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high arches

Posted by sheila p on 3/25/02 at 09:47 (077482)

I've noticed alot of advice for flat feet,what about high arches ? I'd love to hear shoe suggestions, specific stretch's, and whatever else all you fellow 'high arch' sufferers have tried. I'm into my 2nd year w/ PF and achilles tendonitis, have had one cortisone shot, P.T.and have been told by my orthopod that my next step is surgery (efpr). I'm doing everything to avoid it. Starting acupuncture tomorrow and hoping for the best. I did have 6 months of relief after the shot but I'm reluctant to have it again. I do hair for a living so I'm on my feet long days. Inserts offer little or no relief. Also, can anyone recommend a good ortho in the Portsmouth,NH area? I'd go to Boston or Maine Med if necessary. Thanks so much. Sheila

Re: high arches

D.Thomas on 3/25/02 at 10:59 (077490)

My Pod says high arches are the hardest to treat for PF. I have had this last episode for over a year.

Shelia do you have insetional PF (pain in the heel) or pain in the arches? If it is in the arch, is it in the medial band (inner part of foot) of the fascia?

Re: high arches

Carole C in NOLA on 3/25/02 at 11:38 (077496)

I can sure sympathize. So often it seems to be assumed that a PF sufferer is always a pronator that tends towards flat feet, because so many are. But not all!

To the best of my knowledge my arch is a little on the high side of normal, and I don't need pronation control. Even though I'm probably not an extreme high arch case, I'd like to share ideas.

Have you tried SAS shoes? Some PF sufferers with higher arches like them (and specifically, I like them). You can't buy them online, and it's difficult to impossible to find out online where to buy them since SAS prohibits stores that carry their shoes from publicizing that fact online. Often they are carried in SAS shoes stores, or else in stores that sell orthopedic and diabetic shoes, or else in better shoes stores. Try the 'yellow pages' at http://www.yahoo.com or your regular (paper) yellow pages to see if there's a SAS shoe store in your area.

Another great shoe is the Birkenstock, but we need the high arched version. Some Tatamis are high arched, and I have (and highly recommend!) the Amsterdam clog and the Fulda sandal. If you do not have any Birkenstocks, it might help to go to a Birkenstock store to be fitted before ordering them online, so that you know the arch 'bump' is in the right place for your foot.

Also, you probably should be using custom orthotics since you would have different needs in an orthotic than a flat footed pronator would have.

I don't know of any specific stretches for high arched people. Do stretches that are not weight bearing (sitting stretches are nice). I've been sitting on a bed with my leg and foot out in front of me and supported by the bed, and pointing my toes towards my nose, and holding for 30 seconds. If it hurts, I don't point so hard or for so long. If I'm feeling pretty good and the stretching didn't hurt, I pull on my toes with my hands a bit.

Good luck, and I'll be interested in reading other comments and suggestions in this thread.

Carole C

Re: high arches

sheila p on 3/25/02 at 12:03 (077500)

I have both, although the most vicious area is right where the end of the heel tissue meets the soft part of the arch. Yes, it's medial. Why do you ask?

Re: high arches

D.Thomas on 3/25/02 at 13:56 (077509)

Well,

People with insertional PF have more options than people with pain in the arches. For example, if your pain is mainly the insertional PF (in the heel) I would see if I was a good canidate for ESTW way before I would consider surgrey. ESTW has only been tested on insertional PF.

If it is in the arches, then you are with me and considered a very low minority. Most PF'ers tend to be flat footed and/or have pain in the heel (insertional PF). Having pain in the arch and having high arches is what my Pod says is the hardest to treat.

I can honestly say I don't think I am going to be on the mend anytime soon. And to be honest, us high arch and arch pain don't have that many options avialable as others. I have tried four different orthotics to no avail. I wore tape everyday for 6 months straight. I haven't taken a shower in 6 months (only baths). I rest whenever possible. I have tried every stretch with all varations of when and how much. I am on my second stint of PT and I can tell my Pod is coming to the end where he says the only thing left is surgrey. I really don't know what I am going to do next. I guess you just have to accept this is the way it is going to be for a while.

My emotions have been so up and down from PF, I don't even try and think about it anymore and just accept the way my life has changed. Surgrey scares me too much, I probably will just keep doing what I have been and hope it heals some time soon or they develop something that helps. I know one thing for sure, there is absolutely no quick fix.

Re: high arches

john h on 3/25/02 at 14:10 (077512)

I was just reading the most recent issue of the Mayo Clinic Health Letter. One of their subjects was Flat Feet. They talked about the Post Tibal Tendon as being the main support of the arch and flat feet resulting in both Post Tibal Tendonitis and Plantar Fasciaitis. I think I would prefer high arches to flat feet. Flat feet will keep you out of the military. High arches will not.

Re: high arches

Carole C in NOLA on 3/25/02 at 14:34 (077514)

I am so sorry to hear you are having this much trouble still, D. Thomas. Having PF can be such an emotional and physical roller coaster. I can really relate to what you are saying about up and down. I want to give you hope, because without hope we can plunge into a pretty deep depression. Please hang in there. I think there is hope. I really do.

