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Hi Everyone. New here. Here's what I'm using..

Posted by IanJ on 11/14/02 at 00:46 (100106)

Hi everyone! I'm sad to have to be here but i'm going on 6 weeks of this ailment. No end in sight yet. Both my feet on the arches, not the heels. I'm 39, about 20-30 lbs overweight, have a history of achilles tendonitis, used old shoes and went for a run with little stretching.

I self-diagnosed and have been to my GP for confirmation. He prescribed Naproxen which I took for 2 weeks but just went off of it because of swelling in feet and face.

I ice my feet about 5x / day which brings some relief.

I've just switched from load bearing stretches to non-load bearing. I now wear my shoes indoors all the time except for the shower.

I bought some Asics 2070's and put in Spencos at about week 3. They're ok but I feel the spencos are not quite right. I'll probably try the New Balance 1121 with Powersteps which I just ordered.

I bought the A-Force Dorsal night splints but don't find they keep my foot flexed enough and the left one is very uncomfortable on the top and bottom of my foot so I seldom wear it. Thinking of the Strassburg Socks but don't like the price. $35 / 1 sock despite things I've read in this message board, I just emailed him and he confirmed that price.

I travel to Toronto from time to time so am considering ESWT in a few months if things don't get better. What is the price in USD?

Re: Hi Everyone. New here. Here's what I'm using..

Lara T on 11/14/02 at 07:43 (100119)

Tarsal Tunnel Syndrome and Plantar Fascitis can have overlapping symptoms, but the treatments options are different, with some overlap. Lots of people are diagnosed with PF, until it lasts long enough and doesn't respond to treatment, and additional tests and investigation are conducted. The treatments you have list suggest you are treating for PF. It's my impression that where things often start, and reasonably so.

I have TTS (diagnosed as PF for about 2-3 years and 3 doctors) before coming across a doctor that recognized it as TTS), and was questioning whether to try ESWT, until someone (one of hte doctors I believe) advised against ESWT for TTS. I believe it's success with with PF. I would want to be certain which I had before trying ESWT.

Good Luck.

Re: Hi Everyone. New here. Here's what I'm using..

Richard, C.Ped on 11/14/02 at 08:19 (100123)

Hi Ian,
With your history or Achilles tendonitis, I would suggest finding out if you have a short heel cord. I see quite a bit if PF in patients with short heel cords. If so, I would suggest a softer orthoisis with a slight heel lift to relieve the tension. As sore as your arches are, I would stay away from a hard orthosis in the beginning. Just my thoughts though.
Richard, C.Ped

Re: Hi Everyone. New here. Here's what I'm using..

IanJ on 11/14/02 at 09:40 (100129)

Are Powerstep inserts considered hard or soft?

Re: Hi Everyone. New here. Here's what I'm using..

IanJ on 11/14/02 at 09:41 (100130)

What are some of the differing treatment options for Tarsal Tunnel Syndrome vs PF (other than ESWT)?

Re: Hi Everyone. New here. Here's what I'm using..

john h on 11/14/02 at 10:06 (100133)

Ian: Bayshore clinic in Toronto who performs a large number of ESWT treatments at a very reasonble price. I think their webpage is http://www.bayshore .com If that is not correct look further on this website and Scott has the address of the various ESWT providers and phone numbers. They will be glad to give you the charges. Their treatment protocol will require 3 treatments spaced 1 day apart. You might also do a search under 'Sunny' on this site as he is a frequent poster and is a Bayshore official.

Re: Hi Everyone. New here. Here's what I'm using..

john h on 11/14/02 at 10:07 (100136)

Having used Power Step I would call them semi-rigid.

Re: Hi Everyone. New here. Here's what I'm using..

Lara T on 11/14/02 at 10:15 (100138)

I've put PF next to things that work for PF, and TTS, for Tarsal Tunnel Syndrom, which work for some people - to the best of my knowledge (which is a lay person's knowledge at best) I welcome comments from those with more knowlege. None of these treatments work for everyone, and all of them worked for someone. It's also good to be careful about rejecting or accepting something. Many of us were diagnosed with PF or TTS and later were determined to have the other (particularly going from PF to TTS) or something else completely. For some of the treatments mentioned it wasn't clear from the archives whether it was PF or TTS, or something else?

