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Appreciate any advice

Posted by Lisa C on 8/07/01 at 00:54 (055725)

Dissappointed in visit w/new pod. He did do x-rays which showed 2 enormus heel spurs. He said I have heel pain in 3 different areas on both heels. Said I have PF, heelspurs, neuritis of calcaneal nerve &(?) something else. He pressed way too hard all over my heels and said does this hurt? My first scream didn't stop him. I felt it was hard way beyond what was necessary to find out where the pain was. I was surprized at how much it hurt (and lingered) as I felt I was doing so well. I am still 80% improved from where I started, but I know I could relapse. Tried Vioxx and I cannot take them or Advil, Aleve anymore due to severe side effects... I can take aspirin, & I ice. What else to do for immflammation? My heels hurt when squeezed on the sides. What are the chances that I could have a stress fracture? What would the treatment be if I do? Dr. ok'd PT w/ cort cream & ultrasound. Told me to tell the pt what I want & have them call him & he will ok anything. How many times should I have this done? WHat else should I ask for? I made an appointment with another pod. Is there any point? Should I ask for a bone scan or mri? I'm doing all the right things that I read here. What else can I do? Am I missing something obvious? Thank you for your time.

Re: Appreciate any advice

Dr. Zuckerman on 8/07/01 at 08:21 (055741)

What is your typical daily routine like

Re: Appreciate any advice

Lisa C on 8/07/01 at 12:30 (055782)

I stretch in bed before I slip into my Mephistos. I take 2 bromlain on empty stomach & wait an hour before eating. I shower with arch support shower shoes. I wear Brooks with superfeet inserts or Mephisto's to go out. I take aspirin (was advil) midday. Once a week I go to the waterpark (w/proper shoes) or theme park with kids(season passes) once a week I pick up donations for foster kids/families it involves some walking & carring/lifting. I daily go to our business or the market or the park. Ususal cooking/cleaning/laundry at home stuff. I'm currently sanding & painting window frames... I ice each evening, sit with feet up & use Jade before bed. I keep fairly busy but I am not working 8 hours straight on my feet. I am careful about squatting... and I sit and rest my feet throughout the day. Any ideas?

Re: Appreciate any advice Re: Physical Therapy How Often & For How Long?

Lisa C on 8/08/01 at 00:35 (055876)

I do not have any idea 'how much' PT is 'normal'. I have been to PT once a week for 8 weeks. I have read posts of people going to PT 3 & 4 times a week for months! I guess I would like to go with the minimum due to the inconveinence and the cost. Minimum visits with maximum effect would be perfect! Should I do cort cream & ultrasound everytime? Is there good success with a tens unit? Something more effective then heat massage & ice?Any suggestions are greatly appreciated!

Re: Appreciate any advice Re: Physical Therapy How Often & For How Long?

Ed Davis, DPM on 8/09/01 at hrmin (056090)

Physical therapy modalities, in order to be effective, must be done with regularity. Starting with 3 times a week for the first 2 to 3 weeks, then reducing the frequency of visits as symptoms subside. There is not a whole lot of good that can be done with PT going only once a week unless the visits are primarily instructional in nature.

A good therapist monitors the effects of treatment, regularly making adjustments in the treatments based on the patient's response. Individuals who go for many months are often individuals who are being rehabilitated after stroke or reconstructive surgery. There are good and not so good practitioners out there as with all professions--some 'mills' that keep people coming back for long periods of time without significant results.
Ideally, the doctor who prescribes the PT should be monitoring the results and making adjustments in the treatment plan---my desk is stacked high with PT treatment plans which I must read, make recommendations and sign off on.
Ed

Re: ATTN **Dr. Davis** Re: Physical Therapy How Often & For How Long?

Lisa C on 8/11/01 at 14:28 (056336)

Thank you for your time and reply. I hate making decisions, especially those I am not qualified to make. My pod told me to ask for whatever I wanted re:PT and he would OK it. I will start with 3x a week for 2 weeks and see where I am at. The ortho orig ordered 2x a week for 4 weeks. It was the PT office that suggested 1x a week for 8 weeks to stretch it out. This makes me inclined NOT to ask for their advice about PT now that I have your wisdom on the subject. I hate to think that I wasted all those visits! Thank you again. I'm certainly open to suggestion re: WHAT to have done during PT and if I should do 'it' each time...