I think that IF it is possible to keep from re-injuring your feet at all for a couple of months that might help to get you off the roller coaster. Thing is, that's a big IF.. I don't know if it's always possible to prevent re-injury. If it's not possible now, it might be next month. When PF is bad, every little thing seems to re-injure the feet and I could even re-injure them sitting down! Guess I'm 'talented' at messing up my feet. Now, it seems like doing less than I thought I could do, rather than more has helped me to get off that roller coaster and I feel like I am well on the road to recovery, if not recovered. I can do a lot more without re-injury at present. I'm glad you are resting because I think it's vital in order to decrease the re-injuries and the pain that results from them, and I hope that soon you can get off that doggone rollercoaster too.

My PF hurts more in the arch than in the heel, although it started in the back of the bottom of my heel but then within a month it moved into my arch and the lateral side of the bottom of my foot; sometimes it feels like the whole bottom of my foot (except the toes and metatarsal area) is burning and hurts a lot. But overall, the pain is worst in the medial arch rather than at the insertional point. I've found that for me arch support alone is not as helpful as it seemed like it would be. It does help. My custom orthotics worked out pretty well for me, and with lots of rest, stretching, and all the rest of what we do here, I am doing OK.

I am not taking baths, because I feel that standing up from a seated position without my orthotics would strain my PF too much. So, I'm using a shower stool and shower shoes both, in the shower. I still do that, although I have recovered for the most part.

Carole C

Re: high arches

Carole C in NOLA on 3/25/02 at 14:37 (077515)

That is true, John. I would prefer average normal feet without PF to either flat feet or high arches, personally! LOL

Carole C

Re: high arches

Ed Davis, DPM on 3/25/02 at 23:59 (077564)

You have not really considered the conservative treatment options before surgery. Surgery is a last resort. Unfortunately, time is working against you--- plantar fasciitis gets harder to treat when it has been around for a long time. You really need to see a doctor who is ready to treat you with the full spectrum of conservative modalities and do so expeditiously.

Study Scott's Heel Pain Book for a an excellent overview of the conservative treatment modalities for PF --- orthotics, stretching, night splints, ESWT....

Most prefabricated orthotics are designed for individuals who are overpronators or for flat feet, thus individuals with high arches may do better with the custom option.
Ed

Re: high arches

Ed Davis, DPM on 3/26/02 at 00:01 (077565)

John:
I think flat feet may keep you out of the infantry but not necessarily the military any more. There are quite a few podiatrists in the military now.
Ed

Re: high arches

Ed Davis, DPM on 3/26/02 at 00:06 (077566)

D. Thomas:
Has your ankle dorsiflexion range of motion been measured? Individuals with high arches more commonly have tight achilles-gastrosoleus complexes.
Ed

Re: high arches

john h on 3/26/02 at 11:19 (077597)

Dr. Davis: I have an email friend who is a paratrooper. A couple of years ago he had a surgery on his achilles tendon and some surgery on his great toe (cheiletomy) by a military podiatrist. He is back to jumping out of aircraft again. I wonder what restrictions there are on people with flat feet as I really do not know anymore. I would think people who are carrying 100lb back packs (typical for a grunt) and operating in rocky mountainous enviroments like Afganistan do with flat feet? What about a paratrooper hitting the ground with a lage amount of equipment? That would seem to be sure trouble in the making.

Re: high arches

CatherineL on 3/26/02 at 14:18 (077614)

Sheila,

I also have high arches.

I'm told I have very high arches (size 5 1/2 feet), an underpronator, very tight calve muscles, little flex, and insertional pain. Have also had this pain for about 2 years...

My only relief was with vioxx, laser therapy, and now... oddly flexril (presribed for something completely different)has seems to be help. It may make sense, since my problems are linked to wearing high heels for so many years that my calves are extremely tight, so the flexril may be loosening the muscles and helping the heel from being pulled upward... thus, not putting so much strain on the PF...

It's all just a guessing game at this point.

Catherine

Re: high arches

D.Thomas on 3/26/02 at 15:48 (077624)

Dr. Ed,

Here is my measurments from PT:

When I started last month I was (Gastro Left 7, Right 12) (Soleus Left 7, Right 16) (Hamstrings Left -25, Right -25).

Now they are (Gastro Left 11, Right 17) (Soleus Left 16, Right 20) (Hamstrings Left -16, Right -20).

I have had improvement in my flexibility, but the pain hasn't really changed that much. As you can probably see the left foot has more pain than the right. The medial part of the fascia is very bumpy in my left foot. When he does the soft tissue massage they feel like rice crispes along the whole medial band.

He did say that the density of the fascia feels much better than it did when we started, but I really havent felt any improvements.

