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Strassburg Sock and heel swelling?

Posted by Jen on 11/12/02 at 09:39 (099872)

Hello,
I was going to get the product but I read the precaution in the Strassburg sock's page 'If you have a known circulatory problem, pregnant,..... swelling or sever edema, consult our physician prior to using this product.'
The swelling with my heels are not as bad as two months ago, but it can definitely be felt when I stand up. Should I try the Strassburg socks? I don't want to do things to aggrevate the heel problem, meanwhile I think I need to keep the fascia stretched at night.
Thanks in advance!

Re: Strassburg Sock and heel swelling?

dave r on 11/12/02 at 10:13 (099876)

i would think that a more conservative night splint may work. Then after a few months 'graduate ' to the strassburg sock.

Re: Strassburg Sock and heel swelling?

Denise N on 11/12/02 at 14:10 (099900)

Have you found the sock to do any good? I have just gotten back from my doctor and that is what he prescribed. I have done the anti-inflammitories, the cast, the shots, the ultrasounds. I amy hoping that these are the magic cure.

Good luck

Re: Strassburg Sock and heel swelling?

Jen on 11/12/02 at 15:39 (099913)

Hi Denise,
Do you have any sweelling in your feet now? If yes, did your doctor take note of it? Have those treatment helped you?
I did not use the socks yet, and I want to make sure it won't cause any problem.

Re: Strassburg Sock and heel swelling?

dave r on 11/13/02 at 14:29 (100048)

I tried the sock and it only made things worse. It really puts alot of tension on the plantar fascia by bending your toes upwards. It also stretches the achilles complex much more that a typical nightsplint.......
be careful if you use it.

Re: Strassburg Sock and heel swelling?

Julie on 11/13/02 at 15:07 (100057)

Dave, that's interesting. I have not received a satisfactory explanation of why the windlass mechanism (the flexion of the toes) which is a feature of the Strassburg Sock is of any help with PF. I can't believe it is. It's the flexion at the ankle that is significant for PF if a shortened calf/achilles complex is the cause. Flexion of the toes would, and as you say does, put excessive tension on the fascia.

Re: Strassburg Sock and heel swelling?

dave r on 11/13/02 at 15:22 (100059)

Alot of people get relief from pf by excersising there toes. ie. flexing their toes up and down. Alot of people experiance pain when there toes are pointed up. i would bet that flexing your toes up puts excessive strain on the central bands of the plantar fascia. The strassburg sock also bends the big toe up. this would put stress on the medial fibers of the plantar fascai. For me it is just to much. A nightsplint puts your foot at a positive nine degree angle without any pressure on the toes. I have found that my feet have adjusted well to the nightsplint.

Re: Strassburg Sock and heel swelling?

dave r on 11/13/02 at 15:38 (100062)

Hi Julie, i believe that the plantar fascia doesnt not stretch. I have read that many times.
The achilles gastro complex can stretch. But over time will actually shrink. This is the main cause of pf to alot of people. Once it shrinks it pulls the heel back. Causing the plantar fascia to tear at the insertion point. This scaring causes bad tissue quality. eventually the tissue loses its ability to stretch. Causing more injury. Once pf progresses to its chronic stage, then tissue quality means everything.Eswt can help reverse this in alot of people.For some it may not help at all. In my case i have had eswt twice. I improved 20% from the first treatment and i am still recovering from the second. If i dont see a big improvemnent in 6 months i will reevaluate my situation. I have thought alot about having the lengthening procedure of the achilles gastro complex.

Re: Strassburg Sock and heel swelling?

Dr. David S. Wander on 11/13/02 at 17:54 (100070)

I think that there needs to be some clarification. The warning on the Strassburg Sock is basically addressing patients that have significant swelling in the feet or legs from circulatory problems, not the small amount of swelling that may occur with heel pain syndromes. The Strassburg Sock is an elastic material, and patients with circulatory problems and significant swelling/fluid retention should avoid this product.

