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PF getting worse

Posted by Jim C on 8/13/02 at 18:49 (092388)

I was a avid runner until this condition PF. I came about this by the usual methods bad shoes, 20# weight gain, increase in milage ect.ect.
I seen a Pod. 3 months ago and he gave me a shot in the left foot (the bad one). He told me I could run as long as I iced afterwards. In three days I was completly pain free in both feet, so I ran in my new air pegusus ( I used to run 60 miles a week in this model so I thought it a good choice). Very wrong move, I made it about a 1/2 of a mile and I limped home in very excruiciating pain. Two weeks later I got a second shot and arch supports/inserts, this shot seemed to make it worse for a while, but it did no good overall. I have stopped running/walking and for the last two months I stretch 4/5 times daily, ice 2/4 times daily, NSAIDS 1200mgs Ibuprofin, I rest/elivate as much as possible, I'm on my feet for about 2 hrs out of a 8 hour day, I wear nothing but my nikes with inserts, I have lost 15#, I weight 190#,6'tall.
Up until 3 weeks ago I considered this PF a minor annoyance( except for the fact I couldn't run). But in the past weeks the pain has gotten really bad to the point it is a major condition. My right foot has become worse than my left(formaly the bad one). The pain is like throbbing stone bruises in my heels, very painfull just to walk, always worse in the morning and better through the day after much ice and stretching. I have read everything I can get my hands on and I have been very consistant with my treatment.
I would think that I would see some improvment at this point?
Night splints?
Should I go back to the Doctor?
Help!!!

Re: PF getting worse

Steve P on 8/13/02 at 20:16 (092396)

Jim -- I suggest you see a Sports Medicine specialist & get a complete re-evaluation. Your arch supports might be the problem, esp. if they're off-the-shelf rather than custom-made orthotics. But see a Sports Med doctor to be sure. In the mean time take it easy with rest, icing, etc.

Good luck..........Steve

Re: PF getting worse

BrianG on 8/13/02 at 21:05 (092401)

Hi Jim,

Just wondering how old you are, and what you do for work? Have you read Scott's book, also found at this site. It appears your going to have to work hard to cure your PF at this point. Good luck

BrianG

PS: Some people believe Nike's are not the best shoe, for us. New Balance makes quite a lot of different styles. They may be a better choice. Also, you can increase the ibuprofen, 1,200mg is not that much. You should have a doctor prescribe it though. He can prescribe 800mg pills, times three a day.

Re: PF getting worse

john h on 8/14/02 at 09:55 (092429)

Jim: I think the most important thing is to find the 'right doctor'! some will take the time to diagnose your problem and offer some sensable treatments. some will immediately want to place you in some expensvie orthotics. Read all you can on this board because everything that is available for PF has been tried by people who frequent our board. By all means quit running until you get this under control. There are a lot of good conservative measures and there is ESWT if those fail. Ask your Doctor if he knows anything about ESWT. That will give you a clue on how up to date he is on treating PF. Read and heed. Good luck.

Re: PF getting worse

john h on 8/14/02 at 10:12 (092431)

I read an article last year that Nike's or any air cushioning shoe could be bad for the achilles tendon if you have problems in that area. A lot of people including me migrated from Nike Air to New Balance.

Re: PF getting worse(Thanks)

Jim C on 8/14/02 at 19:04 (092495)

Thanks to all that responded.
I'm 40 years old and I have read Scott's book, a very thorough and informative piece. I stopped running after that last 1/2 mile when I limped home, about 2 months ago.
After scouring many sites for more info and differing opinions I came to this conclusion on stretching. What I have learned is the cause of PF is the over stretching of the plantar fascia resulting in micro tears that cause inflamation and pain. Well, if over stretching is the cause how can stretching be part of the cure? So for the last two days since my post I have stopped my routine of stretching and I have experienced at least a 60% improvement in my condition, it's back to minor rather than major, in just two days!!! YAHOO!!! Now, I still have stretched first thing in the morning when it feels OH soooo good, but very gently, but I have not stretched any more. Now I will be the first to admit that I was problaly over doing it as I tend to do. But my opinion based on very limited experience would be to avoid a plantar stretching regimon until the inflamation is gone and you have had time to heal a bit.
I will post this as some may miss this being apart of a thread.

