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recently diagnosed

Posted by Claudia F on 4/01/02 at 06:50 (078136)

I am 53 years old with an active life style and have recently been diagnosed with heel spurs. I have been using a silicon pad in my shoe and taking a pain medication. The pain is more bearable now. Before this pain started 6 months ago, I was walking 6 miles a week on a treadmill. I have a back problem which prohibits me from using most exercise machines which is why I was walking. I gradually tapered this walking time and finally I am not doing it at all. I would like to resume this walking as I am gaining weight and feel better when I exercise. I would guess I may not be able to go back to the same level, but I want to know if I try to start again would that cause more harm.

Re: recently diagnosed

Julie on 4/01/02 at 11:12 (078156)

Claudia

I think the answer is that any weight-bearing exercise is contra-indicated right now, until you have the condition under control. (It's possible that the treadmill walking contributed to it.)

The pain of plantar fasciitis (which sounds like what you've got) is rarely caused by heel spurs: it's an injury to the plantar fascia which can have a number of causes. You should see a foot specialist (a podiatrist) for a full examination, an evaluation of your gait, and a correct diagnosis of the cause of your particular problem, so that it can be addressed with a co-ordinated treatment plan. Pads and pain pills may give temporary relief but are very unlikely to do the job of healing.

Read the heel pain book (click here) for information and ideas about conservative treatments. Don't go barefoot, and always wear good, supportive shoes: your arches need constant support.

If you can swim and have a pool handy, go swimming for your exercise.

Re: recently diagnosed ps

Julie on 4/01/02 at 11:12 (078157)

I should have said: I am not a doctor, but I have had PF (now recovered).

Re: recently diagnosed ps

Dr. David S. Wander on 4/01/02 at 13:43 (078174)

Julie made excellent points and I agree with her 100%. Resuming your activity isn't prudent until you've got the problem properly diagnosed and under control. Treadmills often contribute to the problem more than 'regular' walking, since treadmills cause an additional drag on the foot and an increased toe-off, therefore causing additional stretching of the plantar fascia. (This may sound confusing, but often on a treadmill, the foot 'drags' back more than in real gait. It doesn't always mimic a true heel to toe gait and can cause additional stress on the fascia). A swimming program or water exercise as Julie recommended is also an excellent suggestion. Once again Julie is correct in telling you that the actual heel spur is rarely if ever the actual cause of the pain. The pain is usually from the inflammation of the plantar fascia. Find a good doctor and receive a proper diagnosis based on a good examination. Good luck.

Re: recently diagnosed ps

Ellen J. on 4/01/02 at 19:14 (078219)

Hi,
I'm so glad you mentioned the problem that treadmills can create, as I think that explains why I got reinjured. Since I could walk around town fine, I thought I would have no problem on the treadmill. However, as I walked on it, I started feeling little twinges and after 2 short workouts on the treadmill I was reinjured. I thought it was my athletic shoes (and maybe it sill is to some degree) but I'm pretty sure that machine contributed in a big way. Although my feet were extremely painful after that, I am improving rapidly this time because of the great information generated by the people on this site. The first time I got P.F. I walked around as much as usual, not knowing I should be off my feet. As a result it took me a year to become pain free. This time I've stayed off my feet for 2 solid weeks so far and I'm dramatically improved, though it will be some time before I'm back to where I was before the treadmill episode. Although it's really boring to sit around all the time, I'm very thankful for all the help I'm receiving on this site.
Ellen J.
PS. I really like the freezable gel pack I bought because it conforms to the feet and is soft.

Re: recently diagnosed ps

Julie on 4/02/02 at 00:30 (078226)

Hi Ellen

It's good to hear you're improving. Keep up the good work. Once the penny drops that relative rest is what's needed, the healing process can kick in in earnest. I'm sure you'll keep improving now - just don't go wild too soon.

I like the gel packs too, and used one a lot when my foot needed icing. My husband is using it at the moment on his sore shoulders.

