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The Best Stretch

Posted by Glenn X on 12/11/01 at 13:17 (066721)

Some readers may recall my obsessive quest for flexibility --- for increasing the angle of my ankle's dorsiflexion. About three months ago I plateaued my right (worst) ankle at about 87 degrees or so. Couldn't get past it. So in an effort to kick-start more progress I began PT calf massage and added, what I thought was careful and controlled weight-bearing stretches, the infamous runner's stretch. Despite my most conscientious efforts to control these stretches short of pain, they were too much, and really set me back.

To help calm things down, Dr. Ed. put my right foot and calf in a hard, non-removable cast. My foot was slightly dorsiflexed at about 87 degrees.

I wore this cast for 15 days. When Dr. Ed then took it off I was astonished to discover I had picked up at least 5 more degrees of dorsiflexion, and I am now close to 80 degrees. I should say too that I had been concerned that my lack of 'stretching' for two weeks was going to further set me back. So when I say astonished, I mean with a capital A exclamation point.

Dr. Ed has written here before about the subtle value of mild tensioning for improved flexibility (aka the night splint), but this (for me) was a dramatic demonstration of that principle at work -- in a relatively short time period.

I should say too, that I'd been using night splints for months up to this time without much noticeable effect. My mistake was in assuming that night splinting works like other stretching regimens --- that you needed to 'feel' the pull on your muscle just short of pain, and hold that for 30 or 60 seconds (or all night) to get any benefit. So I had been cinching up my night splint (the N'ice Stretch brand) pretty snug. I'd also been waking up most mornings sore footed. What I now realize is that I had been fighting against a natural process. It's like my foot's soft tissues were perceiving danger and fighting against the threat all night. BUT a nice and comfortable tensioning, for a sustained period of time, instead communicates to soft tissues that 'my environment is different AND safe, and I need to gradually adjust to this new dynamic.'

I should acknowledge that when Dr. Ed first prescribed the N'ice Stretch splints he recommended a comfortable tensioning. Ever in pursuit of managing the hell out of my recovery I of course assumed that, if a mild pull helped, a major pull would help more. I am learning to not fight my body . . . my self.

I might also remark that I've read people dissing the N'ice Stretch, and bet it's because they couldn't get a good, sustained, all-night ambitious stretch with it. Sometimes I even added a nylon strap to the splints to create a more agressive dorsiflexion. But I don't believe NOW, that's how they do their best work.

For many, this will all be old-hat news, but I am still new to this, and am pleased all over the place to have learned this useful lesson.

I now believe that the right tensioning on a night splint is comfortable all night --- and places mild pressure on the ball of the foot. Meaning the foot is wanting to plantar-flex more than the splint is allowing. Soft tissues gradually accomodate this safe new environment, and 'know' enough to actually over-accomodate a little -- providing for slightly more dorsiflexion than immediate circumstances warrant. Go at it too aggressively though, and they react to the perceived threat and seize up -- and may even shorten.

Holding a slight dorsiflexion during the day helps too. The only other stretching I do is Julie's Yoga Foot Twiddles three times a day. Combination seems to be working nicely.

Re: The Best Stretch

D.Thomas on 12/11/01 at 15:20 (066737)

Glenn,

I can't agree more with what you have said above. I went through the same exact problems where my doctor wanted me to do the running stretch and the squat and hold 30 secs each 3 times. Well, I also believed that the only way it was going to work was to 'feel' the stretch. And I would just end up in worse pain than I was the night before. I actually did this over and over again until I went back to him and he told me that I just need to barely stretch on both exercises. Not to push the stretch at all. Well I tried it for a couple of weeks even though I could feel nothing when I stretched and was thinking that there is no way this is going to help beccuase I can't feel anything. And wouldn't you know it that this has been the best improvement I have had for 7 months. I still don't believe that such a little stretch can have such a dramatic effect. And you are right 100%, the only thing I have to fight is making sure I don't over stretch. That is the hardest part. I am very impatient and want to test it, but that always leads to reinjury. PF is all about making baby steps and making sure you don't push it and step back to step one.

Re: The Best Stretch

Julie on 12/11/01 at 16:23 (066740)

Hi Glenn! Nice to hear from you. What you say about the night splint is fascinating. Just proves that we all want to be 'doing something' - but 'doing' isn't necessarily the answer.

I am absolutely delighted to hear about your 80 degrees of dorsiflexion. Keep 'not doing' and Twiddling. And keep us up to date on your progress. There will be a huge cheer around here when you're off the crutches.