Re: Physical Therapy How Often & For How Long?

Glenn X on 8/11/01 at hrmin (056352)

Lisa: I've tried the PT route some, and while I can't speak to your particular needs, let me share with you what I think helps some.

MEASURE your flexibility, most simply defined as the angle formed by your foot and leg when you stretch your toes toward your face as far as you can. Ideally your foot can move past a right angle to something like 15 more degrees, making the angle between leg and foot 75 degrees. Getting this measured by your PT can help determine a plan.

If you find you are inflexible, treatment designed to increase this range of motion can be beneficial.

MASSAGING your calves, and then applying heat pads to them for some 10 minutes, prior to stretching them, could be beneficial.

POKING at the soles of your feet may help. My feet were also sore. Some poking by the therapist, without aggressive digging in to my heel/fascia connection, helped relieve this. Took a couple of weeks for this to start helping.

ULTRASOUND the length of your fascia, followed by 'lengthening' massaging of the fascia may help. This should be agreed to by both your doctor and therapist.

I'm seeing a particularly good therapist next Wednesday for a thorough treatment and will take notes. In the meantime, here's one last thought on a full treatment, say one leg/foot at a time:

1) Massage calf muscles lying face down on table
2) Lay warm compress on calf (helps stretching to come)
3) Ultrasound fascia (under doctor's direction)
4) Massage bottom of foot
5) Stretch fascia with mild 'lengthening' massage
6) Stretch calf muscles, which are now nicely warmed

I'd be most interested in what particular PT treatments others have benefitted from. I'll also share more after my appointment next week.

Re: Physical Therapy How Often & For How Long? ATTN: GLENN X

Lisa C on 8/15/01 at 00:36 (056767)

Thank you for this plan Glenn X! I did increase my flexibility (to dorsiflex) by 3 degrees in my right foot, though less in the left. In all my prior PT I have had most of these things done. I think the problem is they were not done on a regular basis. I had my calves massaged once out of 8 PT visits. It does seem like a good idea to have the same thing done each time to be able to make progress with it. Thank you again and please do keep me posted on your PT visits. I really appreciate the ability we have on this board to share all of our experiences and information.

Re: Physical Therapy How Often & For How Long? ATTN: GLENN X

Glenn X on 8/15/01 at hrmin (056828)

Lisa: Good for you. Three degrees is good progress. When you say you increased by three, do you know where you started and where you are now? Have you been given a target angle to work towards re this?

When I was first measured in February I was plus 14 degrees in my right and plus 12 degrees in my left (foot pointed too much). A couple of weeks ago I was zero degrees in right and minus 2 degrees in left (meaning I'd improved 14 degrees, but it took six months, and wasn't nearly enough). I need about 10 more degrees, preferably 15, which may take 2 or 3 more months of painstaking work. I'm told minus 15 degrees (foot bent more than a right angle toward face) is a good place to be.

Re: Physical Therapy How Often & For How Long? ATTN: GLENN X

Lisa C on 8/16/01 at 04:01 (056874)

I really do not know the starting point. (Could find out though) The PT seemed pleased, she knew I was doing my stretching at home. If you improved 14 degrees, 3 sounds pretty puny! I called to set up PT and they were a bit confused about me selecting the PT and them calling the Dr. to okay it. I decided to wait until the 30th when I go to a new Dr. and see what he recommends. Don't laugh but this Dr. is on KGO radio regularly doing a weekend talk show with another well known (fitness) personality Joanie Greggins. He seems up to date on the latest and I don't know how I can do any worse. Not famous last words I hope!

Re: Physical Therapy How Often & For How Long? ATTN: GLENN X

Glenn X on 8/16/01 at hrmin (056898)

Lisa. My doctor, Ed Davis, recommended my current PT, Eddie Brewer, and he's great. He's also 160 miles distant, so I only see him every 10 days. I see local PT I found on my own. If your doc feels strongly about a PT he or she recommends, I'd give them a try. Otherwise, seeing someone you have trust in is really important.