Re: high arches

Susan K on 3/26/02 at 20:13 (077665)

Carol, After reading your post I feel like I'm reading my own. My PF has been here for 10 months, but after seeing a Rheumatologist, Podiatrist, PT, and surgeon I may have found relief. I too received the shot and it did nothing last year, but the one I got lately has helped. My surgeon has PF & says the BEST treatment is stretching. So, between the stretching, wearing my Asics all the time, and sleeping with magnets ace-bandaged to my foot I think its improving. Honestly, I thought the magnets were bull, but after a week my foot feels good even when sitting for a awhile & getting up. The depression that this condition causes is tremendous. Trying to find shoes to wear that look somewhat decent with clothes is tough. I am now looking for magnetic shoe inserts. I read of them in a Prevention article. I guess Im a prime candidate for PF- high arches, over-weight, & arthritic. But, I'm not old & wont give in to this pain. Hopefully, this improvement will continue.Good luck! Susan

Re: high arches

Carole C in NOLA on 3/26/02 at 20:55 (077667)

I am feeling a lot better, but only recently so I don't take it for granted and I try to do the right things. I got PF on Sept 22nd, six months and 4 days ago. That may not seem like very long, but it did to me. I was in a lot of pain and dreadfully depressed around Christmas time. But now, my feet are feeling better and I feel more cheerful (naturally!)

You have seen a lot more foot professionals than I have! It sounds to me like your surgeon may very well be right. I've been doing more stretching lately. By that, I mean that I am starting with the same very gentle stretches, and repeating them over a longer total period of time, and I can do more towards the end. That really seems to help me a lot, because it relaxes or loosens my very tight tendons and tissues in my lower leg and feet. Also, it helps to make circles with my feet by rotating my ankles gently to loosen them, and I like gently wiggling my toes and extending and flexing my toes and forefoot gently if it doesn't hurt, also to loosen things up. I am thinking that maybe the depression contributes to this tightness in the tissues, because it makes me tense. But, I don't know if that's the case. Instead of freaking out when my feet start to hurt, now I just do longer and longer periods of gentle stretching and loosening, and I try not to worry about it, and the pain seems to be soothed by all this. I've never had one of those shots but there were times when they sounded like a great idea (shudder!).

What kind of magnets do you use? I haven't tried any because I didn't think they would work either, but they're probably not too expensive.

I finally found some shoes that I like and can wear (SAS Free Times during the day, and Birkenstock Fuldas in the evening). It isn't easy to find the right shoes for one's unique individual feet and foot problems. My custom orthotics were best on my feet but my C.Ped made them huge and fitted them into humungous men's shoes; as the pain receded I felt a need to wear more normal shoes. But, I still wear them sometimes.

Carole C

Re: high arches

Susan K on 3/27/02 at 07:01 (077703)

I really agree re: the foot circles and loosening before the actual stretches. I do need to find some supportive slippers to wear in the house. I'm not a shoe-person @ home so this is a challenge. It seems like this is a slow process of trial & error to attain the right system for yourself and hopefully get better.

I got these magnets @ Champs. They were meant to be put into holders to wear for ankle sprains,etc. They are 4 small magnets in a soft/velcro covering shaped like an oval. I just ace-bandage it to the area & sleep with it. Honestly, it supposedly generates the blood to flow better to the injured area. SOme people it helps, others not. But they were on sale for $3.00 and I thought it couldnt hurt. Maybe they could help you?

Are you able to work out at all since this started? I try & walk at least 3x a week. THis condition sure doesnt aid weight loss!

Re: high arches

D.Thomas on 3/27/02 at 08:42 (077711)

Dr. Ed,

I been thinking about something else. I have been having problems with finding orthotics that help. The last pair from my current Pod did good in helping the pain in my arch but created weird vibration sensations on the inner part of my feet. He lowered the prescription and it still was doing the same. He told me that if he lowers the prescription any more it will be like just another insert. So he wanted me to try the PowerStep for a while. The vibration sensations are better, but now my arches are starting to hurt again. I don't think my Pod knows what to try next with the orthotics. I was hoping I could have him write down what problems I have and what he prescribed in the orthotics ans see if you have anything you might suggest. I just don't know how he will react, I hope he doesn't think I am questioning his ability, I just want to make sure we try everything. What do you think?

Re: high arches

Ed Davis, DPM on 3/27/02 at 10:54 (077724)

It appears that the tissue quality of your plantar fascia is an issue although I am surprised that you have not benefitted from the increase in flexibility. This is the area in which ESWT makes its improvement-- causing remodeling of the tissue. Have you looked into ESWT.

If you do eventually opt for surgery, I have generally found that individuals with high arches and tight thick fasciae seem to have the most benefit.
Ed

Re: high arches

D.Thomas on 3/27/02 at 12:08 (077732)

I have been told that ESWT is only for people who have insertional PF, not for people who have pain in the arch. The whole medial band from the heel to the big toe seems pretty tight and has that rice crispy feel on both feet. I think that area is to big for ESWT to do any good.

Re: high arches

Carole C in NOLA on 3/27/02 at 14:11 (077736)

I stopped all my working out when this started. I apparently got PF from riding my recumbent bike barefoot, on maximum tension, with my seat too far back so my tendons were getting 'twanged' on each go-around. My other exercise at the time was calisthenics, and many of the leg lifts and so on pull on the Achilles and other tendons, so I quit that too. My doctor had already advised against walking for exercise, due to my arthritis. Since I got PF, I've only been able to maintain my weight although I still attend Weight Watchers. At least I didn't gain!

