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reinjury - due to stretching

Posted by niels on 12/03/01 at 14:01 (065988)

Hi

After almmost 2 years in foot pain hell -trying everything but surgery and ESWT(not available in my country)- to cure my foot pain i finally expirienced significant improvement. For xample I was able go to a little shopping or cook a meal.

BUT now I am crippled again... I think its because of too heavy streching maybe combined with the increase in activity. I also get acupucture.

My symptoms are a sharp/cutting pain at the bottom and back of the heel and also pain at the heelspur place. My foot also feels warm there. Even the slightest streching or even just bending the ankle joint upwards causes this very sharp pain. Pain is also other places at my foot, even when just sitting on a chair.

I have now -unfortunately too late- stopped streching, started taking vioxx, icing once or twice a day, reduced time on my feet as much as possible. However, it doesnt seem to help.

What else can i do ? How will I know when to resume streching ?

How much and how often should i ice ? or should i ice at all ?

Could Acupuncture be the cause ?. I get lots of needles in my foot and calf muscles, and electricity is applied to some of the needles. Its really helped me a lot, i believe.

I have a very high arch and i wear orthotics, but i dont think the are perfect.

Please help me to get back on track.

Niels

Re: reinjury - due to stretching

Ed Davis, DPM on 12/05/01 at 15:52 (066232)

Weight bearing stretching is often too intense for many plantar fasciitis sufferers. A long slow gentle stretch works better than quicker, harder stretches. Individuals with high arches often have tight achilles tendons.

One of the advantages of the night splints is that they allow a stretch that is rarely harmful and usually beneficial. They maintain a light prolonged stretch on the fascia and achilles that gradually allows elongation of the achilles.

Also--read the Heel Pain Book here to go over the various modalities available---a lot of people who believe they have tried everything find more useful treatments.

What country do you live in? ESWT is generally more available in Europe than the US.
Ed

Re: reinjury - due to stretching

Carole C on 12/05/01 at 17:53 (066257)

Oh Niels, I am so sorry to hear this! I think it was you that described a stretching technique (gentle foot circles, gentle ups and downs, then more vigorous circles and ups and downs, then up and hold a bit a few times). That seemed to help me, but in the future I'll try to keep in mind that I must be careful not to overdo. I hope you feel less pain soon!!!

Carole

Re: it was not me

niels on 12/06/01 at 02:11 (066299)

Hi Carol and thanks for your concern.

No, it was not me who wrote that.

I did also read it,but i did not qite understand the explanation.

could yuo please expand on it. Do yuo lie down ? Do the feet have to do all the work by themselves or is it a weight bearing exercise ? Do you lie down with straight legs and then grab the toes to make a strech (thats what i have done with good results..until now) ?

Niels

Re: It was Nils, not Niels

Julie on 12/06/01 at 05:20 (066303)

Confusing, Carole: the names are rather similar! I registered Nils's post a couple of weeks ago because the exercises he briefly described were ones that I posted several times, months ago. I'll do it again.

These are simple yoga exercises for the feet. They're part of a series for all the joints called Pawanmuktasana. That means 'energy-releasing exercises', and they release energy by speeding the removal of toxins from the joints. They work systematically and precisely on the joints and on their associated muscles, tendons and ligaments. They can be done sitting on the floor with the legs outstretched (a difficult position to hold, especially for people with low back problems), or lying down, or sitting in a chair, or standing on alternate legs (a non-no for folks with PF). Sitting in a chair and lying down are best.

TOE BENDING AND STRETCHING

This one works the toe joints (all 28 of them) while holding a gentle stretch through the achilles tendons and calf muscles; and works the entire musculature of the feet.

Extend one heel forward and hold this gentle stretch while working on your toes.

Curl your toes forward, as if making fists of your feet. (Don't do this so enthusiastically that you give yourself a cramp.)

Then stretch the toes and spread them: make spaces between them.

Do this nine times, breathing out as you curl the toes, and breathing in as you stretch them.

Repeat with the other foot, then with both feet.

ANKLE BENDING

This one works on the ankle joints and on the achilles/soleus/ gastrocnemuis complex. It helps to increase ankle dorsiflexion, the essential thing for PF-ers who are generally tight in this area.

