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rest for PF

Posted by Jean P on 9/04/02 at 21:37 (094485)

I have PF that is resisting conservatice treatment (NSAIDS, orthotics, reduced activity, stretches). I may have even done the stretches too hard in the beginning and made my own condition worse. The dr. said next step might be complete rest--no weight bearing. How effective is this? Obviously very inconvenient, etc.

Re: rest for PF

Julie on 9/05/02 at 01:59 (094501)

Opinions differ. I think that rest is a good thing for PF, but I'm not sure about 'complete' rest. What was your doctor actually suggesting? Complete rest for how long? A few days would undoubtedly give healing a good start, any longer and you'd have to start being concerned about muscle atrophy. It's a fine balance.

If you do decide to go down that road, make sure you regularly do non-weightbearing exercises that will keep your muscles and your toe and ankle joints moving. There is a link somewhere to a series of yoga exercises for the feet that I've posted - if I can find it I'll let you have it. Or perhaps Carole, who bookmarked it, will see this and point you in its direction. Carole's input here would be encouraging: she rested her feet almost completely for some time, and it was effective in her case - she did keep them moving, though, and that's vital.

There are conservative treatments that you haven't mentioned and perhaps haven't used. Taping, if you haven't tried it, might be helpful to you. It actually 'rests' the injured fascia by substituting its support for the arch that the fascia can no longer give. So it not only relieves the pain, it promotes healing. There are instructions in part 2 of the heel pain book (have you read the book? you'll find it very informative).

Do be careful with stretching. Most weightbearing stretching is, I feel, more likely to do damage than good. The commonly advised wall stretch, which pulls on the fascia at its weakest point and can also irritate the achilles tendon, has made many people's PF worse.

Re: Hang on there...

Julie on 9/05/02 at 02:07 (094502)

Jean, I've just realised that you are probably the same Jean P who posted yesterday about not wanting to stop running and dancing. (Are you? Or is this a co-incidence?)

There is a whole WORLD between running and dancing and complete rest! What are we actually talking about here?

If by complete rest you mean bed rest, or sitting in a chair and never getting up on your feet, I'm doubtful. But if by complete rest you mean not running and dancing and staying off your feet as much as possible, but carrying on with life, then I agree that this is what anyone with PF ought to do. PF is an injury, and like any injury it needs time, and rest, in order to heal.

Anyone with PF who has continued to run will tell you that they regret it. It will make the condition worse, and in many cases result in chronic, lifelong pain. Please stop running and dancing.

Re: rest for PF

Dr. John Cozzarelli on 9/05/02 at 05:40 (094509)

Hi Jean:

Like everything else sometimes it works for some patients and sometimes it does not. If he casted your foot in a BK cast and you rested it for six weeks it should help.

Dr. John Cozzarelli

Re: rest for PF

Carole C in NOLA on 9/05/02 at 07:31 (094510)

Julie, I bookmarked your stretches on another computer, or I'd provide the link as you suggested.

Thanks for suggesting that I provide my two cents here.

For me, rest had a vital role during the most acute, most painful early stages of PF when pain was around 5-9 on a scale of 1-10. It is very difficult to keep from re-injuring the feet when they are already injured and hurting so much. At this stage almost any little thing would be too much for them and would result in that tearing pain and a setback. For me, the key to recovery was managing to not re-injure my feet at all for a few weeks, so that I didn't have a setback and they could heal some.

Resting for a week would have done little good, because my feet would not have been able to heal sufficiently. I think it takes somewhere from 2-8 weeks of rest to get to that point. Then, the healed tissues are stronger and no longer as vulnerable to further injury as they are earlier. After they had healed more and the pain was less, I was able to do more things. It's important to build up activity gradually rather than abruptly after resting for several weeks, in order to avoid re-injury. If you re-injure your feet along the way, you are starting over from scratch on the resting.

Resting sufficiently is terribly difficult and takes a good deal of self-discipline. As Julie mentioned, I did keep my feet moving a little bit even during the resting phases. For example I would wiggle my toes gently now and then, to the extent that this did not cause me any pain, and gently rotate my ankles and so on. Pain is your friend in that it tells you not to do things that hurt.

I hope this helps.

Carole C

Re: rest for PF

Sharon W on 9/05/02 at 08:51 (094512)

Jean,

Here's a link for 'Julie's Stretches'. (I have it bookmarked, too!)

bbv.cgi?n=91080

Sharon

Re: rest for PF

Julie on 9/05/02 at 09:40 (094515)

Thanks, Sharon! I was just getting ready to look for it when I saw your post. Jean, I hope youj'll find them helpful.

