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To, Dr David Lee

Posted by Pete R on 7/28/02 at 17:18 (090828)

In your post of a couple of weeks ago you mention 2 things which intrigue me.

1. After ESWT, don't use an orthotic on the treated foot ? Why is this, if there maybe a biomechanical fault causing the problem ?

2. You metion a specific stretch of the achilles, can you describe this. Do you agree that the calf should also be stretched. I get confused on what should be stretched, how it should be done, and for how long.

Thanks

Re: To, Dr David Lee

Dr. David Lee on 8/10/02 at 22:50 (092163)

Hi Pete,

Sorry for the delay, for some reason I didn't get the thread.

First, it's not that I don't have my patients use an orthotic in the treated foot, it's that sometimes that can't tolerate it due to the residual bruising effect of ESWT. You are correct that there is a biomech fault. Additionally, one should always wear functional orthotics on both extremities to avoid potential lower back problems.

Second, The claf muscle is the area that I am focused on. This is because the achilles is connected to the calf muscles (gastrocnemius/soleus copmlex). These muscles have the greatest impact on how the arch reacts to standing. With tight calf muscles you will often get more heel pain especially upon rising from the bed or seated position.

An important aspect of performing this stretch is it's technique. Stand facing a wall. You should have your feet straight ahead (or perpendicular to the wall) not turned outward. Your back in line with your back leg so you don't hurt your back (my wife's a chiropractor). Bend your front knee while keeping your back knee locked and hold it for one minute. Repeat for your other leg. During this time you should be sure to keep your arch slightly supported to prevent it from flattening as this may lead to a less efficient stretch. Repeat this exercise 5 times each day.

If you have any further question please write. Dr. David Lee

Re: To, Dr David Lee

Dr. David Lee on 8/10/02 at 22:50 (092163)

Hi Pete,

Sorry for the delay, for some reason I didn't get the thread.

First, it's not that I don't have my patients use an orthotic in the treated foot, it's that sometimes that can't tolerate it due to the residual bruising effect of ESWT. You are correct that there is a biomech fault. Additionally, one should always wear functional orthotics on both extremities to avoid potential lower back problems.

Second, The claf muscle is the area that I am focused on. This is because the achilles is connected to the calf muscles (gastrocnemius/soleus copmlex). These muscles have the greatest impact on how the arch reacts to standing. With tight calf muscles you will often get more heel pain especially upon rising from the bed or seated position.

An important aspect of performing this stretch is it's technique. Stand facing a wall. You should have your feet straight ahead (or perpendicular to the wall) not turned outward. Your back in line with your back leg so you don't hurt your back (my wife's a chiropractor). Bend your front knee while keeping your back knee locked and hold it for one minute. Repeat for your other leg. During this time you should be sure to keep your arch slightly supported to prevent it from flattening as this may lead to a less efficient stretch. Repeat this exercise 5 times each day.

If you have any further question please write. Dr. David Lee