The windlass effect has often been implicated as a cause of plantar fasciitis, with the greatest stress on the plantar fascia occurring with the toes dorsiflexed. Although the actual plantar fascia does not stretch, there are other soft tissue structures and intrinsic muslces that are involved. Additionally, it is well documented that if the Achiles complex is tight, the fascia will be tight, etc. Therefore, when wearing a night splint and placing tension on the fascia, the Achilles will also be stretching. In my practice, I treat a very high number of heel pain patients weekly, and my patients have had the most success with the Strassburg sock, compared to other night splints. Dave R. is correct, and it is easy to overstretch the area by pulling the toes up too much. If you use this product, be careful to not pull the toes up too much. If you do and it's uncomfortable, simply loosen it up a little. It's a great product.

Re: Strassburg Sock and heel swelling?

Julie on 11/14/02 at 01:47 (100107)

Thanks for your clarification, Dr Wander. I was under the impression that the windlass effect was the main feature of the Strassburg Sock, and that this strong, prolonged dorsiflexion of the toes could give rise to problems (which you've confirmed it can if not properly adjusted). I did not realise that it could stretch the gastrosoleus/achilles complex as effectively as the night splint.

Re: Strassburg Sock and heel swelling?

Julie on 11/14/02 at 02:14 (100108)

Hi Dave

No, that's right, the fascia doesn't stretch. I didn't mean to imply that it does, when I said I thought the windlass effect Strassburg Sock could put increased tension on it.

A shortened gastrosoleus/achilles complex is the implicating factor in many though not all cases of PF, and when it is, stretching of the complex is important. From Dr Wander's clarification above, and his other post on the Foot Doctors board about the difference between the sock and the night splint, it's clear to me now that either can accomplish this, the trick with the sock being to adjust it so that the strong toe-dorsiflexion of the windlass effect is minimised. Do you think your problem with the sock could have been that it was too tight?

Re your other post: it's important to encourage and maintain full joint mobility through exercise, and the toes are no exception, so back-and-forth movement, flexion and extension, is useful (unless it causes pain). Flexing the toes gently for a moment or two as part of an exercise is a different matter from holding the toes in a strongly dorsiflexed position overnight.

Re: Strassburg Sock and heel swelling?

Mar on 11/14/02 at 07:03 (100116)

Dave -

What is this lengthening procedure for the achilles gastro complex? I also have had ESWT twice and it is 6 months now and I have had no relief. I keep hoping that it will kick in, but I am also starting to think about what other possibilities exist if the ESWT doesn;t kick in. Mar

Re: Strassburg Sock and heel swelling?

dave r on 11/14/02 at 07:47 (100120)

Mar, i am unsure of what the gastro complex lengthening procedure really is. I believe that part of the calf muscle and achilles is released and allowed to heal. This i believe would give the plantar facia some relief. the achilles wouldnt be pulling on the heel so much. I wish there would be more talk about it on the board. AMybe some of the doctors here would like to comment on it?

Re: Strassburg Sock and heel swelling?

Dr. David S. Wander on 11/14/02 at 08:24 (100124)

Gastroc-soleus lengthening procedures are not commonly used for plantar fasciitis. This procedure is often used in conjuntion with other foot reconstructive procedures to maximize the benefits of these procedures. It is also used for severe contractions/tightness. The gastroc-soleus complex can usually be stretched adequately with physical therapy and/or night splints.

The purpose of most night splints is not only to passively stretch the soft tissue, but also to PREVENT tightness during 6-8 hours of sleep. Many people sleep on his/her stomach, causing plantarflexion of the foot and subsequent shortening of the tissues. Many night splints do not dorsiflex the foot much, but the splints PREVENT plantarflexion during sleep.

Mar, if you have failed with conservative care including ESWT treatments, has any doctor performed any blood tests to rule out a rheumatology/arthritic component? You may want to speak with your doctor or see a rheumatologist for specific blood tests, if you haven't already.

