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Alternate Calf Stretch

Posted by Doug S on 11/28/02 at 06:00 (101312)

Just found this website yesterday after years of PF.
I've been wondering about the possibility of improper stretch in lower calf.
I point the foot inward and find that I can feel a stretch on the bottom of the foot.
Perhaps that's a bad thing?
My pain runs all along the arches on the inside in addition to heel pain.
I have good flexibility in lower leg, about 27 degrees or more.

With that much flexibility perhaps I should use an alternate method.
I have a stretch cloth that comes with a book on stretching.
The cloth is similar to a bathrobe belt but wider and it stretches a little.
I can wrap it around the ball of my foot as I sit on the floor and pull.
I do this with a shoe on and feel no stretch on the bottom of the foot.

Opinions anybody?

Re: Alternate Calf Stretch

Carole C in NOLA on 11/28/02 at 07:21 (101314)

Doug, my C.Ped had me do stretches pointing the foot inwards and up (towards my nose) and holding for up to 30 seconds. She had me do this while sitting on a bed, with my legs straight out and holding the knee down flat with my hands while pointing my toes on that foot in this way. Start by holding for 10 seconds and then work up to 30 seconds, and repeat.

I don't think that the direction your feet are pointing are a problem, but you might want to do your stretches without using the cloth and just pointing, if you have acute PF, just to make sure you don't over-do.

I can attest that toe pointing while sitting down, without weight-bearing or pulling with a cloth, is all you need for your PF. If you only point your toes, you don't have to worry about joining the multitudes who post here about over-doing their stretches and about the subsequent harm to their feet.

Carole C

Re: Alternate Calf Stretch/night splinting

Doug S on 11/28/02 at 08:18 (101317)

Thanks Carole.
This overstretching business is confusing.
Someone has just posted that they got good results by using a lot of stretch with night splinting.
Is that a minority view? (anybody?)
I have not tried night splinting.

Re: Alternate Calf Stretch/night splinting

Julie on 11/28/02 at 08:30 (101318)

Doug, it wasn't clear to me from your post if you were referring to the 'wall stretch' (hands against a wall, one leg straight, one knee bent). If you were, it is awfully important to keep both feet pointing straight forward.

But I would suggest that you not do any weight-bearing stretches: they can do more harm than good. The wall stretch is a perfectly good stretch for healthy tissues, not so good for injured ones.

I agree with Carole that you don't need to pull on your foot to stretch effectively. The exercise she described is good.

I read Jason's post about aggressive night splinting. It disagrees with everything the doctors here have said over the years about how to use a night splint, which is meant (1) to help avoid first-step-in-the-morning pain by avoiding the plantar flexing of the foot overnight, and (2) to apply a consistent but gentle stretch over a period of time and thus lengthen short/tight calf muscles and achilles tendons.

As a rule, stretching-till-it-hurts is a very bad idea for anyone with PF. There will always be the exception to the rule, though, and it worked for Jason. I wouldn't suggest anyone else follow that lead.

Re: Alternate Calf Stretch/night splinting

Doug S on 11/28/02 at 09:13 (101320)

Thanks Julie

I think I'll try the conservative night splinting.
Perhaps Jason's method worked because he is a mailman.
I don't expect most PF sufferors do that much walking,
and in his case probably on concrete sidewalks, OUCH!

Re: Alternate Calf Stretch/night splinting

Carole C in NOLA on 11/28/02 at 09:34 (101323)

Conservative use of night splints is supposed to be very helpful. My C.Ped who is quite a 'foot guru' suggested that I should consider getting one. I just never did.

Julie is our local expert on stretching, and knows what works for most people with PF.

I thought that post about aggressive use of night splints was pretty shocking, though I'm glad that Jason has managed to recover from PF. It hurt my PF just to read the post! I'd suggest that people try more conventional PF treatments before resorting to something like that.

Carole C

Re: Alternate Calf Stretch/night splinting

Julie on 11/28/02 at 16:36 (101349)

Good, Doug. Conservative is generally best. I have no idea why such painful stretching worked for Jason, but I wouldn't risk emulating him even if I were a mailman.

Re: Alternate Calf Stretch/night splinting

Julie on 11/28/02 at 16:37 (101350)

Carole, being thought of as a 'local' expert tickles me! :)

Re: Alternate Calf Stretch/night splinting

Carole C in NOLA on 11/28/02 at 17:57 (101355)

Well you are our international expert on stretching, too! But you are also our 'local' expert, in the sense in which I meant it... which is to say, our expert here within the boundaries of the heelspurs.com message board 'world'.