Bend the feet forwards at the ankles, and then bend them back, one at a time, then together.

Do each nine times on each foot, then both feet, breathing out as you bend forwards, in as you bend back.

ANKLE ROTATIONS

Circle the feet at the ankles, slowly and carefully, nine times in each direction, first one foot, then the other, then both. Breathe freely.

****

If you co-ordinate your movements with your breath it increases their effectiveness because it (a) slows you down and (b) makes you more aware of what you're doing.

I've practised and taught these exercises for many years. They are effective and powerful, and useful for people with PF because they're both non- weight-bearing and specific. And they're very energizing.

I do them in the morning before I get out of bed, and would recommend this to anyone with PF to help avoid the 'first step' pain.

They can be done as many times a day as you like: the more the better. Nils pointed out that he does them before getting up from his desk after sitting for awhile, and this is a very good idea.

Let me know how you get on with them if you decide to take them on board.

Re: It was Nils, not Niels

niels on 12/06/01 at 09:35 (066317)

Hi julie

Thanks a lot for the very instructive advice.

I will do the exercises as soon as i am able to it. Unfortunately, i cant do all of them now, due to my lousy condition. I cant do the toe exercise and ankle bending now without getting this sharp pain in the back and under my heel.

Niels

Re: That's right, Niels

Julie on 12/06/01 at 09:44 (066319)

That's right - don't do anything that hurts. Wait until it's better.

Have you seen your doctor? If your pain is so intense, you should, really.

You said that you didn't think your orthotics were perfect. Perhaps they should be looked at now by whoeever made them for you.

Re: reinjury - due to stretching

niels on 12/06/01 at 09:59 (066321)

Hi Ed

Thanks for the advice on night splints. I will try it.
Wich one do you recommend (available over the internet)? Is the N ice Strech good , though expensive ?

For how long at the time should i wear it. All night ?. Should i ice before/after or not ?Ice has never helped, i feel.

I have not even done weightbearing streching prior to my set back. It harmed me 1 year ago and i havent hardly done it since. My streching was done lying down with straight leg and then grabbing the foot/Toes, holding for a while. Can you suggest a more gentle or better way, to supplement the night splint ?

I have read the heel pain book several times, but i feel the streching there exercises are too violent for me, as they all seem to be weight bearing.

I should mention that i do not have any particular 'first step in the morniing pain'

I live in Denmark and none of the foot 'specialist' doctors i have consulted have even heard of eswt. They only know of cortisone shots, which I have tried several times with no relief but for maximum a week. I have tried to enlighten them by referring the this page, but the are completely uninterested. Quite depressing, isnt it.

Niels

Re: it was not me

Carole C on 12/06/01 at 17:47 (066361)

Oh! I am sorry that I got you mixed up with Nils.

The stretches that Nils described have been helpful for me. I do them when getting out of bed, or getting up after sitting for a long time. I simply rotate my feet in circles gently about seven times each way (maybe a different number for somebody else). Then I alternately point my toes out straight ahead, and point them up towards my head, but gently in each direction. Then I do the circles a little more vigorously, and the pointing. To finish off, I do the pointing again and hold for about a count of five, each time (two out and two up). Then another gentle circle and I'm ready to go.

I also do these in a less formal way, just the first gentle part, when I am lying down. This is nice in the morning, when I am lying there and thinking about getting up eventually. After a few lazy, gentle circles lying down, I sit on the edge of my bed and do the stretches as I described.

I don't do these with weights, and it is not done as a weight bearing exercise at all. In fact I think these stretches work better barefoot than with shoes on for me, because of the weight of the shoes.

And no, I have not grabbed my toes to stretch.

Carole

Re: Thank you, Julie!

Carole C on 12/06/01 at 17:50 (066362)

Julie, thank you once again. I think you are quite an expert in living with PF !!! No wonder everyone was so glad to see you back on the message board. :)

Carole

Re: Catherine

Julie on 12/07/01 at 02:11 (066382)

Thanks Catherine. No, I'm no expert. I just know what helped me - and I didn't have to live with PF that long, only six months or so. Everyone is different, and the important thing is to find a treatment plan that is right for you, and stick with it patiently: there are no quick fixes for PF. Good podiatric care is vital - a foot specialist who is skilled, knowledgeable and patient. I know that many people here have had disappointing experiences with podiatrists, but there are good ones out there, and it's worth searching for one who will really help.