PF/TTS TREATMENT #1: never go barefoot
PF/TTS Treatment #2 don't cheat and go barefoot just to run upstairs, or get something from the other room.

SHOES (shoe selection seems to help for both problems, but which shoe works for you tends to be individual).
Merrill (all Merrill are not created equal check out the particular shoe)
New Balance - (all New Balance are not created equal check out the particular shoe)
Some people have also mentioned Nike.
Dansko clogs (particularly good for limiting the flex motion involved in walking - good for TTS, not sure how it affects PF)

PF/TTS: Find a shoe store that is run/owned/managed by the people who make orthotics. They often have 1) the expertise to know which shoes match your symptoms and 2) a good selection of shoes. As bonuses, you don't have to sift through a lot of lousy shoes and the stores are often modest in size and so service is prompt and responsive. (The ones I know about carry Merrill, Dansko & New Balance).

NON INVASIVE
PF/TTS-prayer
PF/TTS? -orthotics (traditional, Dr. Kiper),
TTS-compression socks
PF/TTS- taping (see Scotts heelbook, online)
PF/TTS?-nightsplints or strassburg sock
PF-ice (daily and/or after activities. You can get ice packs that fit -nicely to the foot). I've heard reports of this being much more successful than would be anticipated, even 15 min/day at the end of the day
PF-stretching (check out thread called 'Julie's stretches' in the archives)
PF?/TTS?-walking case?- It was not a boot cast, but rather the hard fiberglass kind they use for fractures.

TREATMENTS:
PF?/TTS?: Massage (deep friction, ART, deep tissue, w/ biofreeze/ ibuprofen cream/Vit 3, Trigger Point on calves/hamstrings, Rolfing, cross-friction),
form the archives): My experience is that direct massage of the inflamed area makes PF MUCH worse. I am currently getting professional massage from arch to toes only, and focussing on trigger points in calf, hammy, and even quads. I have one point on my calf (that thin strappy lateral muscle, talus?) that if you rub across the trigger point it feels like you are rubbing the arch cast and crutches.

?PF/?TTS-ART (a type of massage)
PF: ESWT ( I believe I was told it bad for TTS)

PF-contrast baths (also helps TTS as it keeps you off your feet and feels good)
??-Pilates, strengthening, and balance exercises, etc.
PF/TTS-boot cast, cam walker, etc. to immobilize foot
?-massage sandals
TTS-Vitamin B/B12 (some people take mega doses - be careful as to which vitamins can cause toxic reactions)

TTS -Trigger Point Massage Therapy

HOME REMEDIES
PF-Ice
PF/TTS?-hamstring stretches
PF: 'aggressive stretching'
PF/TTS- taping (see instructions on web site)
PF/TTS-rest
PF/TTS-Epson salt soak
PF-yoga

PF/TTS?-Capsazin cream
PF/TTS- Ibuprofen cream
PF/TTS? - from archives: Oral dose packs of cortisone have helped some. Also there are much more powerful topical creams that can be compounded by a pharmacist at the request of a doctor that can be much more effective than otc ibuprophen cream. They may contain ingredients like ketamine, ketaprophen, gahapentin, etc. A lot of these medications are much better at not only killing pain, but preventing the nerves from over firing. Even simple Ibuprofen cream could be compounded by your local pharmacist.

*************
MINIMALLY INVASIVE (but not necessarily without significant side effects)
?-Cortisone shots
-OTC Medications:
?Glucosamine & Chondrotin (person reporting said brand makes a difference)

PF/TTS: Anti-inflammatories (There are many anti-inflammatory drugs out there with patients responding very differently. What works best for one patient if often not what works best for the next. Ed)

PF/TTS:-NSAIDS aspirin, ibuprofen
-COX-2 Inhibitors= Vioxx, Celebrex, . . .