One last note: I have found the use of the Strassburg Sock to be very beneficial with my patients, due to the high level of compliance. Many night splints work very well, but are very bulky and difficult to wear in bed. Therefore, no matter how great the product, it won't work if you're not comfortable wearing it. Many of my patients have complained about the bulk of the night splints when worn to bed, but swear it's a great form of birth control!

Re: Strassburg Sock and heel swelling?

Mar on 11/14/02 at 17:05 (100167)

Dr Wander -

Yes, I had blood tests last spring to rule out several things. Is the Strassburg sock something that could work even if ESWT doesn;t? It seems like I would be going backwards in treatment. Is surgery the only other option you know of if ESWT doesn;t work for me? Today was another very painful day and I am so scared and depressed again. Thanks for any help you can offer. Mar

Re: Strassburg Sock and heel swelling?

Dr. David S. Wander on 11/14/02 at 19:38 (100175)

The Strassburg Sock is not a replacement for ESWT, it is simply an additional option and may work despite the unsuccessful ESWT. Therefore, I don't think that the use of a night splint is going backwards. I like to think of the night splint as a maintenance item, that prevents the soft tissue from tightening. Although I've done my share of plantar fascia surgery with excellent results, it is not a procedure that I now recommend very often. In my practice patients end up with surgery for heel pain less than 1% of the time.

What type of shoes/sneakers do you wear? What type of custom or OTC orthoses do you wear? Have you been to physical therapy? Has your foot been immoblized in a cast? Have you had an MRI? What type of work do you do? Is weight a factor in your heel pain? There are lots of questions that I'm sure you've answered before on this site. Feel free to email me with your answers or ask me other questions, at (email removed), I may be able to make some suggestions to help decrease your discomfort.

Re: Strassburg Sock and heel swelling?

MarvinL on 11/16/02 at 10:40 (100388)

My podiatrist had me wear night splints and I have had several shots and I still have pain in my heel. I wear Reebock sneakers with heelcups the Dr sold me and I wear Rockport shoes with the same heel cups. After the last injection, I went 2 weeks without pain and then it came back with a vengeance. Any suggestions, please?

Re: Strassburg Sock and heel swelling?

dave r on 11/12/02 at 10:13 (099876)

i would think that a more conservative night splint may work. Then after a few months 'graduate ' to the strassburg sock.

Re: Strassburg Sock and heel swelling?

Denise N on 11/12/02 at 14:10 (099900)

Have you found the sock to do any good? I have just gotten back from my doctor and that is what he prescribed. I have done the anti-inflammitories, the cast, the shots, the ultrasounds. I amy hoping that these are the magic cure.

Good luck

Re: Strassburg Sock and heel swelling?

Jen on 11/12/02 at 15:39 (099913)

Hi Denise,
Do you have any sweelling in your feet now? If yes, did your doctor take note of it? Have those treatment helped you?
I did not use the socks yet, and I want to make sure it won't cause any problem.

Re: Strassburg Sock and heel swelling?

dave r on 11/13/02 at 14:29 (100048)

I tried the sock and it only made things worse. It really puts alot of tension on the plantar fascia by bending your toes upwards. It also stretches the achilles complex much more that a typical nightsplint.......
be careful if you use it.

Re: Strassburg Sock and heel swelling?

Julie on 11/13/02 at 15:07 (100057)

Dave, that's interesting. I have not received a satisfactory explanation of why the windlass mechanism (the flexion of the toes) which is a feature of the Strassburg Sock is of any help with PF. I can't believe it is. It's the flexion at the ankle that is significant for PF if a shortened calf/achilles complex is the cause. Flexion of the toes would, and as you say does, put excessive tension on the fascia.