Jim C.

Re: PF getting worse(Thanks)

Julie on 8/15/02 at 01:36 (092522)

Jim

I'm sure you're right that your stretching regimen was making you worse - since you improved as soon as you stopped, that's the logical conclusion. The weight-bearing stretches traditionally recommended for PF have proved harmful rather than helpful for many people here. (I obediently performed the wall stretches counselled by my podiatrist for a couple of weeks, though I was not convinced of the theory) and stopped for the same reason you did.

Don't, though, put all exercise into the rubbish bin. It is important to do keep moving, and important to do the right kind of stretching for PF. The gastroc/soleus/achilles complex needs to be worked on, but the best way to do that is with non-weight bearing stretching, which is counterproductive because of the load it puts on the fascia at its most vulnerable (insertion) point.

The night splint, which you asked about in your first post) is probably ideal, because correctly adjusted it provides a consistent, gentle, lengthening stretch for the muscle/tendon complex over an extended period. You might also find the simple yoga foot exercises I've posted several times over the last couple of years, most recently a couple of weeks ago - use the search facility and you'll find them under 'Julie's Stretches' - not my title, but others have recommended them under it. I teach yoga, and have practised these movements for many years: they really came into their own when I was dealing with PF (now long gone) and have been useful to similarly afflicted students, too. It's helpful to do them in bed, before you get up in the morning, and at any time after you've been sitting for a while.

I wouldn't go back to the pod who told you it was ok to run if I were you. Find another: one who will do a complete biomechanical evaluation and diagnosis, and put together a treatment package that is right for you. Then stick to it until you're symptom free. No running until then, and once you've reached that point, re-introduce it and any other weight-bearing exercise very carefully and gradually. Even after the pain has gone, you'll need to be vigilant: full healing can take much longer.

I'm not a runner, but I've observed that most people here counsel staying away from Nike shoes, especially the air-cushioned models. And most, including the doctors, recommend New Balance - of which there seem to be thousands of models, for different types of feet, so you need to be sure which you are.

All the best for your healing.

Re: PF getting worse(Thanks)

Leon S. on 8/20/02 at 14:47 (093003)

I've been reading with great interest these last few threads re. the use of stretching as an aid. I'm relatively new to this problem (2 1/2 months) and fortunately am not as debilitated as some sufferers. I'm grateful for the advice about substituting the wall stretches with the bed stretches. So far, the ibuprofen has helped and I've been icing my foot when I come home from work. I too have been a runner for over 25 yrs but not to the extent that Jim was. To keep up some exercise regimen, I continue to walk the 1 1/4 miles to work and back every day and usually wear Rockport walkers. Does anyone have any opinion on the continued walking and the use of those shoes?

Re: PF getting worse(Thanks)

Julie on 8/20/02 at 16:26 (093006)

Leon

This is just my opinion.

I think two and a half miles a day is far too much walking, and I'm saying this not theoretically, but in response to your own admission that your foot hurts! The best advice I can give you is to limit your weight-bearing activity, and that includes walking, because if you are hurting it indicates that you're re-injuring the fascia with every step. Take the bus, the train, drive, take a taxi - but do cut out the walking for now. Be imaginative and substitute non-weight bearing exercise - swimming, for instance.

Investigate taping: there's a section on it in part 2 of the heel pain book.

I'm sure someone else will have a view about shoes - I don't know the Rockports.

Re: PF getting worse(Thanks)

Jim C on 8/20/02 at 18:44 (093010)

Hi Leon,
I don't know much about the Rockport walkers that you wear but new Balance are highly recommended on this site and others.
I would think that if you are still walking over 2 miles a day that you have problaly cought your PF in the early stage. How I wish I knew what I know now, I believe I could have gotten over my condition in a couple of months with problaly nothing more than a good pair of shoes and a lot of rest, but I let my PF become chronic and let me tell you the pain can become so excruicating to the point that you can't walk or stand. So my advice is to get on this thing hard and heavy before it becomes chronic for you.
Assuming that you have corrected what ever caused your PF, the number one thing you can do is simply rest your feet, and for me that meant no running or walking. If I don't have to stand, I don't. If I do have to stand I try to stand on both feet with my knees slightly bent to keep my weight of my heels, and if it starts to hurt I sit down and rest my feet.
My philosphy is if it hurts don't do it and if I am hurting I need to do something about it, usauly rest/elevation, ice and massage. I stay off my feet as much as possible.
Again, spend your days using the conservative treatments outlined in Scott's book (on this site) or you might end up as I did spending my days just trying to manage my pain.
In the past weeks I have used rest as the corner stone of my treatment and have seen the best results that I have had in the 4 months that I have had this condition.