Carole C

Re: Alternate Calf Stretch/night splinting

Julie on 11/29/02 at 02:45 (101381)

I know. It was a sort of joke.......:o) anyway, everything out here in cyberspace is local, isn't it?

Hope you had a lovely Thanksgiving, Carole!

Re: Alternate Calf Stretch/night splinting

Carole C in NOLA on 11/29/02 at 07:02 (101386)

The internet sure has made our world smaller! :)

Yes I did have a good time on Thanksgiving, and I hope you did too.

Carole C

Re: Alternate Calf Stretch

josh s on 12/10/02 at 12:24 (102564)

With 27 degrees of motion in dorsiflexion you do NOT need to stretch (Unless you like to walk up very steep hills constantly). Stretching the bottom of foot is BAD. I will go on the record with this opinion: any device designed to 'stretch' the plantar fascia (night splints, etc.) is a terrible idea- if your lengthen the plantar fascia you thereby weaken the ability of the foot to support itself with the 'windlass mechanism' while walking and with the 'reverse windlass mechanism' while standing. If you damage your foot's ability to support itself you will eventually have much worse trouble than plantar fasciitis. With 27 degrees, if you feel you must stretch, 'stretch' to 26 degrees and hold for a while. Be assured that you are thereby doing everything that needs to be done in this regard.

Re: Alternate Calf Stretch

Julie on 12/10/02 at 17:18 (102600)

Josh, I don't know if Doug will see your post, as two weeks have passed since he asked the question and he may not even be around any more. If you're concerned, re-post yours on a new thread, which he probably will see - if he's still with us.

The night splint isn't meant to stretch the plantar fascia, but to hold the foot in a gently dorsiflexed position to avoid the inevitable overnight plantar flexion. If it stretches anything, it stretches the gastro/soleus/ achilles complex. I don't think the fascia itself can stretch. But if it could, I agree that it would be a very bad idea to try.

And I agree too that with that degree of dorsiflexion Doug doesn't need to stretch. and could easily overdo it if he does.

Re: Alternate Calf Stretch

Doug S on 12/11/02 at 17:10 (102750)

Josh thanks for that info.

It may be of interest to note that I took part in a heel pain study at the University of Rochester, where they teach physical therapy to Cornell students. Their suggestion was that the preferred stretch was to stretch the bottom of the foot by using your hands to bend the foot back. (I don't recall how gentle they said to be)

I have stopped this practice recently, but don't notice any difference.

BTW I almost missed your reply, thought the thread was dead (and haven't been checking the board), but I recognized Julie's name in my junk filled email box. (thanks again Julie)

Re: Alternate Calf Stretch

josh s on 12/12/02 at 09:01 (102802)

Well, if you read this Julie:

The night splint is actually used by some to stretch the pf. The idea is that in plantar fasciitis the pf is being stretched with every step - in this case stretching is actually microtearing, whereas with muscles stretching=reseting resting length. Anyway, during sleep the foot usually assumes a plantarflexed position which allows the pf to heal in a slightly contracted position. The night splint disallows this by gently stretching the pf. This has the cummulative effect of maintaining the plastic deformation that has occured during a day of microtearing.

Re: Alternate Calf Stretch

Julie on 12/12/02 at 09:13 (102804)

I've read it, Josh, but I don't think I've anything more to contribute. I've no personal experience of the night splint, and have garnered such understanding as I have from the doctors here and from people who have experienced it and found it helpful. If you're saying that you think it's harmful, well, to me that's just another piece of information to fit into the jigsaw, but it could discourage someone from using one who might be helped by it. As many have been helped by it, and as the doctors recommend it, that might be a shame.

The question of whether or not the PF 'stretches' has been much discussed. I've come to the conclusion that, being a ligamentous structure, it probably doesn't. (I would not call microtearing 'stretching'.)

Re: Alternate Calf Stretch

josh s on 12/12/02 at 09:50 (102813)

Well yes, maybe it does help some, but I'm saying in the long run it's probably not such a good idea. As to whether the pf stretches, it's a matter of semantics. Ligaments (and tendons) have an elastic threshold beyond which they tear. When torn, under most conditions (especially if bearing weight during healing) they will heal to the length they've been torn (stretched) to. Like I said, they don't stretch in the same way we stretch muscles (although many people think when stretching that they are actually altering the structure of a muscle - i.e. making it longer)- that is by resetting the resting length - an neurologic alteration.