Three degrees is good. Give yourself credit. I did 14, but it took six months.

I would definitely ask your doctor to assess your flexibility to get a better picture of that. PT should measure it to get more precise, and re-measure every few weeks. Helpful for you to write down the measures . . . for both feet.

I'd think being on KGO is a strong recommendation. Bay area right? I've listened to it up here in Portland before. Probably has him motivated to excel. Last thing he wants is an unhappy patient calling his talk line, reading him the riot act over the radio.

Re: Appreciate any advice

Dr. Zuckerman on 8/07/01 at 08:21 (055741)

What is your typical daily routine like

Re: Appreciate any advice

Lisa C on 8/07/01 at 12:30 (055782)

I stretch in bed before I slip into my Mephistos. I take 2 bromlain on empty stomach & wait an hour before eating. I shower with arch support shower shoes. I wear Brooks with superfeet inserts or Mephisto's to go out. I take aspirin (was advil) midday. Once a week I go to the waterpark (w/proper shoes) or theme park with kids(season passes) once a week I pick up donations for foster kids/families it involves some walking & carring/lifting. I daily go to our business or the market or the park. Ususal cooking/cleaning/laundry at home stuff. I'm currently sanding & painting window frames... I ice each evening, sit with feet up & use Jade before bed. I keep fairly busy but I am not working 8 hours straight on my feet. I am careful about squatting... and I sit and rest my feet throughout the day. Any ideas?

Re: Appreciate any advice Re: Physical Therapy How Often & For How Long?

Lisa C on 8/08/01 at 00:35 (055876)

I do not have any idea 'how much' PT is 'normal'. I have been to PT once a week for 8 weeks. I have read posts of people going to PT 3 & 4 times a week for months! I guess I would like to go with the minimum due to the inconveinence and the cost. Minimum visits with maximum effect would be perfect! Should I do cort cream & ultrasound everytime? Is there good success with a tens unit? Something more effective then heat massage & ice?Any suggestions are greatly appreciated!

Re: Appreciate any advice Re: Physical Therapy How Often & For How Long?

Ed Davis, DPM on 8/09/01 at hrmin (056090)

Physical therapy modalities, in order to be effective, must be done with regularity. Starting with 3 times a week for the first 2 to 3 weeks, then reducing the frequency of visits as symptoms subside. There is not a whole lot of good that can be done with PT going only once a week unless the visits are primarily instructional in nature.

A good therapist monitors the effects of treatment, regularly making adjustments in the treatments based on the patient's response. Individuals who go for many months are often individuals who are being rehabilitated after stroke or reconstructive surgery. There are good and not so good practitioners out there as with all professions--some 'mills' that keep people coming back for long periods of time without significant results.
Ideally, the doctor who prescribes the PT should be monitoring the results and making adjustments in the treatment plan---my desk is stacked high with PT treatment plans which I must read, make recommendations and sign off on.
Ed

Re: ATTN **Dr. Davis** Re: Physical Therapy How Often & For How Long?

Lisa C on 8/11/01 at 14:28 (056336)

Thank you for your time and reply. I hate making decisions, especially those I am not qualified to make. My pod told me to ask for whatever I wanted re:PT and he would OK it. I will start with 3x a week for 2 weeks and see where I am at. The ortho orig ordered 2x a week for 4 weeks. It was the PT office that suggested 1x a week for 8 weeks to stretch it out. This makes me inclined NOT to ask for their advice about PT now that I have your wisdom on the subject. I hate to think that I wasted all those visits! Thank you again. I'm certainly open to suggestion re: WHAT to have done during PT and if I should do 'it' each time...

Re: Physical Therapy How Often & For How Long?

Glenn X on 8/11/01 at hrmin (056352)

Lisa: I've tried the PT route some, and while I can't speak to your particular needs, let me share with you what I think helps some.

MEASURE your flexibility, most simply defined as the angle formed by your foot and leg when you stretch your toes toward your face as far as you can. Ideally your foot can move past a right angle to something like 15 more degrees, making the angle between leg and foot 75 degrees. Getting this measured by your PT can help determine a plan.