Re: Strassburg Sock and heel swelling?

dave r on 11/13/02 at 15:22 (100059)

Alot of people get relief from pf by excersising there toes. ie. flexing their toes up and down. Alot of people experiance pain when there toes are pointed up. i would bet that flexing your toes up puts excessive strain on the central bands of the plantar fascia. The strassburg sock also bends the big toe up. this would put stress on the medial fibers of the plantar fascai. For me it is just to much. A nightsplint puts your foot at a positive nine degree angle without any pressure on the toes. I have found that my feet have adjusted well to the nightsplint.

Re: Strassburg Sock and heel swelling?

dave r on 11/13/02 at 15:38 (100062)

Hi Julie, i believe that the plantar fascia doesnt not stretch. I have read that many times.
The achilles gastro complex can stretch. But over time will actually shrink. This is the main cause of pf to alot of people. Once it shrinks it pulls the heel back. Causing the plantar fascia to tear at the insertion point. This scaring causes bad tissue quality. eventually the tissue loses its ability to stretch. Causing more injury. Once pf progresses to its chronic stage, then tissue quality means everything.Eswt can help reverse this in alot of people.For some it may not help at all. In my case i have had eswt twice. I improved 20% from the first treatment and i am still recovering from the second. If i dont see a big improvemnent in 6 months i will reevaluate my situation. I have thought alot about having the lengthening procedure of the achilles gastro complex.

Re: Strassburg Sock and heel swelling?

Dr. David S. Wander on 11/13/02 at 17:54 (100070)

I think that there needs to be some clarification. The warning on the Strassburg Sock is basically addressing patients that have significant swelling in the feet or legs from circulatory problems, not the small amount of swelling that may occur with heel pain syndromes. The Strassburg Sock is an elastic material, and patients with circulatory problems and significant swelling/fluid retention should avoid this product.

The windlass effect has often been implicated as a cause of plantar fasciitis, with the greatest stress on the plantar fascia occurring with the toes dorsiflexed. Although the actual plantar fascia does not stretch, there are other soft tissue structures and intrinsic muslces that are involved. Additionally, it is well documented that if the Achiles complex is tight, the fascia will be tight, etc. Therefore, when wearing a night splint and placing tension on the fascia, the Achilles will also be stretching. In my practice, I treat a very high number of heel pain patients weekly, and my patients have had the most success with the Strassburg sock, compared to other night splints. Dave R. is correct, and it is easy to overstretch the area by pulling the toes up too much. If you use this product, be careful to not pull the toes up too much. If you do and it's uncomfortable, simply loosen it up a little. It's a great product.

Re: Strassburg Sock and heel swelling?

Julie on 11/14/02 at 01:47 (100107)

Thanks for your clarification, Dr Wander. I was under the impression that the windlass effect was the main feature of the Strassburg Sock, and that this strong, prolonged dorsiflexion of the toes could give rise to problems (which you've confirmed it can if not properly adjusted). I did not realise that it could stretch the gastrosoleus/achilles complex as effectively as the night splint.

Re: Strassburg Sock and heel swelling?

Julie on 11/14/02 at 02:14 (100108)

Hi Dave

No, that's right, the fascia doesn't stretch. I didn't mean to imply that it does, when I said I thought the windlass effect Strassburg Sock could put increased tension on it.

A shortened gastrosoleus/achilles complex is the implicating factor in many though not all cases of PF, and when it is, stretching of the complex is important. From Dr Wander's clarification above, and his other post on the Foot Doctors board about the difference between the sock and the night splint, it's clear to me now that either can accomplish this, the trick with the sock being to adjust it so that the strong toe-dorsiflexion of the windlass effect is minimised. Do you think your problem with the sock could have been that it was too tight?

Re your other post: it's important to encourage and maintain full joint mobility through exercise, and the toes are no exception, so back-and-forth movement, flexion and extension, is useful (unless it causes pain). Flexing the toes gently for a moment or two as part of an exercise is a different matter from holding the toes in a strongly dorsiflexed position overnight.

