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Different kinds of splints, casts, etc. ?

Posted by Dean H on 2/26/02 at 19:49 (075129)

Does anyone have any comments about the different kinds of night splints and casts? I've looked at the survey, and it doesn't distinguish between brands, or between store-bought and custom fit. Also, how do any of these compare to the cam walker? Most of the comments I've seen were from people who used it after surgery, which I'm a long way from needing.

I'm mostly interested in general opinions, but here's some long-winded personal info in case it affects your advice. I'm a 45-year-old male, 5'9', 155lbs., in good health in general, with a relatively mild case of PF. I first noticed it about 6 months ago, while standing longer than usual, in dress shoes I don't normally wear. It started to happen more frequently - almost always while standing. .(I can still walk several blocks, or jog 3 miles once a week (which I now do much more rarely) with no immediate discomfort) I recognized the problem because my girlfriend and another female friend have it. My pain is usually near the center of both soles. The right heel sometimes hurts, which I think is related to driving 25 miles to work. I almost never have first-step-in-the-morning pain.

Here's what I've tried so far:
1) Bought shoes with steel in sole, and rubber heel cups. No appreciable change.
2) Saw a recommended podiatrist in Oakland, CA. He suggested switching to my almost new Asics Gel running shoes, and doing one stretch - a wall push-up. He said 70 percent of people improve from just that. Felt mildly better, but I couldn't do the wall stretch because it aggravated my otherwise tolerable low back pain. (He also said that Birkenstocks weren't good, but better than barefoot around the house, and that ice and ibuprofen are good for pain, but don't help cure PF.)
3) Got custom orthotics. Felt slightly worse where the front of the orthotics pressed against my feet.
4) Podiatrist suggested different exercises, and cut the insoles of the Asics and removed rear pieces the same shape as the orthotics, so I have insoles under the fronts of my feet, and orthotics under the backs. Better that before the adjustment, but the best I can say is that I'm not worse than before.
5) Pod suggests cam walker, cortisone, or maybe ESWT, in approximately that order. (He'd mentioned night splints earlier, but not this time.) Had some concern the walker might bother my back. I decided to give ice, ibuprofen, and experimenting with shoes and supports, before trying anything else. Not much has changed. Overall, I'd say I'm slightly worse than when I first identified the problem.

Thanks in advance!

-- Dean

Re: Different kinds of splints, casts, etc. ?

rich on 2/26/02 at 21:14 (075138)

Hi Dean! I've used the night splint with success on my left foot, wearing it overnight for several weeks. I developed PF in my right foot and find the same splint uncomfortable for long periods, usually last an hour before removing. New Balance athletics and the Sof-Sole brand motion control insert works for me...still have pain, but can't walk at all without. Probably on my way to custom orthotics, though. Haven't tried the cam walker but the Pod feels we may have to. There have been a few recent posts...you might try a search. Good Luck!

Definitely keep icing!
Rich

Re: Different kinds of splints, casts, etc. ?

Julie on 2/27/02 at 02:43 (075159)

Dean, the night splint that Scott sells here (the N'Ice n Stretch, if I've got that right) has been found by many to be the least uncomfortable, and it's the one the doctors here recommend. The point of the night splint is to keep the gastrocnemius/soleus/achilles complex gently dorsiflexed for long periods, and over a period of time to lengthen it and increase the angle of dorsiflexion, which will lessen the tension on the plantar fascia.

've no experience of the night splint myself, but I gather that it takes time to get used to it. One way of getting its beneficial effects without losing sleep while you're getting used to it onvernight, is to wear it during the day, while you're off your feet.

Speaking of being off your feet, I'd suggest in the nicest possible way that you don't EVER jog three miles. The more you can avoid impact exercise (i.e. all but essential walking) the better it will be, for now.

On your other points:

Running shoes may not have the sole-thickness and cushioning that you need for walking. Investigate good cross trainers or hiking shoes. I like North Face Targas, which have the thickness, cushioning and tread that I need for both roughish hill walking and city pavement walking (I'm ok with both now, as my PF resolved with rest, orthotics, taping, and change of footgear including Birkenstocks and Targas - and not going barefoot).