Re: Niels - 'Pain-Gone'

Julie on 12/07/01 at 02:25 (066383)

Niels, you live in Denmark? I wonder if you've heard about a device called the 'Pain-Gone'pen. It was developed by doctors in Denmark, and works on the TNS principle (Transcutaneous Nerve Stimulation). It isn't a TENS unit, it's a small device that you hold in your hand (no leads, no batteries) and it delivers - I'm quoting from the information pack - 'a controlled electronic frequency to the point of pain. This stimulating frequency provides prolonged and often instant pain relief and will also help promote the body's healing process.'

I was sent an information pack, and ordered one out of curiosity - it comes with a 30-day money back guarantee. So far I've tried it out on a mild toothache (it worked) and on a small occasional pain I still have on the outside edge of my heel (it worked) and on my husband's severe low back flare-up (it didn't work - or at least hasn't worked yet).

You operate it by pressing the button at the top 30-40 times. Each press feels like a tiny pin-prick as it delivers its impulse - not unpleasant. The leaflet stresses that it is only for pain relief, it doesn't cure anything.

The company that makes it is marketing it in England (but so far not in the US as far as I can tell from the various website outlets that list it). In case you want to check it out, the Denmark address given on the leaflet is PO 94 - 2970 Horsholm, Denmark, telephone +45 70232425, Fax +45 70232426, e-mail: (email removed). The website address is 222.paingone.com, but it seems to be out of action at the moment.

Re: Niels - 'Pain-Gone'

Julie on 12/07/01 at 02:27 (066384)

That was meant to read http://www.paingone.com of course, not 222.

Re: Catherine

Julie on 12/07/01 at 02:43 (066386)

Oops. I don't know why I typed Catherine. Too early in the morning, I guess. I meant Carole, of course. Sorry, Carole.

Re: reinjury - due to stretching

Ed Davis, DPM on 12/13/01 at 23:42 (066926)

I have tried several different brands of night splints but have found the 'N'Ice and Stretch' available through this site to be one of the more comfortable ones and generally more effective.

Unfortunatley, I do not have a lot of information pertaining to the manner in which medical care is provided in different countries. You are probably familiar with Siemens, based in Germany. They make various elctronic devices as well as healthcare devices from hearing aids to ESWT. I would assume that that treatment would be readily available in Germany.
Ed

Re: reinjury - due to stretching

Ed Davis, DPM on 12/05/01 at 15:52 (066232)

Weight bearing stretching is often too intense for many plantar fasciitis sufferers. A long slow gentle stretch works better than quicker, harder stretches. Individuals with high arches often have tight achilles tendons.

One of the advantages of the night splints is that they allow a stretch that is rarely harmful and usually beneficial. They maintain a light prolonged stretch on the fascia and achilles that gradually allows elongation of the achilles.

Also--read the Heel Pain Book here to go over the various modalities available---a lot of people who believe they have tried everything find more useful treatments.

What country do you live in? ESWT is generally more available in Europe than the US.
Ed

Re: reinjury - due to stretching

Carole C on 12/05/01 at 17:53 (066257)

Oh Niels, I am so sorry to hear this! I think it was you that described a stretching technique (gentle foot circles, gentle ups and downs, then more vigorous circles and ups and downs, then up and hold a bit a few times). That seemed to help me, but in the future I'll try to keep in mind that I must be careful not to overdo. I hope you feel less pain soon!!!

Carole

Re: it was not me

niels on 12/06/01 at 02:11 (066299)

Hi Carol and thanks for your concern.

No, it was not me who wrote that.

I did also read it,but i did not qite understand the explanation.

could yuo please expand on it. Do yuo lie down ? Do the feet have to do all the work by themselves or is it a weight bearing exercise ? Do you lie down with straight legs and then grab the toes to make a strech (thats what i have done with good results..until now) ?