All the best

Julie

Re: The Best Stretch

Kathy G on 12/11/01 at 16:34 (066743)

Glenn,

From reading these boards over the last 5 months, I'm wondering if a certain personality type develops PF. It's amazing how many of us overdo it and overstretch and re-injure our feet! Maybe it's just the nature of the ailment, but it is rather striking.

Now, my question for you, or for Julie. I know I've read of Julie's stretches at some time or another, but what 'Twiddles' are you having results with? I'm very interested.

I was making terrific progress with my PF, but 9 weeks ago, I fell and sprained my ankle and I'm trying to, at least, keep the other foot in somewhat working order. After 5 weeks, I stretched the foot with the sprain, and re-injured the ankle, and set myself back so I'm still in an aircast. See what I mean about overdoing it?

Anyhow, I'd appreciate your advice on 'Twiddling' which somehow sounds obscene when worded that way!!!

Re: The Best Stretch

Julie on 12/11/01 at 16:44 (066747)

Well, Kathy, Glenn likes to call them twiddles, but I call them ankle bending and ankle rotations. I posted the whole series of exercises for the toes and ankles a few days ago for Carole C - if you can't find them come back to me and I'll try to ferret them out.

Re: The Best Stretch

CatherineL on 12/11/01 at 16:46 (066748)

Glenn,

Nice to read this, as I'm on my second month of the nice splint and even though it is helping a bit with the tension and pain in the foot, I was thinking maybe I would up the pull on it to acheive a better stretch. Glad to here it's probably not a good idea, before I did it.

Thanx
Catherine

Re: The Best Stretch

Kathy G on 12/11/01 at 17:04 (066752)

Thanks, Julie. I will search about and let you know if I can't find them. I know I even had printed them out, at one time, but I can't seem to find them. Not that I'm disorganized or anything!!!

Re: Kathy G-Personality Types

rebecca h on 12/11/01 at 17:48 (066763)

Hi Kathy,

I'm pretty new around here but I've wondered the same thing about the personality types. I've always been the kind of person to take on more than I can possibly handle and then somehow I manage to get it all done.
Or at least most of the time. But as I get older (I'm 40) I realize I really need to slow things down and be gentler to my feet. I guess I'm an 'over doer'. I'm glad I read these posts about not over doing the stretching. I think it will help me out.

rebecca

Re: The Best Stretch

Glenn X on 12/11/01 at 20:23 (066773)

Hey D: Nice to hear you're making progress with easy stretching too. Baby Steps . . . What About Bob?

Re: The Best Stretch

Glenn X on 12/11/01 at 20:27 (066774)

Hi Julie: What also came to mind was the story you related of the woman in your Yoga class you thought had as good a dirsiflexion as you've seen; and her comment that she got there doing the simple yoga flexes. Wish I'd listened better through the words back then.

Re: The Best Stretch

Glenn X on 12/11/01 at 20:39 (066776)

Kathy: Very well observed. I feel like a poster person for this personality type. I have WAY overmanaged this condition, and so often assumed if a little is good, more is better.

Even now -- knowing this tendency in me -- I am really going to have to discipline myself to be patient and gentle with treatment and with progress.

A thought that often comes to mind when thinking about over-controlling PF comes from John h. He's often remarked that for him, progress occured (occurs) with his condition as he's able to get his mind off managing PF and onto more distracting or pleasant pursuits. I'm sure that's part of it too.

I see Julie spoke to the Twiddles. I've copied her instructions down too if you have trouble finding them.

Re: The Twiddles and a healing story

Julie on 12/12/01 at 02:19 (066795)

Hi Glenn

I think the explanation of The Twiddles that you have is probably better/fuller than the one I posted the other day. If you still have it on your computer (I stupidly didn't make a copy of it for my desktop file) maybe you could copy it into a new post for Kathy and for anyone else who might be interested.

When I read your first post, I too thought about Celia and her healthy angle of dorsiflexion! She's still absolutely fine, by the way. Her PF took three months to clear, from start to finish. Yes, she did The Twiddles regularly, and they helped, but I attribute her uneventful quick healing only partly to them, mostly to the fact that she started dealing with PF within a couple of days of its onset. She asked me for help because she knew I was going through it (she couldn't help knowing, as I'd been pontificating about it for weeks and always wore my b.i.r.k.s while teaching). I told her what I knew, and she saw my DPM and followed instructions.