Re: recently diagnosed ps

Ellen J. on 4/02/02 at 16:30 (078270)

Thanks, Julie.
I'll try my best to keep resting as much as possible. It sure is hard to sit around with the springtime sun shining and the birds chirping. I really want to get out on my road bike but I'll stay off it for awhile.
You may not get this message, as it is getting down there on the list, but do you (or anyone) know if we should ice if we feel a little twinge? ie, if the feet are sort of pain free with careful walking but there is the occasional twinge, does that mean we should be continuing to ice? I'm still a bit confused about the icing thing and how long to keep it up. Right now the only time I'm icing is if I overdo (guests came today) and my foot started to continuosly hurt. I then sat and iced and the pain went away.
Maybe there's no exact science to this.
Ellen J.

Re: recently diagnosed ps

Julie on 4/03/02 at 01:49 (078310)

Ellen

I know what you mean about the sun and the birds. It's hard to keep off your feet when they call.

I don't think there is any 'rule' about icing. It's not a cure, it just works to relieve inflammation and the associated pain. It's the sort of thing that you know when you need it, and you seem to. But I'm sure there's no harm in icing a 'twinge'.

Re: recently diagnosed ps

Sharon W on 4/03/02 at 08:27 (078331)

Ellen,

Re: icing. As far as I know, there's no reason NOT to do it whenever want, but it's best not to leave the ice on for more than about 20 minutes at a time. Too much cold, applied for too long at once, can actually damage your skin. At the hospital where I worked, the geneneral rule was to leave the ice bag 20 minutes on, 20 minutes off, and repeat for however long is needed.

-- Sharon

Re: recently diagnosed ps

Julie on 4/03/02 at 10:04 (078347)

Ellen and Sharon

20 minutes sounds a very long time. I thought 10 minutes was the maximum, (less if you're using ice directly on bare skin).

Re: an observation concerning icing intervals

Carole C in NOLA on 4/03/02 at 12:01 (078353)

An observation - - putting my foot on a bag of frozen veggies for REPEATED five minute intervals has proved extremely successful and is much less uncomfortable and painful for me.

I get better results from three 5 minute intervals than from one 10 minute interval. Five 5 minute intervals are often better than 3. Between them, I take my foot off the bag for a minute or so, until I'm comfortable and ready to put it back on.

I guess my point is to suggest that maybe caution (by using short intervals) and efficacy of the treatment aren't mutually exclusive. I realize that neither of you were saying that they are, and this is sort of a peripheral thought.

Carole C

Re: recently diagnosed ps

Sharon W on 4/03/02 at 12:14 (078358)

Julie,

We did not use ice on bare skin. The ice bag was first wrapped in a thin towel before applying it. The 20 minutes was per policy, not my idea. I usually don't leave the ice on my foot that long, either.

-- Sharon

Re: recently diagnosed ps

Dr. David S. Wander on 4/03/02 at 13:19 (078366)

When using ice, it should never be placed directly on the skin. There should always be a sock, thin towel, etc., between the ice and the skin. Medically, the ideal time to leave ice in place is 20 minutes. If the ice is taken off much sooner than that, there is decreased benefit. If the ice is left on too long, several things can occur. In some instances, it can cause damage and create early signs of frostbite. In other cases, as a reflex to prevent the area from freezing, the body actually will shunt more blood to the area to attempt to prevent injury, therefore causing a temporaray increased flow to the area (reflex hyeremia). This would defeat the original purpose of using the ice, which is to decrease inflammation. So, ideally if you can tolerate it, 20 minutes is the recommended time.

Re: Icing

Julie on 4/03/02 at 15:19 (078371)

Ellen, here's the passage on icing from the heel pain book, in case you've not seen it.