I'm not sure how the following pain relievers are classified. If anyone knows, please let me know.
-Mobic (Mobic is as a drug halfway between a classical anti-inflammatory and a cox-2 inhibitor. Mobic can thus be harder on the GI system.)
Bextra

TTS: -Rx Medications: Neurontin, Elavil
? -PT like iontophoresis (sp)? with a steroid

DRUGS-RX
TTS - neurontin
? - muscle relaxants
? - flexril
? - Jade

INVASIVE
PF- -PF release surgery
TTS -TT release surgery

When NOTHING works:
-consider a pain management clinic/doctor.
from archives: (I'm not sure how long you should suffer, or how many things you should try first. If in doubt, call a pain management doctor and ask.
2 things to consider:
1. a pain management doctor will know how to manage pain. She or he won't necessarily know what treatments you haven't tried for PF/TTS that might work.
2. Many of the the treatments pain management has are heavy duty drugs. This isn't bad. But I would want to be sure I'd tried lots of other stuff first.

Posted by john h on 3/02/2000
i was thinking today of some possible treatments for PF that no one has tried:
1. Faith healer
2. In some societies they beat your feet with a cane if you do something bad. Might help?
3. Witch Doctor? Hey! Why not it beats a cortisone shot!
4. Radiation. Tie a rod of plutonium 238 around your foot.
5. Bio-feedback. good luck!
5. Break both legs which will force you into bed for 4 or 5 months. (something less drastic which I tried unintentionally but very effectively - get a fungal infection requiring soaking 6x day for a week, or have knee surgery).
6. Psycharisit. some idiots think the pain is in our head.
7. I once had a wart on my hand. my grandmother had me rub it with a dirty wash cloth and then bury the cloth. For real- the wart went away. Unfortunately, my wife does not keep any dirty dishcloths around.
8. Get a boyfriend like Brad Pitt or girlfriend like Julia Roberts and forget your pain.

Re: Hi Everyone. New here. Here's what I'm using..

Richard, C.Ped on 11/14/02 at 10:58 (100144)

Hi Ian,
when I said orthois, I meant a custom orthosis made for your foot only, not an off the shelf type. Soft to me is the use of the material, EVA. 40 durometer for posting and 30 durometer for the shell.
Richard, C.Ped

Re: Hi Everyone. New here. Here's what I'm using..

Pamela S on 11/14/02 at 13:42 (100153)

6 weeks is still really early. Keep resting, stretching, getting support. You might want to try taping and personal foot trainers for those non-weight bearing stretches. I also swore by New Balance shoes, and a custom orthotic. I did get rid of the PF completely but it took me 3 years. I know many other people who have gotten rid of it in 6 months to 1 year.

Re: Hi Everyone. New here. Here's what I'm using..

Ed Davis, DPM on 11/14/02 at 23:38 (100209)

Dr. Wander pointed out that the Strassberg 'sock' is really a type of night splint. Sounds expensive when only you think of it as a sock.

My preference is the N'Ice and Stretch which Scott sells on this site.
Ed

Re: Hi Everyone. New here. Here's what I'm using..

john h on 11/15/02 at 11:04 (100254)

Dr. Ed: my preference is also the Nice n Stretch. I tried the Strassberg sock but it ended up bending my big toe more than anything and had a tendency to loosen up during the night.

Re: Hi Everyone. New here. Here's what I'm using..

Ed Davis, DPM on 11/15/02 at 17:40 (100315)

John:
I have tested a bunch of them. I try new ones out from time to time. I keep coming back to the N'ice and Stretch. There certainly are individuals who do best with a particular brand so I keep a few different one's available. I could imagine the Strassburg sock being a good option for patients who need to wear two splints -- they often have difficulty trying to sleep with a pair of the rigid splints.(Not to mention the splints getting in the way of their love life.)
Ed

Re: Hi Everyone. New here. Here's what I'm using..

IanJ on 11/15/02 at 19:36 (100324)

ya my wife is not a big fan of the splints.

Re: Hi Everyone. New here. Here's what I'm using..

IanJ on 11/15/02 at 22:22 (100337)

How do I find out if I have a short heel cord? Is it diagnosed by a doctor using ultrasound or measured or what?

I was using the Spenco inserts which are soft so maybe I should continue using those along with a heel lift? My Powersteps just arrived and they are quite rigid.