Yesterday I started riding my recumbent bike again, with the lowest tension, with the seat positioned better, and with my custom orthotics and sturdy shoes. I don't think I injured myself, but it always takes a day or two to find out. I also wore the custom orthotics today, to make sure I was doing all I could to prevent any damage from the workout. I only rode for three minutes total, in two sessions, but I want to be very careful and not mess up my feet again. It was very exhilarating, though!

I wear my Birkenstock sandals around the house instead of slippers. They are nice because they are backless, so I can just slip into them or out of them and don't have to fasten anything. They have a very supportive footbed and many of us wear them; maybe you do too. I don't recall if you mentioned them or not. If you haven't ever tried them on it might be an option to consider.

Thanks for the info on the magnets. If I see some, I'll get them. For $3, what's there to lose? They might help.

Carole C

Re: high arches

D.Thomas on 3/27/02 at 15:16 (077749)

Hmm. That last post was not mine. What I wrote is that I have looked into ESWT but I have been told that it only has been tested on insertional PF and my pain is in the arch. Plus, it's the whole medial band from the heel to the big toe that has that rice crispy feel when you try and do soft tissue massage. I think my problem area is too large of an area for even a trial test on ESTW.

Re: high arches

BG CPed on 3/27/02 at 21:26 (077796)

Is it possible for you to post a few pics? a shot from front and back standing w/out socks on on hard floor. Also a pic of your orthotics from back and side ( should fit both views on 1 pic) also perhaps a pic of your foot standing on just the orthotics then 1 standing with them in your most common footwear (also front on views). This may sound like a hassle but it would be easier for a few of us to perhaps offer a suggestion on your fo and or footwear.

I have seen you have been dealing with this for a long time

Re: high arches

D.Thomas on 3/28/02 at 08:55 (077826)

Well I was actually thinking about making a video of my walking and inserts that I could send Dr. Ed and would also send you a copy. But, I see my Pod tomorrow morning for a follow up to discuss how the PT has been going. We will also discuss the orthotics since I stopped using his and just went to PowerSteps to see if the vibration sensations would go away. I have a feeling he doesn't know what to do next with the orthotics.

I guess the next step is I go somewhere else to see if somebody else has any other ideas about orthotics, or we start to talk about surgrey. I know my Pod is a pretty good doctor, so if I decide to go somewhere else, it will either be Seattle to see Dr. Ed or up in Detroit to see Dr. Manoli. I guess I will try and figure it out tomorrow after talking with my Pod. Thanks for the reply and help.

I just want to be sure I have tried every option to the best of my ability before I go surgrey. I am starting to actually consider it given all the options that I have tried to date.

Re: BG

D.Thomas on 3/29/02 at 08:43 (077953)

I just got back from my Pod. He wants to try another adjustment to his orthotics. We didn't have time to talk about exactly what my problems are but he did mention that he was trying exactly what your and Manoli's paper describes. In my case, it appears, that methodology helps my arch, but it appears that it is also irritating a nerve. He said if this last adjustment doesn't work we might try a softer material and see what happens.

Does any of this ring a bell with you? I don't know if knowing he is using what is in your paper is enough information to understand what is going on with my situation?

I just haven't understood exactly what are bad about my feet and what he is trying to correct. I can't understand the jargon.

Re: high arches

Jill T. on 3/29/02 at 14:34 (077985)

Carole:

I have a similar story to yours however I have had symptoms on and off for four years...altho I think my symptoms are milder than most.
I believe I injured my feet (both have PF) doing step aerobics. Like an idiot I never stretched before it...and I know I was often tense and tight. My first and only foot Dr. (up until January) just suggested I stretch a little and that eventually they would heal themselves or I would have to have surgery. Finally in January I got referred to someone else who only wanted me to have shots. I told her, flat out NO, having read this board many times...and feeling that shots are a next to last resort (surgery being the last resort). She then acquiesced and let me begin physical therapy. In therapy they have been using the sonogram machine on my arch and heel, taught me several exercises to strengthen legs, hips, ankles and feet. Given me stretches to do, direct ice massage (ick), and stimulation. All of which (along with me icing a ton at home/office/riding in the car on longer trips and exercising and stretching religiously) has resulted in a left foot being pain free! Right foot is still tender - but I now have hope.
I wear my Birkis in the house too and LOVE them...would highly recommend them. My dr. prescribed foot orthotics, which I wear but am not fully confident in them. My Birkis often feel better to me.
Most successful therapy for me seems to be icing and stretching...My right foot gets taped by my PT but I don't know if it helps much beyond the first couple of hours...and it's the whole sole of my foot taped except for toes and the ball. Massaging my arches and heels myself also seems to help somewhat.
Thank God for this forum...I don't know what I would have done without this as a reference all this time! Best wishes to everyone and their feet!

Re: high arches

Carole C in NOLA on 3/29/02 at 14:51 (077986)

I think I'm finally, precariously, beginning to be able to exercise riding my recumbent bike again. Last night I went from 2 minutes twice a day to one 5 minute session (I'm being very cautious). You know what was neat? This morning when I woke up, my KNEES were sore. Not my feet, not my tendons, but my knees. I was thrilled! Not so much that my knees hurt, but that my feet didn't and yet I had done enough workout for something else to be feeling it. I took my Celebrex and the knee pain is gone now. I hope I can keep exercising like this.