Re: the link

Carole C in NOLA on 9/05/02 at 18:26 (094550)

Here's the link to Julie's stretches: bbv.cgi?n=91080

Carole C

Re: rest for PF

Jim C on 9/05/02 at 20:38 (094561)

Hi Jean,

I certainly aggrevated my condition with aggresive streching. I gave it a break and then resumed with very gentle stretching (Julie's), much better now.
I think non weight bearing rest would be very benificial if one could do it, as for me it would be very difficult. I just try and stay off my feet as much as possible, what little walking/standing I do certainly slows my progress but I'm still making great progress. One thing I have done is go off the nsaid's (to avoid other complications)and as expected the pain levels went up. But all of the sudden I found myself sitting down alot more at work simply because my feet were hurting. I also found that my $300 custom inserts were killing my arches, it felt like I was walking with golfballs under my arches, so I stopped wearing them and starting taping. The taping has been awesome. Anyway the past weeks I have made tremendous progress, I have days where I don't even think about my feet and my recovery times are much faster, when my feet hurt I sit down and rest/stretch, then I'm good for a couple of more hours. I think the nsaid's were covering up some problems with the orthos and maybe some overdoing it on my part. I'm also a big tapeing fan now. I'm not saying that everyone should get rid of their orthos and go off nsaids, but I think this condition is so indivdualy specific, we need to consantly 'tweak' our treatments until we find what works for us.

Jim

Re: rest for PF

Jean P on 9/05/02 at 20:53 (094563)

I wondered about the NSAID's masking th e pain but my podiatrist said try it ocntinuously for 3 weeks for the inflammation. Saw a musculskeletal physician today who does prolotherapy also and he adjusted my foot--bones were way out of place. My overall foot feels better but the heel pain is still intense. I figure I;ll ride out the 3 weeks just to make sure to finish the theraly as recommended then stop-- don't need stomach ulcers. I also think I was overstretching with weighted stretches...

Re: rest for PF

Jean P on 9/05/02 at 21:00 (094564)

Would this be a walking cast or a non weight bearing situation for the approx 6 weeks?

Re: rest for PF

Jean P on 9/05/02 at 21:03 (094565)

Thanks-- how much did you rest-- completely non weight bearing? I should go to work 2 days per week. I'm wondering if it would be enough to still go those 2 days in a walking cast and stay off it those evenings and the other 5 days. I can't use crutches b/c of carpel tunnel nor will the school where I work part time allow them anyways.

Re: Hang on there...

Jean P on 9/05/02 at 21:07 (094566)

I'm a different Jean P! I saw that posting too. I did persist in rollerblading for about 2-3 weeks after injury then stopped b/c of pain. Hope I didn't ruin my feet for life!

My podiatrist mentioned non weight bearing rest for 3-4 weeks. Just don't know how to pull it off. Need to got o work 2 days per week, can do the rest from home. Now I'm swimming, I have 2 kids. I ordered a hands free crutch to try and have at least when most painful. Can't use regular crutches b/c of carpel tunnel.

Re: rest for PF

Jean P on 9/05/02 at 21:12 (094567)

The dr suggested a walking cast and then if no great improvement a non weight bearing situation for 3-4 weeks. I was doing weight bearing stretches (as suggested by physical therapy when I first did this a year ago) but stopped those a few weeks ago. Some very, very minor improvement perhaps from that. I'm very concerned with muscle atrophy. I have a removable walking cast and assume I could to mobility exercises and general leg strengthening--just keep the weight off my foot. Or just make it to work those 2 days per week and non weight bearing otherwise????? I'd still try to make it to the gym for upper body and ab's so my whole body does not crumble. Since cast is removable I still wonder if i could swim--just keep the weight off my foot?

Re: rest for PF

Jean P on 9/05/02 at 21:13 (094568)

What is a BK cast? Is this walking or totally non weight bearing?

Re: rest for PF

Jean P on 9/05/02 at 21:23 (094573)

Thanks for yoga link 'Julies Stretches'

Re: rest for PF

pala on 9/05/02 at 21:44 (094577)

jean can you tell me if the walking cast helps. what particular type or brand? i have a rocker bottom one for a previous broken little toe and was wondering if there's a specific kind for various foot problems, or one kind for all foot probems.

Re: BK cast

Sharon W on 9/05/02 at 21:48 (094578)

Jean,

Glad to help. By the way, I think what Dr. Z means by 'BK cast' is 'below the knee'.