Re: Ian re short heel cord

Julie on 11/16/02 at 02:48 (100345)

Ian, any podiatrist can and should check this out, because it is one of the main causes of PF and one of the first things to look for, but you can check it out for yourself. Somewhere on this website is a test that you can do to measure your angle of dorsiflexion (that is, the degree to which your foot can bend backwards. If I can find it (it's a couple of years since I took it myself) I will point it out to you, or perhaps someone else who sees your post can do so.

A rough-and-ready test is to bend your foot back as far as you can, and have a look at the angle formed by the top of your foot and your shin. If it's visibly less than 90 degrees, you can take it that you have a short heel cord.

Non-weight bearing exercises to lengthen it without aggravating the fascia are called for.

Re: Hi Everyone. New here. Here's what I'm using..

Lara T on 11/14/02 at 07:43 (100119)

Tarsal Tunnel Syndrome and Plantar Fascitis can have overlapping symptoms, but the treatments options are different, with some overlap. Lots of people are diagnosed with PF, until it lasts long enough and doesn't respond to treatment, and additional tests and investigation are conducted. The treatments you have list suggest you are treating for PF. It's my impression that where things often start, and reasonably so.

I have TTS (diagnosed as PF for about 2-3 years and 3 doctors) before coming across a doctor that recognized it as TTS), and was questioning whether to try ESWT, until someone (one of hte doctors I believe) advised against ESWT for TTS. I believe it's success with with PF. I would want to be certain which I had before trying ESWT.

Good Luck.

Re: Hi Everyone. New here. Here's what I'm using..

Richard, C.Ped on 11/14/02 at 08:19 (100123)

Hi Ian,
With your history or Achilles tendonitis, I would suggest finding out if you have a short heel cord. I see quite a bit if PF in patients with short heel cords. If so, I would suggest a softer orthoisis with a slight heel lift to relieve the tension. As sore as your arches are, I would stay away from a hard orthosis in the beginning. Just my thoughts though.
Richard, C.Ped

Re: Hi Everyone. New here. Here's what I'm using..

IanJ on 11/14/02 at 09:40 (100129)

Are Powerstep inserts considered hard or soft?

Re: Hi Everyone. New here. Here's what I'm using..

IanJ on 11/14/02 at 09:41 (100130)

What are some of the differing treatment options for Tarsal Tunnel Syndrome vs PF (other than ESWT)?

Re: Hi Everyone. New here. Here's what I'm using..

john h on 11/14/02 at 10:06 (100133)

Ian: Bayshore clinic in Toronto who performs a large number of ESWT treatments at a very reasonble price. I think their webpage is http://www.bayshore .com If that is not correct look further on this website and Scott has the address of the various ESWT providers and phone numbers. They will be glad to give you the charges. Their treatment protocol will require 3 treatments spaced 1 day apart. You might also do a search under 'Sunny' on this site as he is a frequent poster and is a Bayshore official.

Re: Hi Everyone. New here. Here's what I'm using..

john h on 11/14/02 at 10:07 (100136)

Having used Power Step I would call them semi-rigid.

Re: Hi Everyone. New here. Here's what I'm using..

Lara T on 11/14/02 at 10:15 (100138)

I've put PF next to things that work for PF, and TTS, for Tarsal Tunnel Syndrom, which work for some people - to the best of my knowledge (which is a lay person's knowledge at best) I welcome comments from those with more knowlege. None of these treatments work for everyone, and all of them worked for someone. It's also good to be careful about rejecting or accepting something. Many of us were diagnosed with PF or TTS and later were determined to have the other (particularly going from PF to TTS) or something else completely. For some of the treatments mentioned it wasn't clear from the archives whether it was PF or TTS, or something else?

PF/TTS TREATMENT #1: never go barefoot
PF/TTS Treatment #2 don't cheat and go barefoot just to run upstairs, or get something from the other room.

SHOES (shoe selection seems to help for both problems, but which shoe works for you tends to be individual).
Merrill (all Merrill are not created equal check out the particular shoe)
New Balance - (all New Balance are not created equal check out the particular shoe)
Some people have also mentioned Nike.
Dansko clogs (particularly good for limiting the flex motion involved in walking - good for TTS, not sure how it affects PF)

PF/TTS: Find a shoe store that is run/owned/managed by the people who make orthotics. They often have 1) the expertise to know which shoes match your symptoms and 2) a good selection of shoes. As bonuses, you don't have to sift through a lot of lousy shoes and the stores are often modest in size and so service is prompt and responsive. (The ones I know about carry Merrill, Dansko & New Balance).