If your Birkenstocks feel better than your custom orthotics, I think you need to have the orthotics adjusted maybe. They should feel at least as good, it seems to me. Mine do, unless I have worn them a long time and need to wiggle my toes a bit. :)

Good luck to you! It sounds like you're well on the road to recovery.

Carole C

Re: high arches

D.Thomas on 3/25/02 at 10:59 (077490)

My Pod says high arches are the hardest to treat for PF. I have had this last episode for over a year.

Shelia do you have insetional PF (pain in the heel) or pain in the arches? If it is in the arch, is it in the medial band (inner part of foot) of the fascia?

Re: high arches

Carole C in NOLA on 3/25/02 at 11:38 (077496)

I can sure sympathize. So often it seems to be assumed that a PF sufferer is always a pronator that tends towards flat feet, because so many are. But not all!

To the best of my knowledge my arch is a little on the high side of normal, and I don't need pronation control. Even though I'm probably not an extreme high arch case, I'd like to share ideas.

Have you tried SAS shoes? Some PF sufferers with higher arches like them (and specifically, I like them). You can't buy them online, and it's difficult to impossible to find out online where to buy them since SAS prohibits stores that carry their shoes from publicizing that fact online. Often they are carried in SAS shoes stores, or else in stores that sell orthopedic and diabetic shoes, or else in better shoes stores. Try the 'yellow pages' at http://www.yahoo.com or your regular (paper) yellow pages to see if there's a SAS shoe store in your area.

Another great shoe is the Birkenstock, but we need the high arched version. Some Tatamis are high arched, and I have (and highly recommend!) the Amsterdam clog and the Fulda sandal. If you do not have any Birkenstocks, it might help to go to a Birkenstock store to be fitted before ordering them online, so that you know the arch 'bump' is in the right place for your foot.

Also, you probably should be using custom orthotics since you would have different needs in an orthotic than a flat footed pronator would have.

I don't know of any specific stretches for high arched people. Do stretches that are not weight bearing (sitting stretches are nice). I've been sitting on a bed with my leg and foot out in front of me and supported by the bed, and pointing my toes towards my nose, and holding for 30 seconds. If it hurts, I don't point so hard or for so long. If I'm feeling pretty good and the stretching didn't hurt, I pull on my toes with my hands a bit.

Good luck, and I'll be interested in reading other comments and suggestions in this thread.

Carole C

Re: high arches

sheila p on 3/25/02 at 12:03 (077500)

I have both, although the most vicious area is right where the end of the heel tissue meets the soft part of the arch. Yes, it's medial. Why do you ask?

Re: high arches

D.Thomas on 3/25/02 at 13:56 (077509)

Well,

People with insertional PF have more options than people with pain in the arches. For example, if your pain is mainly the insertional PF (in the heel) I would see if I was a good canidate for ESTW way before I would consider surgrey. ESTW has only been tested on insertional PF.

If it is in the arches, then you are with me and considered a very low minority. Most PF'ers tend to be flat footed and/or have pain in the heel (insertional PF). Having pain in the arch and having high arches is what my Pod says is the hardest to treat.

I can honestly say I don't think I am going to be on the mend anytime soon. And to be honest, us high arch and arch pain don't have that many options avialable as others. I have tried four different orthotics to no avail. I wore tape everyday for 6 months straight. I haven't taken a shower in 6 months (only baths). I rest whenever possible. I have tried every stretch with all varations of when and how much. I am on my second stint of PT and I can tell my Pod is coming to the end where he says the only thing left is surgrey. I really don't know what I am going to do next. I guess you just have to accept this is the way it is going to be for a while.

My emotions have been so up and down from PF, I don't even try and think about it anymore and just accept the way my life has changed. Surgrey scares me too much, I probably will just keep doing what I have been and hope it heals some time soon or they develop something that helps. I know one thing for sure, there is absolutely no quick fix.

Re: high arches

john h on 3/25/02 at 14:10 (077512)

I was just reading the most recent issue of the Mayo Clinic Health Letter. One of their subjects was Flat Feet. They talked about the Post Tibal Tendon as being the main support of the arch and flat feet resulting in both Post Tibal Tendonitis and Plantar Fasciaitis. I think I would prefer high arches to flat feet. Flat feet will keep you out of the military. High arches will not.

Re: high arches

Carole C in NOLA on 3/25/02 at 14:34 (077514)

I am so sorry to hear you are having this much trouble still, D. Thomas. Having PF can be such an emotional and physical roller coaster. I can really relate to what you are saying about up and down. I want to give you hope, because without hope we can plunge into a pretty deep depression. Please hang in there. I think there is hope. I really do.

I think that IF it is possible to keep from re-injuring your feet at all for a couple of months that might help to get you off the roller coaster. Thing is, that's a big IF.. I don't know if it's always possible to prevent re-injury. If it's not possible now, it might be next month. When PF is bad, every little thing seems to re-injure the feet and I could even re-injure them sitting down! Guess I'm 'talented' at messing up my feet. Now, it seems like doing less than I thought I could do, rather than more has helped me to get off that roller coaster and I feel like I am well on the road to recovery, if not recovered. I can do a lot more without re-injury at present. I'm glad you are resting because I think it's vital in order to decrease the re-injuries and the pain that results from them, and I hope that soon you can get off that doggone rollercoaster too.