Niels

Re: It was Nils, not Niels

Julie on 12/06/01 at 05:20 (066303)

Confusing, Carole: the names are rather similar! I registered Nils's post a couple of weeks ago because the exercises he briefly described were ones that I posted several times, months ago. I'll do it again.

These are simple yoga exercises for the feet. They're part of a series for all the joints called Pawanmuktasana. That means 'energy-releasing exercises', and they release energy by speeding the removal of toxins from the joints. They work systematically and precisely on the joints and on their associated muscles, tendons and ligaments. They can be done sitting on the floor with the legs outstretched (a difficult position to hold, especially for people with low back problems), or lying down, or sitting in a chair, or standing on alternate legs (a non-no for folks with PF). Sitting in a chair and lying down are best.

TOE BENDING AND STRETCHING

This one works the toe joints (all 28 of them) while holding a gentle stretch through the achilles tendons and calf muscles; and works the entire musculature of the feet.

Extend one heel forward and hold this gentle stretch while working on your toes.

Curl your toes forward, as if making fists of your feet. (Don't do this so enthusiastically that you give yourself a cramp.)

Then stretch the toes and spread them: make spaces between them.

Do this nine times, breathing out as you curl the toes, and breathing in as you stretch them.

Repeat with the other foot, then with both feet.

ANKLE BENDING

This one works on the ankle joints and on the achilles/soleus/ gastrocnemuis complex. It helps to increase ankle dorsiflexion, the essential thing for PF-ers who are generally tight in this area.

Bend the feet forwards at the ankles, and then bend them back, one at a time, then together.

Do each nine times on each foot, then both feet, breathing out as you bend forwards, in as you bend back.

ANKLE ROTATIONS

Circle the feet at the ankles, slowly and carefully, nine times in each direction, first one foot, then the other, then both. Breathe freely.

****

If you co-ordinate your movements with your breath it increases their effectiveness because it (a) slows you down and (b) makes you more aware of what you're doing.

I've practised and taught these exercises for many years. They are effective and powerful, and useful for people with PF because they're both non- weight-bearing and specific. And they're very energizing.

I do them in the morning before I get out of bed, and would recommend this to anyone with PF to help avoid the 'first step' pain.

They can be done as many times a day as you like: the more the better. Nils pointed out that he does them before getting up from his desk after sitting for awhile, and this is a very good idea.

Let me know how you get on with them if you decide to take them on board.

Re: It was Nils, not Niels

niels on 12/06/01 at 09:35 (066317)

Hi julie

Thanks a lot for the very instructive advice.

I will do the exercises as soon as i am able to it. Unfortunately, i cant do all of them now, due to my lousy condition. I cant do the toe exercise and ankle bending now without getting this sharp pain in the back and under my heel.

Niels

Re: That's right, Niels

Julie on 12/06/01 at 09:44 (066319)

That's right - don't do anything that hurts. Wait until it's better.

Have you seen your doctor? If your pain is so intense, you should, really.

You said that you didn't think your orthotics were perfect. Perhaps they should be looked at now by whoeever made them for you.

Re: reinjury - due to stretching

niels on 12/06/01 at 09:59 (066321)

Hi Ed

Thanks for the advice on night splints. I will try it.
Wich one do you recommend (available over the internet)? Is the N ice Strech good , though expensive ?

For how long at the time should i wear it. All night ?. Should i ice before/after or not ?Ice has never helped, i feel.

I have not even done weightbearing streching prior to my set back. It harmed me 1 year ago and i havent hardly done it since. My streching was done lying down with straight leg and then grabbing the foot/Toes, holding for a while. Can you suggest a more gentle or better way, to supplement the night splint ?

I have read the heel pain book several times, but i feel the streching there exercises are too violent for me, as they all seem to be weight bearing.

I should mention that i do not have any particular 'first step in the morniing pain'

I live in Denmark and none of the foot 'specialist' doctors i have consulted have even heard of eswt. They only know of cortisone shots, which I have tried several times with no relief but for maximum a week. I have tried to enlighten them by referring the this page, but the are completely uninterested. Quite depressing, isnt it.