Sharon

Re: rest for PF

Dr. Z on 9/05/02 at 22:00 (094581)

BK could be both walking and non-weighting. Usually is weight bearing when used for pf . Sometimes is non- weighting if you have had extensive open surgery including TTS release

Re: rest for PF

Carole C in NOLA on 9/05/02 at 22:05 (094582)

Not completely non weight bearing. I didn't use crutches or a wheel chair, and I'd get up to use the restroom. I still went to work, but I work at a desk job and that only involved walking a few feet to my car. I didn't do much of any walking other than that. I didn't go to the grocery store (ate at drive throughs or delivery). I didn't stand to do dishes or housework (just let it go and used paper plates). I didn't put away my laundry. I didn't even get up to get a book to read if one wasn't within reach. I just made myself sit, sit, sit.

It takes a lot of self discipline to be able to do that, because the body cries out for movement and there is a lot of social pressure for that too. It's probably not possible for those with small children to care for.

But if you can rest, it can make a big difference.

Carole

Re: Jim

Julie on 9/06/02 at 03:08 (094588)

Hi Jim

Great post. I'm so glad you're feeling better and that the yoga exercises have been helping you. I'm a committed tape fan too: it was definitely a major factor in my healing. Keep taping until after you don't think you need to any more: there'll come a time when you just forget to do it and then realise you really don't need it. Till then, keep taping. If it helps, it's - IMHO - the most helpful of allthe modalities.

You're so right that we need to keep 'tweaking', listening to what our feet say, and adjusting what we do for them accordingly.

Thanks again for a useful post.

Re: rest for PF

Jean P on 9/06/02 at 11:29 (094613)

Thanks-- How long did you go on like this (resting) for? Two days ago I went to a drive through for dinner and I did feel better at the end of the day. It seems to be I might get through the day OK but it is the dinner hour plus where it really hurts! Now I have chairs by the kitchen sink and my bathroom to sit or kneel on--anything to get off my foot!!

Re: rest for PF

Jean P on 9/06/02 at 18:04 (094629)

Thanks to all for advice and encouragement. I've concluded I stretched too much and need to really rest and fdraw on all the patience I have. Someone asked about the walking cast (strap on ) I was given by a second podiatrist. I think it helps decrease the end of the day pain, but have not used it enough to really say for sure. I've been stubborn about still riding my bike but I'm going to temporarily give that up and stick with just swimmming. I'm going to commit myself to the walking cast for now. At least I can take it off to stretch and roll the ankle, and swim.

Re: rest for PF

Julie on 9/05/02 at 01:59 (094501)

Opinions differ. I think that rest is a good thing for PF, but I'm not sure about 'complete' rest. What was your doctor actually suggesting? Complete rest for how long? A few days would undoubtedly give healing a good start, any longer and you'd have to start being concerned about muscle atrophy. It's a fine balance.

If you do decide to go down that road, make sure you regularly do non-weightbearing exercises that will keep your muscles and your toe and ankle joints moving. There is a link somewhere to a series of yoga exercises for the feet that I've posted - if I can find it I'll let you have it. Or perhaps Carole, who bookmarked it, will see this and point you in its direction. Carole's input here would be encouraging: she rested her feet almost completely for some time, and it was effective in her case - she did keep them moving, though, and that's vital.

There are conservative treatments that you haven't mentioned and perhaps haven't used. Taping, if you haven't tried it, might be helpful to you. It actually 'rests' the injured fascia by substituting its support for the arch that the fascia can no longer give. So it not only relieves the pain, it promotes healing. There are instructions in part 2 of the heel pain book (have you read the book? you'll find it very informative).

Do be careful with stretching. Most weightbearing stretching is, I feel, more likely to do damage than good. The commonly advised wall stretch, which pulls on the fascia at its weakest point and can also irritate the achilles tendon, has made many people's PF worse.

Re: Hang on there...

Julie on 9/05/02 at 02:07 (094502)

Jean, I've just realised that you are probably the same Jean P who posted yesterday about not wanting to stop running and dancing. (Are you? Or is this a co-incidence?)

There is a whole WORLD between running and dancing and complete rest! What are we actually talking about here?

If by complete rest you mean bed rest, or sitting in a chair and never getting up on your feet, I'm doubtful. But if by complete rest you mean not running and dancing and staying off your feet as much as possible, but carrying on with life, then I agree that this is what anyone with PF ought to do. PF is an injury, and like any injury it needs time, and rest, in order to heal.

Anyone with PF who has continued to run will tell you that they regret it. It will make the condition worse, and in many cases result in chronic, lifelong pain. Please stop running and dancing.