NON INVASIVE
PF/TTS-prayer
PF/TTS? -orthotics (traditional, Dr. Kiper),
TTS-compression socks
PF/TTS- taping (see Scotts heelbook, online)
PF/TTS?-nightsplints or strassburg sock
PF-ice (daily and/or after activities. You can get ice packs that fit -nicely to the foot). I've heard reports of this being much more successful than would be anticipated, even 15 min/day at the end of the day
PF-stretching (check out thread called 'Julie's stretches' in the archives)
PF?/TTS?-walking case?- It was not a boot cast, but rather the hard fiberglass kind they use for fractures.

TREATMENTS:
PF?/TTS?: Massage (deep friction, ART, deep tissue, w/ biofreeze/ ibuprofen cream/Vit 3, Trigger Point on calves/hamstrings, Rolfing, cross-friction),
form the archives): My experience is that direct massage of the inflamed area makes PF MUCH worse. I am currently getting professional massage from arch to toes only, and focussing on trigger points in calf, hammy, and even quads. I have one point on my calf (that thin strappy lateral muscle, talus?) that if you rub across the trigger point it feels like you are rubbing the arch cast and crutches.

?PF/?TTS-ART (a type of massage)
PF: ESWT ( I believe I was told it bad for TTS)

PF-contrast baths (also helps TTS as it keeps you off your feet and feels good)
??-Pilates, strengthening, and balance exercises, etc.
PF/TTS-boot cast, cam walker, etc. to immobilize foot
?-massage sandals
TTS-Vitamin B/B12 (some people take mega doses - be careful as to which vitamins can cause toxic reactions)

TTS -Trigger Point Massage Therapy

HOME REMEDIES
PF-Ice
PF/TTS?-hamstring stretches
PF: 'aggressive stretching'
PF/TTS- taping (see instructions on web site)
PF/TTS-rest
PF/TTS-Epson salt soak
PF-yoga

PF/TTS?-Capsazin cream
PF/TTS- Ibuprofen cream
PF/TTS? - from archives: Oral dose packs of cortisone have helped some. Also there are much more powerful topical creams that can be compounded by a pharmacist at the request of a doctor that can be much more effective than otc ibuprophen cream. They may contain ingredients like ketamine, ketaprophen, gahapentin, etc. A lot of these medications are much better at not only killing pain, but preventing the nerves from over firing. Even simple Ibuprofen cream could be compounded by your local pharmacist.

*************
MINIMALLY INVASIVE (but not necessarily without significant side effects)
?-Cortisone shots
-OTC Medications:
?Glucosamine & Chondrotin (person reporting said brand makes a difference)

PF/TTS: Anti-inflammatories (There are many anti-inflammatory drugs out there with patients responding very differently. What works best for one patient if often not what works best for the next. Ed)

PF/TTS:-NSAIDS aspirin, ibuprofen
-COX-2 Inhibitors= Vioxx, Celebrex, . . .

I'm not sure how the following pain relievers are classified. If anyone knows, please let me know.
-Mobic (Mobic is as a drug halfway between a classical anti-inflammatory and a cox-2 inhibitor. Mobic can thus be harder on the GI system.)
Bextra

TTS: -Rx Medications: Neurontin, Elavil
? -PT like iontophoresis (sp)? with a steroid

DRUGS-RX
TTS - neurontin
? - muscle relaxants
? - flexril
? - Jade

INVASIVE
PF- -PF release surgery
TTS -TT release surgery

When NOTHING works:
-consider a pain management clinic/doctor.
from archives: (I'm not sure how long you should suffer, or how many things you should try first. If in doubt, call a pain management doctor and ask.
2 things to consider:
1. a pain management doctor will know how to manage pain. She or he won't necessarily know what treatments you haven't tried for PF/TTS that might work.
2. Many of the the treatments pain management has are heavy duty drugs. This isn't bad. But I would want to be sure I'd tried lots of other stuff first.