I think it's a classic case. With so many straightforward cases, the sooner it's dealt with, the quicker it resolves, of course taking into account such factors as age, biomechanics and the skill and expertise of the treating doctor. If only everyone with early-onset PF could be transported to heelspurs.com! Perhaps by means of some automatic cyber-connection between the sore heel and the http://www . Most of the recalcitrant sore feet around here belong to people who waited x months or years before seeking help.

You're an engineer, aren't you? You could work something out...

Keep healing, Glenn - you're doing great.

All the best

Julie

Re: The Best Stretch

john h on 12/12/01 at 09:29 (066812)

Glenn: I still find that when I am distracted for a period of time like a trip to New Jersey for instance that somehow my Pf gets better. It is common knowledge that our subconcious and concious mind can tighten up our muscles. Pain also begets more pain. Having had a bad back for many years I clearly understand that if my back becomes painful my muscles tend to tighten up creating more pain. These same back muscles effect effect your gluts,hamstrings,calves and on down the line. Who is to say that stress which causes a tightening of the muscles ultimately cannot make your feet hurt? Some non traditional treatement such as Yoga (I still have not tried it) may lead some individuals to a more calm mindset and more flexable muscles resulting in less pain for a variety of conditions. Some people can slow down their heartbeat and reduce their blood pressure significantly through mind control. there is much to be learned about the mind and pain control.

Re: The Twiddles and a healing story

Glenn X on 12/12/01 at 09:47 (066816)

Hi Julie:

You are so right about the importance of catching and treating this early. I actually did catch-on right away and within a month saw a DPM. His care was capable, but like a lot of subsequent care givers, lacked focus, a real plan, and failed to convey a needed atmosphere of seriousness. He said many things, mostly about OTC orthotics and stretching and occasional icing. But his instructions were lackadaisical -- essentially a brief demo and a 'do this every day.' I do recall that one of his demos was the stair step stretch, which I subsequently learned is the worst.

The worst 'mistake' he made though was to comment that 95% of PF patients are cured with these simple, conservative means. Which, of course I heard as, 'this is like any other minor injury you've had in the past. Don't worry about it.' And I didn't.

Being an engineer is the wrong job description for treating this. Too left brained. Too much problem solving and experimentation, and impatience with the pace of results. Too much trying to work something out. As Kathy sort of remarked, for me it's part my 'PF personality disorder.' I've way overengineered my own recovery.

Glad to hear your friend, and you are still doing well. I am always heartened by success stories, of all kinds.

Re: Julie's Yoga Stretches

Glenn X on 12/12/01 at 09:51 (066817)

Julie: I copied this from one of your more recent posts. I think this the best version.

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 no-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.

Julie

Re: Julie's Yoga Stretches

Julie on 12/12/01 at 10:01 (066822)

Glenn, thanks for doing this. This is the most recent version. I thought the previous one was more detailed, but I agree with you that this one is fine (maybe better for being less detailed).

I've kept a copy of this one so that I can re-post it in future without having to write it all out again, if anyone asks.

Re: Yoga

Julie on 12/12/01 at 10:04 (066823)

Hi John

You're right. And there is nothing mysterious about it: anyone can slow their heartbeat and lower blood pressure simply by learning to breathe well, and by learning to relax (the two are intimately connected). Of course this will lead to the breaking of the vicious tension cycle and a more relaxed attitude, which help with pain management.

Re: Julie's Yoga Stretches

Kathy G on 12/12/01 at 10:48 (066827)

Glenn,

Thank you so much for taking the time to post the stretches. I've actually been doing the Ankle Bending and Rotations all along, but not as regularly as I should. I printed them out and will be much better in the future!

Thanks so much! And thank you for pointing out how important it is to take early action when diagnosed with PF. I'm one of those idiots who made my condition much worse by thinking it would go away, and continuing my regular activities. Man, did I find out how wrong I was! 'Toughing it out' just doesn't work with this condition!

Re: Julie's Yoga Stretches

Julie on 12/12/01 at 10:52 (066828)

Kathy, hi. Be careful with your sprained ankle: even these simple exercises can be painful when tissues are injured. Go gently.