My PF hurts more in the arch than in the heel, although it started in the back of the bottom of my heel but then within a month it moved into my arch and the lateral side of the bottom of my foot; sometimes it feels like the whole bottom of my foot (except the toes and metatarsal area) is burning and hurts a lot. But overall, the pain is worst in the medial arch rather than at the insertional point. I've found that for me arch support alone is not as helpful as it seemed like it would be. It does help. My custom orthotics worked out pretty well for me, and with lots of rest, stretching, and all the rest of what we do here, I am doing OK.

I am not taking baths, because I feel that standing up from a seated position without my orthotics would strain my PF too much. So, I'm using a shower stool and shower shoes both, in the shower. I still do that, although I have recovered for the most part.

Carole C

Re: high arches

Carole C in NOLA on 3/25/02 at 14:37 (077515)

That is true, John. I would prefer average normal feet without PF to either flat feet or high arches, personally! LOL

Carole C

Re: high arches

Ed Davis, DPM on 3/25/02 at 23:59 (077564)

You have not really considered the conservative treatment options before surgery. Surgery is a last resort. Unfortunately, time is working against you--- plantar fasciitis gets harder to treat when it has been around for a long time. You really need to see a doctor who is ready to treat you with the full spectrum of conservative modalities and do so expeditiously.

Study Scott's Heel Pain Book for a an excellent overview of the conservative treatment modalities for PF --- orthotics, stretching, night splints, ESWT....

Most prefabricated orthotics are designed for individuals who are overpronators or for flat feet, thus individuals with high arches may do better with the custom option.
Ed

Re: high arches

Ed Davis, DPM on 3/26/02 at 00:01 (077565)

John:
I think flat feet may keep you out of the infantry but not necessarily the military any more. There are quite a few podiatrists in the military now.
Ed

Re: high arches

Ed Davis, DPM on 3/26/02 at 00:06 (077566)

D. Thomas:
Has your ankle dorsiflexion range of motion been measured? Individuals with high arches more commonly have tight achilles-gastrosoleus complexes.
Ed

Re: high arches

john h on 3/26/02 at 11:19 (077597)

Dr. Davis: I have an email friend who is a paratrooper. A couple of years ago he had a surgery on his achilles tendon and some surgery on his great toe (cheiletomy) by a military podiatrist. He is back to jumping out of aircraft again. I wonder what restrictions there are on people with flat feet as I really do not know anymore. I would think people who are carrying 100lb back packs (typical for a grunt) and operating in rocky mountainous enviroments like Afganistan do with flat feet? What about a paratrooper hitting the ground with a lage amount of equipment? That would seem to be sure trouble in the making.

Re: high arches

CatherineL on 3/26/02 at 14:18 (077614)

Sheila,

I also have high arches.

I'm told I have very high arches (size 5 1/2 feet), an underpronator, very tight calve muscles, little flex, and insertional pain. Have also had this pain for about 2 years...

My only relief was with vioxx, laser therapy, and now... oddly flexril (presribed for something completely different)has seems to be help. It may make sense, since my problems are linked to wearing high heels for so many years that my calves are extremely tight, so the flexril may be loosening the muscles and helping the heel from being pulled upward... thus, not putting so much strain on the PF...

It's all just a guessing game at this point.

Catherine

Re: high arches

D.Thomas on 3/26/02 at 15:48 (077624)

Dr. Ed,

Here is my measurments from PT:

When I started last month I was (Gastro Left 7, Right 12) (Soleus Left 7, Right 16) (Hamstrings Left -25, Right -25).

Now they are (Gastro Left 11, Right 17) (Soleus Left 16, Right 20) (Hamstrings Left -16, Right -20).

I have had improvement in my flexibility, but the pain hasn't really changed that much. As you can probably see the left foot has more pain than the right. The medial part of the fascia is very bumpy in my left foot. When he does the soft tissue massage they feel like rice crispes along the whole medial band.

He did say that the density of the fascia feels much better than it did when we started, but I really havent felt any improvements.

Re: high arches

Susan K on 3/26/02 at 20:13 (077665)

Carol, After reading your post I feel like I'm reading my own. My PF has been here for 10 months, but after seeing a Rheumatologist, Podiatrist, PT, and surgeon I may have found relief. I too received the shot and it did nothing last year, but the one I got lately has helped. My surgeon has PF & says the BEST treatment is stretching. So, between the stretching, wearing my Asics all the time, and sleeping with magnets ace-bandaged to my foot I think its improving. Honestly, I thought the magnets were bull, but after a week my foot feels good even when sitting for a awhile & getting up. The depression that this condition causes is tremendous. Trying to find shoes to wear that look somewhat decent with clothes is tough. I am now looking for magnetic shoe inserts. I read of them in a Prevention article. I guess Im a prime candidate for PF- high arches, over-weight, & arthritic. But, I'm not old & wont give in to this pain. Hopefully, this improvement will continue.Good luck! Susan

Re: high arches

Carole C in NOLA on 3/26/02 at 20:55 (077667)

I am feeling a lot better, but only recently so I don't take it for granted and I try to do the right things. I got PF on Sept 22nd, six months and 4 days ago. That may not seem like very long, but it did to me. I was in a lot of pain and dreadfully depressed around Christmas time. But now, my feet are feeling better and I feel more cheerful (naturally!)