Re: Strassburg Sock and heel swelling?

Mar on 11/14/02 at 07:03 (100116)

Dave -

What is this lengthening procedure for the achilles gastro complex? I also have had ESWT twice and it is 6 months now and I have had no relief. I keep hoping that it will kick in, but I am also starting to think about what other possibilities exist if the ESWT doesn;t kick in. Mar

Re: Strassburg Sock and heel swelling?

dave r on 11/14/02 at 07:47 (100120)

Mar, i am unsure of what the gastro complex lengthening procedure really is. I believe that part of the calf muscle and achilles is released and allowed to heal. This i believe would give the plantar facia some relief. the achilles wouldnt be pulling on the heel so much. I wish there would be more talk about it on the board. AMybe some of the doctors here would like to comment on it?

Re: Strassburg Sock and heel swelling?

Dr. David S. Wander on 11/14/02 at 08:24 (100124)

Gastroc-soleus lengthening procedures are not commonly used for plantar fasciitis. This procedure is often used in conjuntion with other foot reconstructive procedures to maximize the benefits of these procedures. It is also used for severe contractions/tightness. The gastroc-soleus complex can usually be stretched adequately with physical therapy and/or night splints.

The purpose of most night splints is not only to passively stretch the soft tissue, but also to PREVENT tightness during 6-8 hours of sleep. Many people sleep on his/her stomach, causing plantarflexion of the foot and subsequent shortening of the tissues. Many night splints do not dorsiflex the foot much, but the splints PREVENT plantarflexion during sleep.

Mar, if you have failed with conservative care including ESWT treatments, has any doctor performed any blood tests to rule out a rheumatology/arthritic component? You may want to speak with your doctor or see a rheumatologist for specific blood tests, if you haven't already.

One last note: I have found the use of the Strassburg Sock to be very beneficial with my patients, due to the high level of compliance. Many night splints work very well, but are very bulky and difficult to wear in bed. Therefore, no matter how great the product, it won't work if you're not comfortable wearing it. Many of my patients have complained about the bulk of the night splints when worn to bed, but swear it's a great form of birth control!

Re: Strassburg Sock and heel swelling?

Mar on 11/14/02 at 17:05 (100167)

Dr Wander -

Yes, I had blood tests last spring to rule out several things. Is the Strassburg sock something that could work even if ESWT doesn;t? It seems like I would be going backwards in treatment. Is surgery the only other option you know of if ESWT doesn;t work for me? Today was another very painful day and I am so scared and depressed again. Thanks for any help you can offer. Mar

Re: Strassburg Sock and heel swelling?

Dr. David S. Wander on 11/14/02 at 19:38 (100175)

The Strassburg Sock is not a replacement for ESWT, it is simply an additional option and may work despite the unsuccessful ESWT. Therefore, I don't think that the use of a night splint is going backwards. I like to think of the night splint as a maintenance item, that prevents the soft tissue from tightening. Although I've done my share of plantar fascia surgery with excellent results, it is not a procedure that I now recommend very often. In my practice patients end up with surgery for heel pain less than 1% of the time.

What type of shoes/sneakers do you wear? What type of custom or OTC orthoses do you wear? Have you been to physical therapy? Has your foot been immoblized in a cast? Have you had an MRI? What type of work do you do? Is weight a factor in your heel pain? There are lots of questions that I'm sure you've answered before on this site. Feel free to email me with your answers or ask me other questions, at (email removed), I may be able to make some suggestions to help decrease your discomfort.

Re: Strassburg Sock and heel swelling?

MarvinL on 11/16/02 at 10:40 (100388)

My podiatrist had me wear night splints and I have had several shots and I still have pain in my heel. I wear Reebock sneakers with heelcups the Dr sold me and I wear Rockport shoes with the same heel cups. After the last injection, I went 2 weeks without pain and then it came back with a vengeance. Any suggestions, please?