Re: The Best Stretch

Glenn X on 12/12/01 at 11:35 (066833)

John: I hear you buddy. Except for a little collateral wrist soreness from driving the crutches into the ground for so long, I'm as healthy otherwise as I've ever been: physically and mentally. I don't fret about stuff, and hardly think about a sneeze. Pains disappear overnight, and I can't recall my last cold. Perhaps these other 'ailments' lacking attention, wane more rapidly. Perhaps too, all my bad spirits and distempers find their way to my foot where they'll be better appreciated.

Re: Julie's Yoga Stretches -- early version

Glenn X on 12/12/01 at 11:48 (066835)

Julie: Below is a post of yours I copied from June. It got me started.

There may be a more complete version somewhere, but I think the recent one I copied earlier nails it good.

One little add-on I do is half circles (From 3:00 p.m. to 9:00 p.m.) before full circles. Helps me ease into the ankle motion. Think I saw it on a yoga show.

From Julie (to Rudy) -- June 2001
'Curl your toes forward, as if making a fist of your feet. Then draw them back towards you, stretching and spreading them. Try to make space between each toe and its neighbour. Don't move the ankles, just the toes. Breathe out as you curl the toes, in as you stretch them. 9 times.

Bend your feet forward at the ankles, pointing the toes away. Then bend them back. Make this 'hingeing' movement as full as you can, without causing pain. Breathe out as you bend the feet forward, in as you bend them back. 9 times.

Circle your feet at the ankles, first one at a time, then together. Pretend you're drawing circles with your big toe and make the circles as big as you can. Breathe naturally as you do this one. 9 times with each ankle, 9 times with both.

These three movements are part of a group of simple yoga exercises for the joints called Pawanmuktasana. I've practised and taught them for many years, and they have general beneficial effects on body and mind, apart from the specific ones on the feet. Since I've been working on healing my PF, I've given more time to them, and they have been an important and effective element of my treatment strategy.

My podiatrist recommended the wall stretches. I'd known them for a long time, and they are certainly effective stretches for the gastrocnemius and soleus muscles if done correctly (a big 'if' in my experience) but I doubt their suitability for people with PF. I think they can easily irritate the achilles tendon, and pull on the 'weak' point of the plantar fascia, where it has begun to tear away from the calcaneus. I did them for awhile, but they hurt, and I felt they were making things worse, so I stopped. I know that not everyone agree with me, but it is my view of the matter and it's a fairly educated view.

I hope you'll find this helpful.For a concise explanation of why the generally recommended weight-bearing stretches for PF are not appropriate, see Mike Wilmot's web page: http://www.foottrainer.com . I've ordered and just received a pair of Mike's Personal Foot Trainers, and I think the theory makes sense, but it's too early for a report. I know Dr Zuckerman thinks highly of them and recommends them to his patients.'

Re: The Best Stretch

John h on 12/12/01 at 18:49 (066855)

Glenn: there is a guy at my health club who appears to be about 55. He has only one leg and has been on crutches as long as I have seen him (years). He moves better than i do on two feet and his arms look like a middle linebackers. I am amazed at how people can adapt. Two weeks on crutches and I still had trouble negotiating a curb.

Re: Julie's Yoga Stretches

Kathy G on 12/13/01 at 15:38 (066897)

Julie,

Thank you so much for your concern! I found out the hard way not to do ANY stretches on the leg that has the sprained ankle. I actually set myself back because I thought, after 5 weeks, I could start stretching. Now I'm at 10 weeks, and hopeful that in a couple of weeks, I'll be able to take off the aircast. Once again, I needed to show a little patience, which has never been my strong suit. Becoming a bit more patient is one positive thing I've gained from PF, I guess!

Re: Crutches

Glenn X on 12/14/01 at 14:22 (066962)

John: If you did it long enough you'd get good at it too, and even take stairs two at a time. Sometimes adapting isn't the ideal option. For me it meant ignoring my worsening condition longer than I should have because I could 'easily' detour around it. I don't do that now.

Re: The Best Stretch

D.Thomas on 12/11/01 at 15:20 (066737)

Glenn,

I can't agree more with what you have said above. I went through the same exact problems where my doctor wanted me to do the running stretch and the squat and hold 30 secs each 3 times. Well, I also believed that the only way it was going to work was to 'feel' the stretch. And I would just end up in worse pain than I was the night before. I actually did this over and over again until I went back to him and he told me that I just need to barely stretch on both exercises. Not to push the stretch at all. Well I tried it for a couple of weeks even though I could feel nothing when I stretched and was thinking that there is no way this is going to help beccuase I can't feel anything. And wouldn't you know it that this has been the best improvement I have had for 7 months. I still don't believe that such a little stretch can have such a dramatic effect. And you are right 100%, the only thing I have to fight is making sure I don't over stretch. That is the hardest part. I am very impatient and want to test it, but that always leads to reinjury. PF is all about making baby steps and making sure you don't push it and step back to step one.