You have seen a lot more foot professionals than I have! It sounds to me like your surgeon may very well be right. I've been doing more stretching lately. By that, I mean that I am starting with the same very gentle stretches, and repeating them over a longer total period of time, and I can do more towards the end. That really seems to help me a lot, because it relaxes or loosens my very tight tendons and tissues in my lower leg and feet. Also, it helps to make circles with my feet by rotating my ankles gently to loosen them, and I like gently wiggling my toes and extending and flexing my toes and forefoot gently if it doesn't hurt, also to loosen things up. I am thinking that maybe the depression contributes to this tightness in the tissues, because it makes me tense. But, I don't know if that's the case. Instead of freaking out when my feet start to hurt, now I just do longer and longer periods of gentle stretching and loosening, and I try not to worry about it, and the pain seems to be soothed by all this. I've never had one of those shots but there were times when they sounded like a great idea (shudder!).

What kind of magnets do you use? I haven't tried any because I didn't think they would work either, but they're probably not too expensive.

I finally found some shoes that I like and can wear (SAS Free Times during the day, and Birkenstock Fuldas in the evening). It isn't easy to find the right shoes for one's unique individual feet and foot problems. My custom orthotics were best on my feet but my C.Ped made them huge and fitted them into humungous men's shoes; as the pain receded I felt a need to wear more normal shoes. But, I still wear them sometimes.

Carole C

Re: high arches

Susan K on 3/27/02 at 07:01 (077703)

I really agree re: the foot circles and loosening before the actual stretches. I do need to find some supportive slippers to wear in the house. I'm not a shoe-person @ home so this is a challenge. It seems like this is a slow process of trial & error to attain the right system for yourself and hopefully get better.

I got these magnets @ Champs. They were meant to be put into holders to wear for ankle sprains,etc. They are 4 small magnets in a soft/velcro covering shaped like an oval. I just ace-bandage it to the area & sleep with it. Honestly, it supposedly generates the blood to flow better to the injured area. SOme people it helps, others not. But they were on sale for $3.00 and I thought it couldnt hurt. Maybe they could help you?

Are you able to work out at all since this started? I try & walk at least 3x a week. THis condition sure doesnt aid weight loss!

Re: high arches

D.Thomas on 3/27/02 at 08:42 (077711)

Dr. Ed,

I been thinking about something else. I have been having problems with finding orthotics that help. The last pair from my current Pod did good in helping the pain in my arch but created weird vibration sensations on the inner part of my feet. He lowered the prescription and it still was doing the same. He told me that if he lowers the prescription any more it will be like just another insert. So he wanted me to try the PowerStep for a while. The vibration sensations are better, but now my arches are starting to hurt again. I don't think my Pod knows what to try next with the orthotics. I was hoping I could have him write down what problems I have and what he prescribed in the orthotics ans see if you have anything you might suggest. I just don't know how he will react, I hope he doesn't think I am questioning his ability, I just want to make sure we try everything. What do you think?

Re: high arches

Ed Davis, DPM on 3/27/02 at 10:54 (077724)

It appears that the tissue quality of your plantar fascia is an issue although I am surprised that you have not benefitted from the increase in flexibility. This is the area in which ESWT makes its improvement-- causing remodeling of the tissue. Have you looked into ESWT.

If you do eventually opt for surgery, I have generally found that individuals with high arches and tight thick fasciae seem to have the most benefit.
Ed

Re: high arches

D.Thomas on 3/27/02 at 12:08 (077732)

I have been told that ESWT is only for people who have insertional PF, not for people who have pain in the arch. The whole medial band from the heel to the big toe seems pretty tight and has that rice crispy feel on both feet. I think that area is to big for ESWT to do any good.

Re: high arches

Carole C in NOLA on 3/27/02 at 14:11 (077736)

I stopped all my working out when this started. I apparently got PF from riding my recumbent bike barefoot, on maximum tension, with my seat too far back so my tendons were getting 'twanged' on each go-around. My other exercise at the time was calisthenics, and many of the leg lifts and so on pull on the Achilles and other tendons, so I quit that too. My doctor had already advised against walking for exercise, due to my arthritis. Since I got PF, I've only been able to maintain my weight although I still attend Weight Watchers. At least I didn't gain!

Yesterday I started riding my recumbent bike again, with the lowest tension, with the seat positioned better, and with my custom orthotics and sturdy shoes. I don't think I injured myself, but it always takes a day or two to find out. I also wore the custom orthotics today, to make sure I was doing all I could to prevent any damage from the workout. I only rode for three minutes total, in two sessions, but I want to be very careful and not mess up my feet again. It was very exhilarating, though!