Re: rest for PF

Dr. John Cozzarelli on 9/05/02 at 05:40 (094509)

Hi Jean:

Like everything else sometimes it works for some patients and sometimes it does not. If he casted your foot in a BK cast and you rested it for six weeks it should help.

Dr. John Cozzarelli

Re: rest for PF

Carole C in NOLA on 9/05/02 at 07:31 (094510)

Julie, I bookmarked your stretches on another computer, or I'd provide the link as you suggested.

Thanks for suggesting that I provide my two cents here.

For me, rest had a vital role during the most acute, most painful early stages of PF when pain was around 5-9 on a scale of 1-10. It is very difficult to keep from re-injuring the feet when they are already injured and hurting so much. At this stage almost any little thing would be too much for them and would result in that tearing pain and a setback. For me, the key to recovery was managing to not re-injure my feet at all for a few weeks, so that I didn't have a setback and they could heal some.

Resting for a week would have done little good, because my feet would not have been able to heal sufficiently. I think it takes somewhere from 2-8 weeks of rest to get to that point. Then, the healed tissues are stronger and no longer as vulnerable to further injury as they are earlier. After they had healed more and the pain was less, I was able to do more things. It's important to build up activity gradually rather than abruptly after resting for several weeks, in order to avoid re-injury. If you re-injure your feet along the way, you are starting over from scratch on the resting.

Resting sufficiently is terribly difficult and takes a good deal of self-discipline. As Julie mentioned, I did keep my feet moving a little bit even during the resting phases. For example I would wiggle my toes gently now and then, to the extent that this did not cause me any pain, and gently rotate my ankles and so on. Pain is your friend in that it tells you not to do things that hurt.

I hope this helps.

Carole C

Re: rest for PF

Sharon W on 9/05/02 at 08:51 (094512)

Jean,

Here's a link for 'Julie's Stretches'. (I have it bookmarked, too!)

bbv.cgi?n=91080

Sharon

Re: rest for PF

Julie on 9/05/02 at 09:40 (094515)

Thanks, Sharon! I was just getting ready to look for it when I saw your post. Jean, I hope youj'll find them helpful.

Re: the link

Carole C in NOLA on 9/05/02 at 18:26 (094550)

Here's the link to Julie's stretches: bbv.cgi?n=91080

Carole C

Re: rest for PF

Jim C on 9/05/02 at 20:38 (094561)

Hi Jean,

I certainly aggrevated my condition with aggresive streching. I gave it a break and then resumed with very gentle stretching (Julie's), much better now.
I think non weight bearing rest would be very benificial if one could do it, as for me it would be very difficult. I just try and stay off my feet as much as possible, what little walking/standing I do certainly slows my progress but I'm still making great progress. One thing I have done is go off the nsaid's (to avoid other complications)and as expected the pain levels went up. But all of the sudden I found myself sitting down alot more at work simply because my feet were hurting. I also found that my $300 custom inserts were killing my arches, it felt like I was walking with golfballs under my arches, so I stopped wearing them and starting taping. The taping has been awesome. Anyway the past weeks I have made tremendous progress, I have days where I don't even think about my feet and my recovery times are much faster, when my feet hurt I sit down and rest/stretch, then I'm good for a couple of more hours. I think the nsaid's were covering up some problems with the orthos and maybe some overdoing it on my part. I'm also a big tapeing fan now. I'm not saying that everyone should get rid of their orthos and go off nsaids, but I think this condition is so indivdualy specific, we need to consantly 'tweak' our treatments until we find what works for us.

Jim

Re: rest for PF

Jean P on 9/05/02 at 20:53 (094563)

I wondered about the NSAID's masking th e pain but my podiatrist said try it ocntinuously for 3 weeks for the inflammation. Saw a musculskeletal physician today who does prolotherapy also and he adjusted my foot--bones were way out of place. My overall foot feels better but the heel pain is still intense. I figure I;ll ride out the 3 weeks just to make sure to finish the theraly as recommended then stop-- don't need stomach ulcers. I also think I was overstretching with weighted stretches...

Re: rest for PF

Jean P on 9/05/02 at 21:00 (094564)

Would this be a walking cast or a non weight bearing situation for the approx 6 weeks?

Re: rest for PF

Jean P on 9/05/02 at 21:03 (094565)

Thanks-- how much did you rest-- completely non weight bearing? I should go to work 2 days per week. I'm wondering if it would be enough to still go those 2 days in a walking cast and stay off it those evenings and the other 5 days. I can't use crutches b/c of carpel tunnel nor will the school where I work part time allow them anyways.