Re: The Best Stretch

Julie on 12/11/01 at 16:23 (066740)

Hi Glenn! Nice to hear from you. What you say about the night splint is fascinating. Just proves that we all want to be 'doing something' - but 'doing' isn't necessarily the answer.

I am absolutely delighted to hear about your 80 degrees of dorsiflexion. Keep 'not doing' and Twiddling. And keep us up to date on your progress. There will be a huge cheer around here when you're off the crutches.

All the best

Julie

Re: The Best Stretch

Kathy G on 12/11/01 at 16:34 (066743)

Glenn,

From reading these boards over the last 5 months, I'm wondering if a certain personality type develops PF. It's amazing how many of us overdo it and overstretch and re-injure our feet! Maybe it's just the nature of the ailment, but it is rather striking.

Now, my question for you, or for Julie. I know I've read of Julie's stretches at some time or another, but what 'Twiddles' are you having results with? I'm very interested.

I was making terrific progress with my PF, but 9 weeks ago, I fell and sprained my ankle and I'm trying to, at least, keep the other foot in somewhat working order. After 5 weeks, I stretched the foot with the sprain, and re-injured the ankle, and set myself back so I'm still in an aircast. See what I mean about overdoing it?

Anyhow, I'd appreciate your advice on 'Twiddling' which somehow sounds obscene when worded that way!!!

Re: The Best Stretch

Julie on 12/11/01 at 16:44 (066747)

Well, Kathy, Glenn likes to call them twiddles, but I call them ankle bending and ankle rotations. I posted the whole series of exercises for the toes and ankles a few days ago for Carole C - if you can't find them come back to me and I'll try to ferret them out.

Re: The Best Stretch

CatherineL on 12/11/01 at 16:46 (066748)

Glenn,

Nice to read this, as I'm on my second month of the nice splint and even though it is helping a bit with the tension and pain in the foot, I was thinking maybe I would up the pull on it to acheive a better stretch. Glad to here it's probably not a good idea, before I did it.

Thanx
Catherine

Re: The Best Stretch

Kathy G on 12/11/01 at 17:04 (066752)

Thanks, Julie. I will search about and let you know if I can't find them. I know I even had printed them out, at one time, but I can't seem to find them. Not that I'm disorganized or anything!!!

Re: Kathy G-Personality Types

rebecca h on 12/11/01 at 17:48 (066763)

Hi Kathy,

I'm pretty new around here but I've wondered the same thing about the personality types. I've always been the kind of person to take on more than I can possibly handle and then somehow I manage to get it all done.
Or at least most of the time. But as I get older (I'm 40) I realize I really need to slow things down and be gentler to my feet. I guess I'm an 'over doer'. I'm glad I read these posts about not over doing the stretching. I think it will help me out.

rebecca

Re: The Best Stretch

Glenn X on 12/11/01 at 20:23 (066773)

Hey D: Nice to hear you're making progress with easy stretching too. Baby Steps . . . What About Bob?

Re: The Best Stretch

Glenn X on 12/11/01 at 20:27 (066774)

Hi Julie: What also came to mind was the story you related of the woman in your Yoga class you thought had as good a dirsiflexion as you've seen; and her comment that she got there doing the simple yoga flexes. Wish I'd listened better through the words back then.

Re: The Best Stretch

Glenn X on 12/11/01 at 20:39 (066776)

Kathy: Very well observed. I feel like a poster person for this personality type. I have WAY overmanaged this condition, and so often assumed if a little is good, more is better.

Even now -- knowing this tendency in me -- I am really going to have to discipline myself to be patient and gentle with treatment and with progress.

A thought that often comes to mind when thinking about over-controlling PF comes from John h. He's often remarked that for him, progress occured (occurs) with his condition as he's able to get his mind off managing PF and onto more distracting or pleasant pursuits. I'm sure that's part of it too.

I see Julie spoke to the Twiddles. I've copied her instructions down too if you have trouble finding them.

Re: The Twiddles and a healing story

Julie on 12/12/01 at 02:19 (066795)

Hi Glenn

I think the explanation of The Twiddles that you have is probably better/fuller than the one I posted the other day. If you still have it on your computer (I stupidly didn't make a copy of it for my desktop file) maybe you could copy it into a new post for Kathy and for anyone else who might be interested.

