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Joyce - casting?

Posted by R C on 5/18/02 at 22:02 (084527)

This message is addressed in part to Joyce, who posted earlier about her severe PF and worries about her future collegiate soccer career. I am not a doctor, but I am a fellow PF sufferer; I read her post and thought she might find this helpful.

Joyce:

It seems to me that if you are suffering from PF, you should not be going to soccer practice and playing in soccer games. Any gains that you might have made in your treatment program would be instantly undone during such vigorous activity. Rest is a necessary component of a successful treatment program.

I urge you to consider setting aside several weeks at a minimum, and making a complete recovery your number one priority. Work out a treatment plan with your health care professional, and devote yourself to it 100%, Until you recover completely, resist the urge to resume normal activity and thereby risk re-injury.

Casting gets a somewhat bad rap in these message boards, and I want to offer the opposing point of view. A cast makes sense since it isolates the injured tissue completely and gives it a chance to heal. It also keeps the ankle bent at a right angle (neutral). It may take 4 to 8 weeks. I believe that many people have a problem with casting since (1) they continue to walk in their cast (rather than use crutches exclusively) - this could perpetuate the injury; and (2) they expect the be cured as soon as the cast is off (in fact, substantial physical therapy is necessary). I was cured after 2 years of PF by 4 weeks of casting plus 4 weeks of physical therapy. Casting, used properly with crutches, is very inconvenient, however.

Your youth and physical fitness no doubt work in your favor. Best wishes, and good luck.

Re: Joyce - casting?

Ed Davis, DPM on 5/20/02 at 15:07 (084684)

Casting can be a good way to allow injured areas to heel. It is important to know if there are biomechnical problems that led to the injury in the first place and treat those problems in order to help prevent recurrence of the problem.
Ed

Re: Joyce - casting?

Donna F on 5/20/02 at 18:55 (084714)

Let me add my two cents worth to this. I just came out of a walking cast on my left foot on Friday after two weeks of wearing it. I am scheduled for an open PF release w/bone spur removal during the first week of June. My doctor left it up to me whether or not I wanted to continue to wear a cast until my surgery. I opted not to because I was still experiencing pain in the foot although not really all that severe (some days were worse than others). Well, let me just say that at 8 a.m. this morning, I was on the phone with the doctor's office practically begging them to put the cast back on. My foot has just about killed me all weekend and I am at the point now to where I can hardly walk at all. I am going in in the morning to have it re-cast since by the time I was able to talk to the nurse at about 2 p.m. this afternoon, my entire foot and ankle was too swelled to put in a cast. So even though sometimes it might not feel like it is doing any good, trust me when I say that now I realize differently. I am a very impatient person by nature and was so excited by the thought of actually getting to take a 'normal' shower that I probably caused even more damage to my foot. A hard lesson learned I suppose. Take care.

Re: Joyce - casting?

Donna F on 5/20/02 at 18:59 (084715)

R C,

I meant to comment on the crutches statement you made in your post. My doctor told me it was o.k. to walk without any sort of walking aids. I thought that was kind of weird because I still had pain in the foot when I put weight on it but he told me that was to be expected and to try and stay off the foot as much as possible but that I did not need any walking aids. Does this sound right?

Re: Joyce - casting?

R C on 5/21/02 at 13:00 (084775)

Dear Donna,

My gut feeling is that if it hurts when you walk on the cast, then you are not getting the full benefit of the cast. Immobilization is only part of the goal. You want to keep your weight off the foot *completely* for a number of weeks because each time you take a step, your weight could tear up the injured tissues where they have tried to repair or re-attach.

The other thing to remember is that if you use a cast/crutches for a number of weeks, then the muscles will weaken and get tight -- it will take careful physical therapy to restore them. During this time you should continue to use crutches until you are comfortable walking again.

This was the only thing that worked for me after 2 years of PF, so I recommend it to others with stubborn cases who want an alternative to surgery. It takes patience and is very inconvenient (basically it knocks out 8 to 10 weeks), but it gave me my normal life back.

Re: Joyce - casting?

Pauline on 5/21/02 at 21:25 (084819)

R.C.
I agree with you completely. If you choose the cast route, you must still stay off the foot. The unfortunate by product is that it tightens and weakens the muscles and you must go through physical therapy when the cast comes off. Those that get relief by using a cast are far better off than having surgery.

Re: Joyce - casting?

Ed Davis, DPM on 5/20/02 at 15:07 (084684)

Casting can be a good way to allow injured areas to heel. It is important to know if there are biomechnical problems that led to the injury in the first place and treat those problems in order to help prevent recurrence of the problem.
Ed

Re: Joyce - casting?

Donna F on 5/20/02 at 18:55 (084714)

Let me add my two cents worth to this. I just came out of a walking cast on my left foot on Friday after two weeks of wearing it. I am scheduled for an open PF release w/bone spur removal during the first week of June. My doctor left it up to me whether or not I wanted to continue to wear a cast until my surgery. I opted not to because I was still experiencing pain in the foot although not really all that severe (some days were worse than others). Well, let me just say that at 8 a.m. this morning, I was on the phone with the doctor's office practically begging them to put the cast back on. My foot has just about killed me all weekend and I am at the point now to where I can hardly walk at all. I am going in in the morning to have it re-cast since by the time I was able to talk to the nurse at about 2 p.m. this afternoon, my entire foot and ankle was too swelled to put in a cast. So even though sometimes it might not feel like it is doing any good, trust me when I say that now I realize differently. I am a very impatient person by nature and was so excited by the thought of actually getting to take a 'normal' shower that I probably caused even more damage to my foot. A hard lesson learned I suppose. Take care.

Re: Joyce - casting?

Donna F on 5/20/02 at 18:59 (084715)

R C,

I meant to comment on the crutches statement you made in your post. My doctor told me it was o.k. to walk without any sort of walking aids. I thought that was kind of weird because I still had pain in the foot when I put weight on it but he told me that was to be expected and to try and stay off the foot as much as possible but that I did not need any walking aids. Does this sound right?

Re: Joyce - casting?

R C on 5/21/02 at 13:00 (084775)

Dear Donna,

My gut feeling is that if it hurts when you walk on the cast, then you are not getting the full benefit of the cast. Immobilization is only part of the goal. You want to keep your weight off the foot *completely* for a number of weeks because each time you take a step, your weight could tear up the injured tissues where they have tried to repair or re-attach.

The other thing to remember is that if you use a cast/crutches for a number of weeks, then the muscles will weaken and get tight -- it will take careful physical therapy to restore them. During this time you should continue to use crutches until you are comfortable walking again.

This was the only thing that worked for me after 2 years of PF, so I recommend it to others with stubborn cases who want an alternative to surgery. It takes patience and is very inconvenient (basically it knocks out 8 to 10 weeks), but it gave me my normal life back.

Re: Joyce - casting?

Pauline on 5/21/02 at 21:25 (084819)

R.C.
I agree with you completely. If you choose the cast route, you must still stay off the foot. The unfortunate by product is that it tightens and weakens the muscles and you must go through physical therapy when the cast comes off. Those that get relief by using a cast are far better off than having surgery.