Ice was ranked the third most favorite treatment. Applying ice after activity or injury is very important. Some say it is very beneficial to apply ice 3 times a day. My favorite method is to place a few pieces of ice on a towel (to absorb the water) and to step on it while sitting down for 5 minutes (10 minutes may be too long for direct contact). For me, placing ice directly against the skin seems best. Some patients use frozen water in a plastic soda bottle. This method may need to be applied longer because the plastic provides insulation. It's best to keep the injury cool as much as possible for up to 48 hours after the injury. I would apply ice every evening immediately after daily activities. Keeping a recent injury cool reduces internal 'micro-bleeding' which leads to micro-scars (and possibly calcium spur deposits) and keeps down inflammation. Applying ice for longer periods of time may cause vasodilation (blood vessels increase in diameter in order to keep the tissue warm) that may speed healing by improving blood flow, but it may be harmful by increasing inflammation if the injury occured within the last 2 days. The vasodilation theory of healing with ice has been questioned. Some sources say apply ice for 15 minutes, but that is too long unless the ice is insulated from the skin by plastic, or unless the ice is being moved around and not concentrated on a single area. Some sources recommend moving the ice around during the application. Applying ice until the skin turns blue is a definite sign it has been applied for too long.

Re: Icing

Ellen J. on 4/03/02 at 15:58 (078378)

Thanks, everyone.
After some leaky ziploc bags and some frozen juice containers that got warm too quickly, I ended up with the gel packs (I think Julie reccommended them once). I now wear thin socks with my shoes to give my feet more room in the shoes (shoe pressure seems to aggravate the feet). The thin socks, I discovered, work perfectly for icing because they protect the feet from direct contact but allow enough cold to get through to do the job well. So now I really like the thin sock method and I don't have to go through the process of removing socks like I used to. I also found that the hardness of frozen water was too much for my tender arches so that is why I love the gel packs. You can squish them right up into and beside the arches and do a great job.
One more thing I discovered: I had really sore feet last night and before going to bed I placed the gel pack on top of the bed and iced my feet just before sleeping. Afterward I just left the gel pack on the floor for the night because I don't believe in walking right after icing. So I went to bed after icing my feet and woke up with feet that felt better than they had in a long time. I may just do that every night to see if it was coincidence or not.
Thanks for all the incing advice. It sounds like it's OK to ice any time we want, but not to overdo any one session for fear of frostbite or from vasodilation. I am still surprised at how much it helps.
Ellen J.

Re: recently diagnosed

Julie on 4/01/02 at 11:12 (078156)

Claudia

I think the answer is that any weight-bearing exercise is contra-indicated right now, until you have the condition under control. (It's possible that the treadmill walking contributed to it.)

The pain of plantar fasciitis (which sounds like what you've got) is rarely caused by heel spurs: it's an injury to the plantar fascia which can have a number of causes. You should see a foot specialist (a podiatrist) for a full examination, an evaluation of your gait, and a correct diagnosis of the cause of your particular problem, so that it can be addressed with a co-ordinated treatment plan. Pads and pain pills may give temporary relief but are very unlikely to do the job of healing.

Read the heel pain book (click here) for information and ideas about conservative treatments. Don't go barefoot, and always wear good, supportive shoes: your arches need constant support.

If you can swim and have a pool handy, go swimming for your exercise.

Re: recently diagnosed ps

Julie on 4/01/02 at 11:12 (078157)

I should have said: I am not a doctor, but I have had PF (now recovered).

Re: recently diagnosed ps

Dr. David S. Wander on 4/01/02 at 13:43 (078174)

Julie made excellent points and I agree with her 100%. Resuming your activity isn't prudent until you've got the problem properly diagnosed and under control. Treadmills often contribute to the problem more than 'regular' walking, since treadmills cause an additional drag on the foot and an increased toe-off, therefore causing additional stretching of the plantar fascia. (This may sound confusing, but often on a treadmill, the foot 'drags' back more than in real gait. It doesn't always mimic a true heel to toe gait and can cause additional stress on the fascia). A swimming program or water exercise as Julie recommended is also an excellent suggestion. Once again Julie is correct in telling you that the actual heel spur is rarely if ever the actual cause of the pain. The pain is usually from the inflammation of the plantar fascia. Find a good doctor and receive a proper diagnosis based on a good examination. Good luck.