When I read your first post, I too thought about Celia and her healthy angle of dorsiflexion! She's still absolutely fine, by the way. Her PF took three months to clear, from start to finish. Yes, she did The Twiddles regularly, and they helped, but I attribute her uneventful quick healing only partly to them, mostly to the fact that she started dealing with PF within a couple of days of its onset. She asked me for help because she knew I was going through it (she couldn't help knowing, as I'd been pontificating about it for weeks and always wore my b.i.r.k.s while teaching). I told her what I knew, and she saw my DPM and followed instructions.

I think it's a classic case. With so many straightforward cases, the sooner it's dealt with, the quicker it resolves, of course taking into account such factors as age, biomechanics and the skill and expertise of the treating doctor. If only everyone with early-onset PF could be transported to heelspurs.com! Perhaps by means of some automatic cyber-connection between the sore heel and the http://www . Most of the recalcitrant sore feet around here belong to people who waited x months or years before seeking help.

You're an engineer, aren't you? You could work something out...

Keep healing, Glenn - you're doing great.

All the best

Julie

Re: The Best Stretch

john h on 12/12/01 at 09:29 (066812)

Glenn: I still find that when I am distracted for a period of time like a trip to New Jersey for instance that somehow my Pf gets better. It is common knowledge that our subconcious and concious mind can tighten up our muscles. Pain also begets more pain. Having had a bad back for many years I clearly understand that if my back becomes painful my muscles tend to tighten up creating more pain. These same back muscles effect effect your gluts,hamstrings,calves and on down the line. Who is to say that stress which causes a tightening of the muscles ultimately cannot make your feet hurt? Some non traditional treatement such as Yoga (I still have not tried it) may lead some individuals to a more calm mindset and more flexable muscles resulting in less pain for a variety of conditions. Some people can slow down their heartbeat and reduce their blood pressure significantly through mind control. there is much to be learned about the mind and pain control.

Re: The Twiddles and a healing story

Glenn X on 12/12/01 at 09:47 (066816)

Hi Julie:

You are so right about the importance of catching and treating this early. I actually did catch-on right away and within a month saw a DPM. His care was capable, but like a lot of subsequent care givers, lacked focus, a real plan, and failed to convey a needed atmosphere of seriousness. He said many things, mostly about OTC orthotics and stretching and occasional icing. But his instructions were lackadaisical -- essentially a brief demo and a 'do this every day.' I do recall that one of his demos was the stair step stretch, which I subsequently learned is the worst.

The worst 'mistake' he made though was to comment that 95% of PF patients are cured with these simple, conservative means. Which, of course I heard as, 'this is like any other minor injury you've had in the past. Don't worry about it.' And I didn't.

Being an engineer is the wrong job description for treating this. Too left brained. Too much problem solving and experimentation, and impatience with the pace of results. Too much trying to work something out. As Kathy sort of remarked, for me it's part my 'PF personality disorder.' I've way overengineered my own recovery.

Glad to hear your friend, and you are still doing well. I am always heartened by success stories, of all kinds.

Re: Julie's Yoga Stretches

Glenn X on 12/12/01 at 09:51 (066817)

Julie: I copied this from one of your more recent posts. I think this the best version.

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 no-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.

Julie

Re: Julie's Yoga Stretches

Julie on 12/12/01 at 10:01 (066822)

Glenn, thanks for doing this. This is the most recent version. I thought the previous one was more detailed, but I agree with you that this one is fine (maybe better for being less detailed).

I've kept a copy of this one so that I can re-post it in future without having to write it all out again, if anyone asks.

Re: Yoga

Julie on 12/12/01 at 10:04 (066823)

Hi John

You're right. And there is nothing mysterious about it: anyone can slow their heartbeat and lower blood pressure simply by learning to breathe well, and by learning to relax (the two are intimately connected). Of course this will lead to the breaking of the vicious tension cycle and a more relaxed attitude, which help with pain management.

Re: Julie's Yoga Stretches

Kathy G on 12/12/01 at 10:48 (066827)

Glenn,

Thank you so much for taking the time to post the stretches. I've actually been doing the Ankle Bending and Rotations all along, but not as regularly as I should. I printed them out and will be much better in the future!