I don't know which '70%' your pod is talking about, but at a guess I'd say that at least 70% of people here have found the wall push-up made their PF a good deal worse. It's a diabolical stretch (not in itself, and not for fit folks, but for PF patients) and if it's not done correctly it can certainly irritate the lower back, as it has yours. That's because it's easy to do it with the pelvis tipped forward and the lower back arched, which puts a great deal of pressure on the lumbar discs and the nerves that radiate from them.

What new stretches did the pod suggest?

If the custom orthotics made you worse, they weren't made correctly for you, and need to be adjusted. How were they made? Richard C.Ped and BGC.Ped are our sources of knowledge about orthotics: if you post a question on the 'Shoes, Inserts, Orthotics' board they can probably help.

If your PF is mild, why should you need a cam walker? Or cortisone? ESWT is a good idea, once all other conservative treatments have failed, but it doesn't sound as though they've been tried in a package specifically targetted to the cause of your PF.

Do you know what the cause is? Did your pod evaluate your gait on a treadmill for possible biomechanical faults? If not, then perhaps a look around for another pod might be a good idea. It sounds to me as though you haven't yet got to the bottom of your problem.

This is getting too long, but before I post this I want to point you in the direction of the heel pain book, which will give you lots of information and ideas.

Best of luck - keep reading the boards, too, and asking questions.

Re: Different kinds of splints, casts, etc. ?

rich on 2/26/02 at 21:14 (075138)

Hi Dean! I've used the night splint with success on my left foot, wearing it overnight for several weeks. I developed PF in my right foot and find the same splint uncomfortable for long periods, usually last an hour before removing. New Balance athletics and the Sof-Sole brand motion control insert works for me...still have pain, but can't walk at all without. Probably on my way to custom orthotics, though. Haven't tried the cam walker but the Pod feels we may have to. There have been a few recent posts...you might try a search. Good Luck!

Definitely keep icing!
Rich

Re: Different kinds of splints, casts, etc. ?

Julie on 2/27/02 at 02:43 (075159)

Dean, the night splint that Scott sells here (the N'Ice n Stretch, if I've got that right) has been found by many to be the least uncomfortable, and it's the one the doctors here recommend. The point of the night splint is to keep the gastrocnemius/soleus/achilles complex gently dorsiflexed for long periods, and over a period of time to lengthen it and increase the angle of dorsiflexion, which will lessen the tension on the plantar fascia.

've no experience of the night splint myself, but I gather that it takes time to get used to it. One way of getting its beneficial effects without losing sleep while you're getting used to it onvernight, is to wear it during the day, while you're off your feet.

Speaking of being off your feet, I'd suggest in the nicest possible way that you don't EVER jog three miles. The more you can avoid impact exercise (i.e. all but essential walking) the better it will be, for now.

On your other points:

Running shoes may not have the sole-thickness and cushioning that you need for walking. Investigate good cross trainers or hiking shoes. I like North Face Targas, which have the thickness, cushioning and tread that I need for both roughish hill walking and city pavement walking (I'm ok with both now, as my PF resolved with rest, orthotics, taping, and change of footgear including Birkenstocks and Targas - and not going barefoot).

I don't know which '70%' your pod is talking about, but at a guess I'd say that at least 70% of people here have found the wall push-up made their PF a good deal worse. It's a diabolical stretch (not in itself, and not for fit folks, but for PF patients) and if it's not done correctly it can certainly irritate the lower back, as it has yours. That's because it's easy to do it with the pelvis tipped forward and the lower back arched, which puts a great deal of pressure on the lumbar discs and the nerves that radiate from them.

What new stretches did the pod suggest?

If the custom orthotics made you worse, they weren't made correctly for you, and need to be adjusted. How were they made? Richard C.Ped and BGC.Ped are our sources of knowledge about orthotics: if you post a question on the 'Shoes, Inserts, Orthotics' board they can probably help.

If your PF is mild, why should you need a cam walker? Or cortisone? ESWT is a good idea, once all other conservative treatments have failed, but it doesn't sound as though they've been tried in a package specifically targetted to the cause of your PF.

Do you know what the cause is? Did your pod evaluate your gait on a treadmill for possible biomechanical faults? If not, then perhaps a look around for another pod might be a good idea. It sounds to me as though you haven't yet got to the bottom of your problem.

This is getting too long, but before I post this I want to point you in the direction of the heel pain book, which will give you lots of information and ideas.

Best of luck - keep reading the boards, too, and asking questions.