Posted by john h on 3/02/2000
i was thinking today of some possible treatments for PF that no one has tried:
1. Faith healer
2. In some societies they beat your feet with a cane if you do something bad. Might help?
3. Witch Doctor? Hey! Why not it beats a cortisone shot!
4. Radiation. Tie a rod of plutonium 238 around your foot.
5. Bio-feedback. good luck!
5. Break both legs which will force you into bed for 4 or 5 months. (something less drastic which I tried unintentionally but very effectively - get a fungal infection requiring soaking 6x day for a week, or have knee surgery).
6. Psycharisit. some idiots think the pain is in our head.
7. I once had a wart on my hand. my grandmother had me rub it with a dirty wash cloth and then bury the cloth. For real- the wart went away. Unfortunately, my wife does not keep any dirty dishcloths around.
8. Get a boyfriend like Brad Pitt or girlfriend like Julia Roberts and forget your pain.

Re: Hi Everyone. New here. Here's what I'm using..

Richard, C.Ped on 11/14/02 at 10:58 (100144)

Hi Ian,
when I said orthois, I meant a custom orthosis made for your foot only, not an off the shelf type. Soft to me is the use of the material, EVA. 40 durometer for posting and 30 durometer for the shell.
Richard, C.Ped

Re: Hi Everyone. New here. Here's what I'm using..

Pamela S on 11/14/02 at 13:42 (100153)

6 weeks is still really early. Keep resting, stretching, getting support. You might want to try taping and personal foot trainers for those non-weight bearing stretches. I also swore by New Balance shoes, and a custom orthotic. I did get rid of the PF completely but it took me 3 years. I know many other people who have gotten rid of it in 6 months to 1 year.

Re: Hi Everyone. New here. Here's what I'm using..

Ed Davis, DPM on 11/14/02 at 23:38 (100209)

Dr. Wander pointed out that the Strassberg 'sock' is really a type of night splint. Sounds expensive when only you think of it as a sock.

My preference is the N'Ice and Stretch which Scott sells on this site.
Ed

Re: Hi Everyone. New here. Here's what I'm using..

john h on 11/15/02 at 11:04 (100254)

Dr. Ed: my preference is also the Nice n Stretch. I tried the Strassberg sock but it ended up bending my big toe more than anything and had a tendency to loosen up during the night.

Re: Hi Everyone. New here. Here's what I'm using..

Ed Davis, DPM on 11/15/02 at 17:40 (100315)

John:
I have tested a bunch of them. I try new ones out from time to time. I keep coming back to the N'ice and Stretch. There certainly are individuals who do best with a particular brand so I keep a few different one's available. I could imagine the Strassburg sock being a good option for patients who need to wear two splints -- they often have difficulty trying to sleep with a pair of the rigid splints.(Not to mention the splints getting in the way of their love life.)
Ed

Re: Hi Everyone. New here. Here's what I'm using..

IanJ on 11/15/02 at 19:36 (100324)

ya my wife is not a big fan of the splints.

Re: Hi Everyone. New here. Here's what I'm using..

IanJ on 11/15/02 at 22:22 (100337)

How do I find out if I have a short heel cord? Is it diagnosed by a doctor using ultrasound or measured or what?

I was using the Spenco inserts which are soft so maybe I should continue using those along with a heel lift? My Powersteps just arrived and they are quite rigid.

Re: Ian re short heel cord

Julie on 11/16/02 at 02:48 (100345)

Ian, any podiatrist can and should check this out, because it is one of the main causes of PF and one of the first things to look for, but you can check it out for yourself. Somewhere on this website is a test that you can do to measure your angle of dorsiflexion (that is, the degree to which your foot can bend backwards. If I can find it (it's a couple of years since I took it myself) I will point it out to you, or perhaps someone else who sees your post can do so.

A rough-and-ready test is to bend your foot back as far as you can, and have a look at the angle formed by the top of your foot and your shin. If it's visibly less than 90 degrees, you can take it that you have a short heel cord.

Non-weight bearing exercises to lengthen it without aggravating the fascia are called for.