If you find you are inflexible, treatment designed to increase this range of motion can be beneficial.

MASSAGING your calves, and then applying heat pads to them for some 10 minutes, prior to stretching them, could be beneficial.

POKING at the soles of your feet may help. My feet were also sore. Some poking by the therapist, without aggressive digging in to my heel/fascia connection, helped relieve this. Took a couple of weeks for this to start helping.

ULTRASOUND the length of your fascia, followed by 'lengthening' massaging of the fascia may help. This should be agreed to by both your doctor and therapist.

I'm seeing a particularly good therapist next Wednesday for a thorough treatment and will take notes. In the meantime, here's one last thought on a full treatment, say one leg/foot at a time:

1) Massage calf muscles lying face down on table
2) Lay warm compress on calf (helps stretching to come)
3) Ultrasound fascia (under doctor's direction)
4) Massage bottom of foot
5) Stretch fascia with mild 'lengthening' massage
6) Stretch calf muscles, which are now nicely warmed

I'd be most interested in what particular PT treatments others have benefitted from. I'll also share more after my appointment next week.

Re: Physical Therapy How Often & For How Long? ATTN: GLENN X

Lisa C on 8/15/01 at 00:36 (056767)

Thank you for this plan Glenn X! I did increase my flexibility (to dorsiflex) by 3 degrees in my right foot, though less in the left. In all my prior PT I have had most of these things done. I think the problem is they were not done on a regular basis. I had my calves massaged once out of 8 PT visits. It does seem like a good idea to have the same thing done each time to be able to make progress with it. Thank you again and please do keep me posted on your PT visits. I really appreciate the ability we have on this board to share all of our experiences and information.

Re: Physical Therapy How Often & For How Long? ATTN: GLENN X

Glenn X on 8/15/01 at hrmin (056828)

Lisa: Good for you. Three degrees is good progress. When you say you increased by three, do you know where you started and where you are now? Have you been given a target angle to work towards re this?

When I was first measured in February I was plus 14 degrees in my right and plus 12 degrees in my left (foot pointed too much). A couple of weeks ago I was zero degrees in right and minus 2 degrees in left (meaning I'd improved 14 degrees, but it took six months, and wasn't nearly enough). I need about 10 more degrees, preferably 15, which may take 2 or 3 more months of painstaking work. I'm told minus 15 degrees (foot bent more than a right angle toward face) is a good place to be.

Re: Physical Therapy How Often & For How Long? ATTN: GLENN X

Lisa C on 8/16/01 at 04:01 (056874)

I really do not know the starting point. (Could find out though) The PT seemed pleased, she knew I was doing my stretching at home. If you improved 14 degrees, 3 sounds pretty puny! I called to set up PT and they were a bit confused about me selecting the PT and them calling the Dr. to okay it. I decided to wait until the 30th when I go to a new Dr. and see what he recommends. Don't laugh but this Dr. is on KGO radio regularly doing a weekend talk show with another well known (fitness) personality Joanie Greggins. He seems up to date on the latest and I don't know how I can do any worse. Not famous last words I hope!

Re: Physical Therapy How Often & For How Long? ATTN: GLENN X

Glenn X on 8/16/01 at hrmin (056898)

Lisa. My doctor, Ed Davis, recommended my current PT, Eddie Brewer, and he's great. He's also 160 miles distant, so I only see him every 10 days. I see local PT I found on my own. If your doc feels strongly about a PT he or she recommends, I'd give them a try. Otherwise, seeing someone you have trust in is really important.

Three degrees is good. Give yourself credit. I did 14, but it took six months.

I would definitely ask your doctor to assess your flexibility to get a better picture of that. PT should measure it to get more precise, and re-measure every few weeks. Helpful for you to write down the measures . . . for both feet.

I'd think being on KGO is a strong recommendation. Bay area right? I've listened to it up here in Portland before. Probably has him motivated to excel. Last thing he wants is an unhappy patient calling his talk line, reading him the riot act over the radio.