Jim C.

Re: PF getting worse(Thanks)

Leon S. on 8/20/02 at 19:00 (093013)

Hi Jim,
I really appreciate your input. Julie basically said the same thing about eliminating the walking for the time being. I have New Balance running shoes but because I have been walking to work every day for the past 28 yrs or so, I have been wearing various styles of Rockport walkers because they are extremely comfortable. Incidently, I think I did the most damage to my feet when I ran barefoot on the hard sand on the beach a couple of times, including the day before I came back to work...This message board is mind blowing in seeing how many people are part of this 'help network' and the information and suggestions are invaluable...Thanks again.
Leon

Re: PF getting worse(Thanks)

Julie on 8/21/02 at 02:01 (093049)

Leon

Yes, these message boards are marvellous and they give valuable support. But there is really no substitute for a good foot specialist - by which I mean one who has the knowledge, expertise, experience and equipment to evaluate a person's condition thoroughly, diagnose it accurately, and put in place a treatment programme tailored specifically to that person and that condition. What helps one doesn't necessarily help another.

Following the suggestions given by other sufferers on the board can be helpful, but can too easily lead to a hit-and-miss approach. PF strikes millions of people - but not necessarily in the same way. Different factors apply in different cases, and each individual needs to address the factors that apply in his or her case - bearing in mind Dr Ed Davis's triad: biomechanics, inflammation, and tissue quality.

Some things do seem to apply to every case: most importantly rest, to give the injured/inflamed tissue a chance to heal. So do give the walking a break, however much you enjoy it. Remind yourself that because you love it so much, you want to be able to do it for the rest of your life, and taking a break now will help you avoid a chronic condition that might eventually make that impossible.

I know that sounds dire - but Jim is right, and his advice, to avoid whatever causes pain, is good advice.

Reading the heel pain book will help you to become an 'educated patient' so that when you find your good foot doctor you can co-operate knowledgeably and enthusiastically in your treatment. PF is a challenge. Meeting it can be very rewarding.

That may sound strange to you now, but it was my experience. Maybe it will encourage you to hear that, like you, I had to stop walking but because I caught my PF in the early stages it resolved within six months, and I've been ok for the last 18 months. I can walk as much as I want to, with no ill effects. I hope you'll be able to say the same next year!

Re: PF getting worse

Steve P on 8/13/02 at 20:16 (092396)

Jim -- I suggest you see a Sports Medicine specialist & get a complete re-evaluation. Your arch supports might be the problem, esp. if they're off-the-shelf rather than custom-made orthotics. But see a Sports Med doctor to be sure. In the mean time take it easy with rest, icing, etc.

Good luck..........Steve

Re: PF getting worse

BrianG on 8/13/02 at 21:05 (092401)

Hi Jim,

Just wondering how old you are, and what you do for work? Have you read Scott's book, also found at this site. It appears your going to have to work hard to cure your PF at this point. Good luck

BrianG

PS: Some people believe Nike's are not the best shoe, for us. New Balance makes quite a lot of different styles. They may be a better choice. Also, you can increase the ibuprofen, 1,200mg is not that much. You should have a doctor prescribe it though. He can prescribe 800mg pills, times three a day.

Re: PF getting worse

john h on 8/14/02 at 09:55 (092429)

Jim: I think the most important thing is to find the 'right doctor'! some will take the time to diagnose your problem and offer some sensable treatments. some will immediately want to place you in some expensvie orthotics. Read all you can on this board because everything that is available for PF has been tried by people who frequent our board. By all means quit running until you get this under control. There are a lot of good conservative measures and there is ESWT if those fail. Ask your Doctor if he knows anything about ESWT. That will give you a clue on how up to date he is on treating PF. Read and heed. Good luck.