Re: recently diagnosed ps

Ellen J. on 4/01/02 at 19:14 (078219)

Hi,
I'm so glad you mentioned the problem that treadmills can create, as I think that explains why I got reinjured. Since I could walk around town fine, I thought I would have no problem on the treadmill. However, as I walked on it, I started feeling little twinges and after 2 short workouts on the treadmill I was reinjured. I thought it was my athletic shoes (and maybe it sill is to some degree) but I'm pretty sure that machine contributed in a big way. Although my feet were extremely painful after that, I am improving rapidly this time because of the great information generated by the people on this site. The first time I got P.F. I walked around as much as usual, not knowing I should be off my feet. As a result it took me a year to become pain free. This time I've stayed off my feet for 2 solid weeks so far and I'm dramatically improved, though it will be some time before I'm back to where I was before the treadmill episode. Although it's really boring to sit around all the time, I'm very thankful for all the help I'm receiving on this site.
Ellen J.
PS. I really like the freezable gel pack I bought because it conforms to the feet and is soft.

Re: recently diagnosed ps

Julie on 4/02/02 at 00:30 (078226)

Hi Ellen

It's good to hear you're improving. Keep up the good work. Once the penny drops that relative rest is what's needed, the healing process can kick in in earnest. I'm sure you'll keep improving now - just don't go wild too soon.

I like the gel packs too, and used one a lot when my foot needed icing. My husband is using it at the moment on his sore shoulders.

Re: recently diagnosed ps

Ellen J. on 4/02/02 at 16:30 (078270)

Thanks, Julie.
I'll try my best to keep resting as much as possible. It sure is hard to sit around with the springtime sun shining and the birds chirping. I really want to get out on my road bike but I'll stay off it for awhile.
You may not get this message, as it is getting down there on the list, but do you (or anyone) know if we should ice if we feel a little twinge? ie, if the feet are sort of pain free with careful walking but there is the occasional twinge, does that mean we should be continuing to ice? I'm still a bit confused about the icing thing and how long to keep it up. Right now the only time I'm icing is if I overdo (guests came today) and my foot started to continuosly hurt. I then sat and iced and the pain went away.
Maybe there's no exact science to this.
Ellen J.

Re: recently diagnosed ps

Julie on 4/03/02 at 01:49 (078310)

Ellen

I know what you mean about the sun and the birds. It's hard to keep off your feet when they call.

I don't think there is any 'rule' about icing. It's not a cure, it just works to relieve inflammation and the associated pain. It's the sort of thing that you know when you need it, and you seem to. But I'm sure there's no harm in icing a 'twinge'.

Re: recently diagnosed ps

Sharon W on 4/03/02 at 08:27 (078331)

Ellen,

Re: icing. As far as I know, there's no reason NOT to do it whenever want, but it's best not to leave the ice on for more than about 20 minutes at a time. Too much cold, applied for too long at once, can actually damage your skin. At the hospital where I worked, the geneneral rule was to leave the ice bag 20 minutes on, 20 minutes off, and repeat for however long is needed.

-- Sharon

Re: recently diagnosed ps

Julie on 4/03/02 at 10:04 (078347)

Ellen and Sharon

20 minutes sounds a very long time. I thought 10 minutes was the maximum, (less if you're using ice directly on bare skin).

Re: an observation concerning icing intervals

Carole C in NOLA on 4/03/02 at 12:01 (078353)

An observation - - putting my foot on a bag of frozen veggies for REPEATED five minute intervals has proved extremely successful and is much less uncomfortable and painful for me.

I get better results from three 5 minute intervals than from one 10 minute interval. Five 5 minute intervals are often better than 3. Between them, I take my foot off the bag for a minute or so, until I'm comfortable and ready to put it back on.