I wear my Birkenstock sandals around the house instead of slippers. They are nice because they are backless, so I can just slip into them or out of them and don't have to fasten anything. They have a very supportive footbed and many of us wear them; maybe you do too. I don't recall if you mentioned them or not. If you haven't ever tried them on it might be an option to consider.

Thanks for the info on the magnets. If I see some, I'll get them. For $3, what's there to lose? They might help.

Carole C

Re: high arches

D.Thomas on 3/27/02 at 15:16 (077749)

Hmm. That last post was not mine. What I wrote is that I have looked into ESWT but I have been told that it only has been tested on insertional PF and my pain is in the arch. Plus, it's the whole medial band from the heel to the big toe that has that rice crispy feel when you try and do soft tissue massage. I think my problem area is too large of an area for even a trial test on ESTW.

Re: high arches

BG CPed on 3/27/02 at 21:26 (077796)

Is it possible for you to post a few pics? a shot from front and back standing w/out socks on on hard floor. Also a pic of your orthotics from back and side ( should fit both views on 1 pic) also perhaps a pic of your foot standing on just the orthotics then 1 standing with them in your most common footwear (also front on views). This may sound like a hassle but it would be easier for a few of us to perhaps offer a suggestion on your fo and or footwear.

I have seen you have been dealing with this for a long time

Re: high arches

D.Thomas on 3/28/02 at 08:55 (077826)

Well I was actually thinking about making a video of my walking and inserts that I could send Dr. Ed and would also send you a copy. But, I see my Pod tomorrow morning for a follow up to discuss how the PT has been going. We will also discuss the orthotics since I stopped using his and just went to PowerSteps to see if the vibration sensations would go away. I have a feeling he doesn't know what to do next with the orthotics.

I guess the next step is I go somewhere else to see if somebody else has any other ideas about orthotics, or we start to talk about surgrey. I know my Pod is a pretty good doctor, so if I decide to go somewhere else, it will either be Seattle to see Dr. Ed or up in Detroit to see Dr. Manoli. I guess I will try and figure it out tomorrow after talking with my Pod. Thanks for the reply and help.

I just want to be sure I have tried every option to the best of my ability before I go surgrey. I am starting to actually consider it given all the options that I have tried to date.

Re: BG

D.Thomas on 3/29/02 at 08:43 (077953)

I just got back from my Pod. He wants to try another adjustment to his orthotics. We didn't have time to talk about exactly what my problems are but he did mention that he was trying exactly what your and Manoli's paper describes. In my case, it appears, that methodology helps my arch, but it appears that it is also irritating a nerve. He said if this last adjustment doesn't work we might try a softer material and see what happens.

Does any of this ring a bell with you? I don't know if knowing he is using what is in your paper is enough information to understand what is going on with my situation?

I just haven't understood exactly what are bad about my feet and what he is trying to correct. I can't understand the jargon.

Re: high arches

Jill T. on 3/29/02 at 14:34 (077985)

Carole:

I have a similar story to yours however I have had symptoms on and off for four years...altho I think my symptoms are milder than most.
I believe I injured my feet (both have PF) doing step aerobics. Like an idiot I never stretched before it...and I know I was often tense and tight. My first and only foot Dr. (up until January) just suggested I stretch a little and that eventually they would heal themselves or I would have to have surgery. Finally in January I got referred to someone else who only wanted me to have shots. I told her, flat out NO, having read this board many times...and feeling that shots are a next to last resort (surgery being the last resort). She then acquiesced and let me begin physical therapy. In therapy they have been using the sonogram machine on my arch and heel, taught me several exercises to strengthen legs, hips, ankles and feet. Given me stretches to do, direct ice massage (ick), and stimulation. All of which (along with me icing a ton at home/office/riding in the car on longer trips and exercising and stretching religiously) has resulted in a left foot being pain free! Right foot is still tender - but I now have hope.
I wear my Birkis in the house too and LOVE them...would highly recommend them. My dr. prescribed foot orthotics, which I wear but am not fully confident in them. My Birkis often feel better to me.
Most successful therapy for me seems to be icing and stretching...My right foot gets taped by my PT but I don't know if it helps much beyond the first couple of hours...and it's the whole sole of my foot taped except for toes and the ball. Massaging my arches and heels myself also seems to help somewhat.
Thank God for this forum...I don't know what I would have done without this as a reference all this time! Best wishes to everyone and their feet!

Re: high arches

Carole C in NOLA on 3/29/02 at 14:51 (077986)

I think I'm finally, precariously, beginning to be able to exercise riding my recumbent bike again. Last night I went from 2 minutes twice a day to one 5 minute session (I'm being very cautious). You know what was neat? This morning when I woke up, my KNEES were sore. Not my feet, not my tendons, but my knees. I was thrilled! Not so much that my knees hurt, but that my feet didn't and yet I had done enough workout for something else to be feeling it. I took my Celebrex and the knee pain is gone now. I hope I can keep exercising like this.

If your Birkenstocks feel better than your custom orthotics, I think you need to have the orthotics adjusted maybe. They should feel at least as good, it seems to me. Mine do, unless I have worn them a long time and need to wiggle my toes a bit. :)

Good luck to you! It sounds like you're well on the road to recovery.

Carole C