Thanks so much! And thank you for pointing out how important it is to take early action when diagnosed with PF. I'm one of those idiots who made my condition much worse by thinking it would go away, and continuing my regular activities. Man, did I find out how wrong I was! 'Toughing it out' just doesn't work with this condition!

Re: Julie's Yoga Stretches

Julie on 12/12/01 at 10:52 (066828)

Kathy, hi. Be careful with your sprained ankle: even these simple exercises can be painful when tissues are injured. Go gently.

Re: The Best Stretch

Glenn X on 12/12/01 at 11:35 (066833)

John: I hear you buddy. Except for a little collateral wrist soreness from driving the crutches into the ground for so long, I'm as healthy otherwise as I've ever been: physically and mentally. I don't fret about stuff, and hardly think about a sneeze. Pains disappear overnight, and I can't recall my last cold. Perhaps these other 'ailments' lacking attention, wane more rapidly. Perhaps too, all my bad spirits and distempers find their way to my foot where they'll be better appreciated.

Re: Julie's Yoga Stretches -- early version

Glenn X on 12/12/01 at 11:48 (066835)

Julie: Below is a post of yours I copied from June. It got me started.

There may be a more complete version somewhere, but I think the recent one I copied earlier nails it good.

One little add-on I do is half circles (From 3:00 p.m. to 9:00 p.m.) before full circles. Helps me ease into the ankle motion. Think I saw it on a yoga show.

From Julie (to Rudy) -- June 2001
'Curl your toes forward, as if making a fist of your feet. Then draw them back towards you, stretching and spreading them. Try to make space between each toe and its neighbour. Don't move the ankles, just the toes. Breathe out as you curl the toes, in as you stretch them. 9 times.

Bend your feet forward at the ankles, pointing the toes away. Then bend them back. Make this 'hingeing' movement as full as you can, without causing pain. Breathe out as you bend the feet forward, in as you bend them back. 9 times.

Circle your feet at the ankles, first one at a time, then together. Pretend you're drawing circles with your big toe and make the circles as big as you can. Breathe naturally as you do this one. 9 times with each ankle, 9 times with both.

These three movements are part of a group of simple yoga exercises for the joints called Pawanmuktasana. I've practised and taught them for many years, and they have general beneficial effects on body and mind, apart from the specific ones on the feet. Since I've been working on healing my PF, I've given more time to them, and they have been an important and effective element of my treatment strategy.

My podiatrist recommended the wall stretches. I'd known them for a long time, and they are certainly effective stretches for the gastrocnemius and soleus muscles if done correctly (a big 'if' in my experience) but I doubt their suitability for people with PF. I think they can easily irritate the achilles tendon, and pull on the 'weak' point of the plantar fascia, where it has begun to tear away from the calcaneus. I did them for awhile, but they hurt, and I felt they were making things worse, so I stopped. I know that not everyone agree with me, but it is my view of the matter and it's a fairly educated view.

I hope you'll find this helpful.For a concise explanation of why the generally recommended weight-bearing stretches for PF are not appropriate, see Mike Wilmot's web page: http://www.foottrainer.com . I've ordered and just received a pair of Mike's Personal Foot Trainers, and I think the theory makes sense, but it's too early for a report. I know Dr Zuckerman thinks highly of them and recommends them to his patients.'

Re: The Best Stretch

John h on 12/12/01 at 18:49 (066855)

Glenn: there is a guy at my health club who appears to be about 55. He has only one leg and has been on crutches as long as I have seen him (years). He moves better than i do on two feet and his arms look like a middle linebackers. I am amazed at how people can adapt. Two weeks on crutches and I still had trouble negotiating a curb.

Re: Julie's Yoga Stretches

Kathy G on 12/13/01 at 15:38 (066897)

Julie,

Thank you so much for your concern! I found out the hard way not to do ANY stretches on the leg that has the sprained ankle. I actually set myself back because I thought, after 5 weeks, I could start stretching. Now I'm at 10 weeks, and hopeful that in a couple of weeks, I'll be able to take off the aircast. Once again, I needed to show a little patience, which has never been my strong suit. Becoming a bit more patient is one positive thing I've gained from PF, I guess!

Re: Crutches

Glenn X on 12/14/01 at 14:22 (066962)

John: If you did it long enough you'd get good at it too, and even take stairs two at a time. Sometimes adapting isn't the ideal option. For me it meant ignoring my worsening condition longer than I should have because I could 'easily' detour around it. I don't do that now.