Re: PF getting worse

john h on 8/14/02 at 10:12 (092431)

I read an article last year that Nike's or any air cushioning shoe could be bad for the achilles tendon if you have problems in that area. A lot of people including me migrated from Nike Air to New Balance.

Re: PF getting worse(Thanks)

Jim C on 8/14/02 at 19:04 (092495)

Thanks to all that responded.
I'm 40 years old and I have read Scott's book, a very thorough and informative piece. I stopped running after that last 1/2 mile when I limped home, about 2 months ago.
After scouring many sites for more info and differing opinions I came to this conclusion on stretching. What I have learned is the cause of PF is the over stretching of the plantar fascia resulting in micro tears that cause inflamation and pain. Well, if over stretching is the cause how can stretching be part of the cure? So for the last two days since my post I have stopped my routine of stretching and I have experienced at least a 60% improvement in my condition, it's back to minor rather than major, in just two days!!! YAHOO!!! Now, I still have stretched first thing in the morning when it feels OH soooo good, but very gently, but I have not stretched any more. Now I will be the first to admit that I was problaly over doing it as I tend to do. But my opinion based on very limited experience would be to avoid a plantar stretching regimon until the inflamation is gone and you have had time to heal a bit.
I will post this as some may miss this being apart of a thread.

Jim C.

Re: PF getting worse(Thanks)

Julie on 8/15/02 at 01:36 (092522)

Jim

I'm sure you're right that your stretching regimen was making you worse - since you improved as soon as you stopped, that's the logical conclusion. The weight-bearing stretches traditionally recommended for PF have proved harmful rather than helpful for many people here. (I obediently performed the wall stretches counselled by my podiatrist for a couple of weeks, though I was not convinced of the theory) and stopped for the same reason you did.

Don't, though, put all exercise into the rubbish bin. It is important to do keep moving, and important to do the right kind of stretching for PF. The gastroc/soleus/achilles complex needs to be worked on, but the best way to do that is with non-weight bearing stretching, which is counterproductive because of the load it puts on the fascia at its most vulnerable (insertion) point.

The night splint, which you asked about in your first post) is probably ideal, because correctly adjusted it provides a consistent, gentle, lengthening stretch for the muscle/tendon complex over an extended period. You might also find the simple yoga foot exercises I've posted several times over the last couple of years, most recently a couple of weeks ago - use the search facility and you'll find them under 'Julie's Stretches' - not my title, but others have recommended them under it. I teach yoga, and have practised these movements for many years: they really came into their own when I was dealing with PF (now long gone) and have been useful to similarly afflicted students, too. It's helpful to do them in bed, before you get up in the morning, and at any time after you've been sitting for a while.

I wouldn't go back to the pod who told you it was ok to run if I were you. Find another: one who will do a complete biomechanical evaluation and diagnosis, and put together a treatment package that is right for you. Then stick to it until you're symptom free. No running until then, and once you've reached that point, re-introduce it and any other weight-bearing exercise very carefully and gradually. Even after the pain has gone, you'll need to be vigilant: full healing can take much longer.

I'm not a runner, but I've observed that most people here counsel staying away from Nike shoes, especially the air-cushioned models. And most, including the doctors, recommend New Balance - of which there seem to be thousands of models, for different types of feet, so you need to be sure which you are.

All the best for your healing.

Re: PF getting worse(Thanks)

Leon S. on 8/20/02 at 14:47 (093003)

I've been reading with great interest these last few threads re. the use of stretching as an aid. I'm relatively new to this problem (2 1/2 months) and fortunately am not as debilitated as some sufferers. I'm grateful for the advice about substituting the wall stretches with the bed stretches. So far, the ibuprofen has helped and I've been icing my foot when I come home from work. I too have been a runner for over 25 yrs but not to the extent that Jim was. To keep up some exercise regimen, I continue to walk the 1 1/4 miles to work and back every day and usually wear Rockport walkers. Does anyone have any opinion on the continued walking and the use of those shoes?

Re: PF getting worse(Thanks)

Julie on 8/20/02 at 16:26 (093006)

Leon

This is just my opinion.