I guess my point is to suggest that maybe caution (by using short intervals) and efficacy of the treatment aren't mutually exclusive. I realize that neither of you were saying that they are, and this is sort of a peripheral thought.

Carole C

Re: recently diagnosed ps

Sharon W on 4/03/02 at 12:14 (078358)

Julie,

We did not use ice on bare skin. The ice bag was first wrapped in a thin towel before applying it. The 20 minutes was per policy, not my idea. I usually don't leave the ice on my foot that long, either.

-- Sharon

Re: recently diagnosed ps

Dr. David S. Wander on 4/03/02 at 13:19 (078366)

When using ice, it should never be placed directly on the skin. There should always be a sock, thin towel, etc., between the ice and the skin. Medically, the ideal time to leave ice in place is 20 minutes. If the ice is taken off much sooner than that, there is decreased benefit. If the ice is left on too long, several things can occur. In some instances, it can cause damage and create early signs of frostbite. In other cases, as a reflex to prevent the area from freezing, the body actually will shunt more blood to the area to attempt to prevent injury, therefore causing a temporaray increased flow to the area (reflex hyeremia). This would defeat the original purpose of using the ice, which is to decrease inflammation. So, ideally if you can tolerate it, 20 minutes is the recommended time.

Re: Icing

Julie on 4/03/02 at 15:19 (078371)

Ellen, here's the passage on icing from the heel pain book, in case you've not seen it.

Ice was ranked the third most favorite treatment. Applying ice after activity or injury is very important. Some say it is very beneficial to apply ice 3 times a day. My favorite method is to place a few pieces of ice on a towel (to absorb the water) and to step on it while sitting down for 5 minutes (10 minutes may be too long for direct contact). For me, placing ice directly against the skin seems best. Some patients use frozen water in a plastic soda bottle. This method may need to be applied longer because the plastic provides insulation. It's best to keep the injury cool as much as possible for up to 48 hours after the injury. I would apply ice every evening immediately after daily activities. Keeping a recent injury cool reduces internal 'micro-bleeding' which leads to micro-scars (and possibly calcium spur deposits) and keeps down inflammation. Applying ice for longer periods of time may cause vasodilation (blood vessels increase in diameter in order to keep the tissue warm) that may speed healing by improving blood flow, but it may be harmful by increasing inflammation if the injury occured within the last 2 days. The vasodilation theory of healing with ice has been questioned. Some sources say apply ice for 15 minutes, but that is too long unless the ice is insulated from the skin by plastic, or unless the ice is being moved around and not concentrated on a single area. Some sources recommend moving the ice around during the application. Applying ice until the skin turns blue is a definite sign it has been applied for too long.

Re: Icing

Ellen J. on 4/03/02 at 15:58 (078378)

Thanks, everyone.
After some leaky ziploc bags and some frozen juice containers that got warm too quickly, I ended up with the gel packs (I think Julie reccommended them once). I now wear thin socks with my shoes to give my feet more room in the shoes (shoe pressure seems to aggravate the feet). The thin socks, I discovered, work perfectly for icing because they protect the feet from direct contact but allow enough cold to get through to do the job well. So now I really like the thin sock method and I don't have to go through the process of removing socks like I used to. I also found that the hardness of frozen water was too much for my tender arches so that is why I love the gel packs. You can squish them right up into and beside the arches and do a great job.
One more thing I discovered: I had really sore feet last night and before going to bed I placed the gel pack on top of the bed and iced my feet just before sleeping. Afterward I just left the gel pack on the floor for the night because I don't believe in walking right after icing. So I went to bed after icing my feet and woke up with feet that felt better than they had in a long time. I may just do that every night to see if it was coincidence or not.
Thanks for all the incing advice. It sounds like it's OK to ice any time we want, but not to overdo any one session for fear of frostbite or from vasodilation. I am still surprised at how much it helps.
Ellen J.