Re: Hang on there...

Jean P on 9/05/02 at 21:07 (094566)

I'm a different Jean P! I saw that posting too. I did persist in rollerblading for about 2-3 weeks after injury then stopped b/c of pain. Hope I didn't ruin my feet for life!

My podiatrist mentioned non weight bearing rest for 3-4 weeks. Just don't know how to pull it off. Need to got o work 2 days per week, can do the rest from home. Now I'm swimming, I have 2 kids. I ordered a hands free crutch to try and have at least when most painful. Can't use regular crutches b/c of carpel tunnel.

Re: rest for PF

Jean P on 9/05/02 at 21:12 (094567)

The dr suggested a walking cast and then if no great improvement a non weight bearing situation for 3-4 weeks. I was doing weight bearing stretches (as suggested by physical therapy when I first did this a year ago) but stopped those a few weeks ago. Some very, very minor improvement perhaps from that. I'm very concerned with muscle atrophy. I have a removable walking cast and assume I could to mobility exercises and general leg strengthening--just keep the weight off my foot. Or just make it to work those 2 days per week and non weight bearing otherwise????? I'd still try to make it to the gym for upper body and ab's so my whole body does not crumble. Since cast is removable I still wonder if i could swim--just keep the weight off my foot?

Re: rest for PF

Jean P on 9/05/02 at 21:13 (094568)

What is a BK cast? Is this walking or totally non weight bearing?

Re: rest for PF

Jean P on 9/05/02 at 21:23 (094573)

Thanks for yoga link 'Julies Stretches'

Re: rest for PF

pala on 9/05/02 at 21:44 (094577)

jean can you tell me if the walking cast helps. what particular type or brand? i have a rocker bottom one for a previous broken little toe and was wondering if there's a specific kind for various foot problems, or one kind for all foot probems.

Re: BK cast

Sharon W on 9/05/02 at 21:48 (094578)

Jean,

Glad to help. By the way, I think what Dr. Z means by 'BK cast' is 'below the knee'.

Sharon

Re: rest for PF

Dr. Z on 9/05/02 at 22:00 (094581)

BK could be both walking and non-weighting. Usually is weight bearing when used for pf . Sometimes is non- weighting if you have had extensive open surgery including TTS release

Re: rest for PF

Carole C in NOLA on 9/05/02 at 22:05 (094582)

Not completely non weight bearing. I didn't use crutches or a wheel chair, and I'd get up to use the restroom. I still went to work, but I work at a desk job and that only involved walking a few feet to my car. I didn't do much of any walking other than that. I didn't go to the grocery store (ate at drive throughs or delivery). I didn't stand to do dishes or housework (just let it go and used paper plates). I didn't put away my laundry. I didn't even get up to get a book to read if one wasn't within reach. I just made myself sit, sit, sit.

It takes a lot of self discipline to be able to do that, because the body cries out for movement and there is a lot of social pressure for that too. It's probably not possible for those with small children to care for.

But if you can rest, it can make a big difference.

Carole

Re: Jim

Julie on 9/06/02 at 03:08 (094588)

Hi Jim

Great post. I'm so glad you're feeling better and that the yoga exercises have been helping you. I'm a committed tape fan too: it was definitely a major factor in my healing. Keep taping until after you don't think you need to any more: there'll come a time when you just forget to do it and then realise you really don't need it. Till then, keep taping. If it helps, it's - IMHO - the most helpful of allthe modalities.

You're so right that we need to keep 'tweaking', listening to what our feet say, and adjusting what we do for them accordingly.

Thanks again for a useful post.

Re: rest for PF

Jean P on 9/06/02 at 11:29 (094613)

Thanks-- How long did you go on like this (resting) for? Two days ago I went to a drive through for dinner and I did feel better at the end of the day. It seems to be I might get through the day OK but it is the dinner hour plus where it really hurts! Now I have chairs by the kitchen sink and my bathroom to sit or kneel on--anything to get off my foot!!

Re: rest for PF

Jean P on 9/06/02 at 18:04 (094629)

Thanks to all for advice and encouragement. I've concluded I stretched too much and need to really rest and fdraw on all the patience I have. Someone asked about the walking cast (strap on ) I was given by a second podiatrist. I think it helps decrease the end of the day pain, but have not used it enough to really say for sure. I've been stubborn about still riding my bike but I'm going to temporarily give that up and stick with just swimmming. I'm going to commit myself to the walking cast for now. At least I can take it off to stretch and roll the ankle, and swim.