Niels

Re: it was not me

Carole C on 12/06/01 at 17:47 (066361)

Oh! I am sorry that I got you mixed up with Nils.

The stretches that Nils described have been helpful for me. I do them when getting out of bed, or getting up after sitting for a long time. I simply rotate my feet in circles gently about seven times each way (maybe a different number for somebody else). Then I alternately point my toes out straight ahead, and point them up towards my head, but gently in each direction. Then I do the circles a little more vigorously, and the pointing. To finish off, I do the pointing again and hold for about a count of five, each time (two out and two up). Then another gentle circle and I'm ready to go.

I also do these in a less formal way, just the first gentle part, when I am lying down. This is nice in the morning, when I am lying there and thinking about getting up eventually. After a few lazy, gentle circles lying down, I sit on the edge of my bed and do the stretches as I described.

I don't do these with weights, and it is not done as a weight bearing exercise at all. In fact I think these stretches work better barefoot than with shoes on for me, because of the weight of the shoes.

And no, I have not grabbed my toes to stretch.

Carole

Re: Thank you, Julie!

Carole C on 12/06/01 at 17:50 (066362)

Julie, thank you once again. I think you are quite an expert in living with PF !!! No wonder everyone was so glad to see you back on the message board. :)

Carole

Re: Catherine

Julie on 12/07/01 at 02:11 (066382)

Thanks Catherine. No, I'm no expert. I just know what helped me - and I didn't have to live with PF that long, only six months or so. Everyone is different, and the important thing is to find a treatment plan that is right for you, and stick with it patiently: there are no quick fixes for PF. Good podiatric care is vital - a foot specialist who is skilled, knowledgeable and patient. I know that many people here have had disappointing experiences with podiatrists, but there are good ones out there, and it's worth searching for one who will really help.

Re: Niels - 'Pain-Gone'

Julie on 12/07/01 at 02:25 (066383)

Niels, you live in Denmark? I wonder if you've heard about a device called the 'Pain-Gone'pen. It was developed by doctors in Denmark, and works on the TNS principle (Transcutaneous Nerve Stimulation). It isn't a TENS unit, it's a small device that you hold in your hand (no leads, no batteries) and it delivers - I'm quoting from the information pack - 'a controlled electronic frequency to the point of pain. This stimulating frequency provides prolonged and often instant pain relief and will also help promote the body's healing process.'

I was sent an information pack, and ordered one out of curiosity - it comes with a 30-day money back guarantee. So far I've tried it out on a mild toothache (it worked) and on a small occasional pain I still have on the outside edge of my heel (it worked) and on my husband's severe low back flare-up (it didn't work - or at least hasn't worked yet).

You operate it by pressing the button at the top 30-40 times. Each press feels like a tiny pin-prick as it delivers its impulse - not unpleasant. The leaflet stresses that it is only for pain relief, it doesn't cure anything.

The company that makes it is marketing it in England (but so far not in the US as far as I can tell from the various website outlets that list it). In case you want to check it out, the Denmark address given on the leaflet is PO 94 - 2970 Horsholm, Denmark, telephone +45 70232425, Fax +45 70232426, e-mail: (email removed). The website address is 222.paingone.com, but it seems to be out of action at the moment.

Re: Niels - 'Pain-Gone'

Julie on 12/07/01 at 02:27 (066384)

That was meant to read http://www.paingone.com of course, not 222.

Re: Catherine

Julie on 12/07/01 at 02:43 (066386)

Oops. I don't know why I typed Catherine. Too early in the morning, I guess. I meant Carole, of course. Sorry, Carole.

Re: reinjury - due to stretching

Ed Davis, DPM on 12/13/01 at 23:42 (066926)

I have tried several different brands of night splints but have found the 'N'Ice and Stretch' available through this site to be one of the more comfortable ones and generally more effective.

Unfortunatley, I do not have a lot of information pertaining to the manner in which medical care is provided in different countries. You are probably familiar with Siemens, based in Germany. They make various elctronic devices as well as healthcare devices from hearing aids to ESWT. I would assume that that treatment would be readily available in Germany.
Ed