I think two and a half miles a day is far too much walking, and I'm saying this not theoretically, but in response to your own admission that your foot hurts! The best advice I can give you is to limit your weight-bearing activity, and that includes walking, because if you are hurting it indicates that you're re-injuring the fascia with every step. Take the bus, the train, drive, take a taxi - but do cut out the walking for now. Be imaginative and substitute non-weight bearing exercise - swimming, for instance.

Investigate taping: there's a section on it in part 2 of the heel pain book.

I'm sure someone else will have a view about shoes - I don't know the Rockports.

Re: PF getting worse(Thanks)

Jim C on 8/20/02 at 18:44 (093010)

Hi Leon,
I don't know much about the Rockport walkers that you wear but new Balance are highly recommended on this site and others.
I would think that if you are still walking over 2 miles a day that you have problaly cought your PF in the early stage. How I wish I knew what I know now, I believe I could have gotten over my condition in a couple of months with problaly nothing more than a good pair of shoes and a lot of rest, but I let my PF become chronic and let me tell you the pain can become so excruicating to the point that you can't walk or stand. So my advice is to get on this thing hard and heavy before it becomes chronic for you.
Assuming that you have corrected what ever caused your PF, the number one thing you can do is simply rest your feet, and for me that meant no running or walking. If I don't have to stand, I don't. If I do have to stand I try to stand on both feet with my knees slightly bent to keep my weight of my heels, and if it starts to hurt I sit down and rest my feet.
My philosphy is if it hurts don't do it and if I am hurting I need to do something about it, usauly rest/elevation, ice and massage. I stay off my feet as much as possible.
Again, spend your days using the conservative treatments outlined in Scott's book (on this site) or you might end up as I did spending my days just trying to manage my pain.
In the past weeks I have used rest as the corner stone of my treatment and have seen the best results that I have had in the 4 months that I have had this condition.

Jim C.

Re: PF getting worse(Thanks)

Leon S. on 8/20/02 at 19:00 (093013)

Hi Jim,
I really appreciate your input. Julie basically said the same thing about eliminating the walking for the time being. I have New Balance running shoes but because I have been walking to work every day for the past 28 yrs or so, I have been wearing various styles of Rockport walkers because they are extremely comfortable. Incidently, I think I did the most damage to my feet when I ran barefoot on the hard sand on the beach a couple of times, including the day before I came back to work...This message board is mind blowing in seeing how many people are part of this 'help network' and the information and suggestions are invaluable...Thanks again.
Leon

Re: PF getting worse(Thanks)

Julie on 8/21/02 at 02:01 (093049)

Leon

Yes, these message boards are marvellous and they give valuable support. But there is really no substitute for a good foot specialist - by which I mean one who has the knowledge, expertise, experience and equipment to evaluate a person's condition thoroughly, diagnose it accurately, and put in place a treatment programme tailored specifically to that person and that condition. What helps one doesn't necessarily help another.

Following the suggestions given by other sufferers on the board can be helpful, but can too easily lead to a hit-and-miss approach. PF strikes millions of people - but not necessarily in the same way. Different factors apply in different cases, and each individual needs to address the factors that apply in his or her case - bearing in mind Dr Ed Davis's triad: biomechanics, inflammation, and tissue quality.

Some things do seem to apply to every case: most importantly rest, to give the injured/inflamed tissue a chance to heal. So do give the walking a break, however much you enjoy it. Remind yourself that because you love it so much, you want to be able to do it for the rest of your life, and taking a break now will help you avoid a chronic condition that might eventually make that impossible.

I know that sounds dire - but Jim is right, and his advice, to avoid whatever causes pain, is good advice.

Reading the heel pain book will help you to become an 'educated patient' so that when you find your good foot doctor you can co-operate knowledgeably and enthusiastically in your treatment. PF is a challenge. Meeting it can be very rewarding.

That may sound strange to you now, but it was my experience. Maybe it will encourage you to hear that, like you, I had to stop walking but because I caught my PF in the early stages it resolved within six months, and I've been ok for the last 18 months. I can walk as much as I want to, with no ill effects. I hope you'll be able to say the same next year!