they also added stair stepping with weights and had me doing the calf raises with weights. I would feel worse going out than I did coming in, but I figured that PT was not supposed to feel good, so I didn't worry about it until about the third month, when I realized I wasn't getting any better (and they had of course realized this, too). I did everything they asked without question (probably the mistake, right there) and didn't even call my doc to see if this was a good program for me or not--the idea never occurred to me. It wasn't until I read about some others' PT experiences here that I realized that the PT program probably really was keeping me from healing, if not actually making it worse.

So, my advice to you would be to go over everything in the PT with your doctor and make sure that it sounds OK to him. TELL SOMEONE if you hurt, and if they therapist says that it's OK to hurt while doing something, get in touch with your doc about it to be sure. (They had me doing wall stretches and using the Pro Stretch, which I could feel pulling on the problem spot, and they said that was OK. I didn't start to feel better until long after my PT, when I stopped doing weight-bearing stretches, so do beware of those).

That's my long-winded response! Let us know if you need more details/suggestions.

Re: Does physical therapy work on PF and arch pain?

Beverly on 6/24/01 at 13:28 (051418)

I've had both good and bad PT experiences. They have been both the best and worst part of my PF treatment. As others have said, PT's tend to push too hard too fast. I learned the hard way to speak up when something was too much for me and to speak up right away. I've dumped PT's who implied that I was wimpy or just did not seem supportive. There is a PT clinic on almost every corner... no reason to put up with someone who is not helping. I did best with gentle nonweightbearing stretches and increasing the reps at a very slow pace. I also like the massage. Can't handle weightbearing stretches.
At the present, I am not in PT. I get more from a total body massage. I still do some of the stretches I learned in PT. (Some proved to be too much for me.) I like the total body massage, because I tend to be tight all the way up to my neck. What the massage therapist relaxes in my butt sometimes helps my feet and ankles. My main complain about PT's besides the pace at which some push you is that the massage is so targeted to the injury site. I found I needed a massage that took in a broader amount of my body.
Best wishes,
Beverly

Re: Does physical therapy work on PF and arch pain?

Kathy on 6/25/01 at 07:58 (051455)

Thank you all for your responses which have been so helpful! I have an appointment with my doctor and he said he was going to re-evaluate the orthotics and have them re-engineered in hopes of alleviating some of the arch pain. My appointment is in two weeks and I guess I'll go to PT today, but I am going to be firm about what I can and can't do. If all else fails (and I don't mess up the insurance), I'll just suspend PT until I am able to see the doctor. He is, unfortunately for me, currently on vacation. Can't imagine the nerve of these doctors, thinking they can go on vacation!!!