The point is that when we stretch a muscle, if we overstretch odds are we'll tear the muscle and luckily avoid deforming the attached tendon. However, when we 'stretch' a ligament there is no muscle to stretch and our efforts go directly into the ligament.

Some doctors actually place a wedge beneath the toes in the nightsplint to encourage the pf to heal in a longer postition (the Strassbourg sock will do this as well since the toes are dorsiflexed by the way leverage is applied here). The logic here is the same which prompts doctors to cut the pf: Since the pf is being stretched, microtorn and thereby inflamed by daily activity, if we make the pf longer it will be too long to be stressed by daily activity. The problem here is that the pf length is crucial to the autosupport of the foot structure. If you remove that pf's ability to support the truss (arch) of the foot, other structures will have to pick up the slack. In turn these other structures will be stretched, etc. The pf release surgery will go down as one of the ten most idiotic surgeries of the 20th century.

Sorry to rant at you Julie, I know you are not in the least argumentative, but the fact that these surgeries are still being perfomed burns me, and it seems that many professionals don't understand or are not communicating this basic fact.

Re: Alternate Calf Stretch

Julie on 12/14/02 at 02:32 (103023)

Don't worry, Josh, I don't feel ranted at. I'm aware of how muscles, ligaments and tendons stretch/don't stretch, and I certainly agree with you about the illogicality of surgical solutions that cut the plantar fascia.

But my understanding of the night splint is, still, this: it holds the foot in a gently dorsiflexed position, avoiding overnight plantar flexion, with the aim of lengthening (i.e. restoring to optimum resting length) the gastrocnemius, soleus and achilles complex, thereby increasing the angle of dorsflexion, with the ultimate result that the strain on the PF is reduced. I don't see how this can be compared to the aggressive surgeries we both have such grave doubts about.

Now: I'd love to know your candidates for the other nine most idiotic surgeries of the century! This would make a great topic for the social board, so if you feel inclined to take up the idea let's move it over there.

Re: Alternate Calf Stretch

Carole C in NOLA on 11/28/02 at 07:21 (101314)

Doug, my C.Ped had me do stretches pointing the foot inwards and up (towards my nose) and holding for up to 30 seconds. She had me do this while sitting on a bed, with my legs straight out and holding the knee down flat with my hands while pointing my toes on that foot in this way. Start by holding for 10 seconds and then work up to 30 seconds, and repeat.

I don't think that the direction your feet are pointing are a problem, but you might want to do your stretches without using the cloth and just pointing, if you have acute PF, just to make sure you don't over-do.

I can attest that toe pointing while sitting down, without weight-bearing or pulling with a cloth, is all you need for your PF. If you only point your toes, you don't have to worry about joining the multitudes who post here about over-doing their stretches and about the subsequent harm to their feet.

Carole C

Re: Alternate Calf Stretch/night splinting

Doug S on 11/28/02 at 08:18 (101317)

Thanks Carole.
This overstretching business is confusing.
Someone has just posted that they got good results by using a lot of stretch with night splinting.
Is that a minority view? (anybody?)
I have not tried night splinting.

Re: Alternate Calf Stretch/night splinting

Julie on 11/28/02 at 08:30 (101318)

Doug, it wasn't clear to me from your post if you were referring to the 'wall stretch' (hands against a wall, one leg straight, one knee bent). If you were, it is awfully important to keep both feet pointing straight forward.

But I would suggest that you not do any weight-bearing stretches: they can do more harm than good. The wall stretch is a perfectly good stretch for healthy tissues, not so good for injured ones.

I agree with Carole that you don't need to pull on your foot to stretch effectively. The exercise she described is good.

I read Jason's post about aggressive night splinting. It disagrees with everything the doctors here have said over the years about how to use a night splint, which is meant (1) to help avoid first-step-in-the-morning pain by avoiding the plantar flexing of the foot overnight, and (2) to apply a consistent but gentle stretch over a period of time and thus lengthen short/tight calf muscles and achilles tendons.

As a rule, stretching-till-it-hurts is a very bad idea for anyone with PF. There will always be the exception to the rule, though, and it worked for Jason. I wouldn't suggest anyone else follow that lead.

Re: Alternate Calf Stretch/night splinting

Doug S on 11/28/02 at 09:13 (101320)

Thanks Julie

I think I'll try the conservative night splinting.
Perhaps Jason's method worked because he is a mailman.
I don't expect most PF sufferors do that much walking,
and in his case probably on concrete sidewalks, OUCH!

Re: Alternate Calf Stretch/night splinting

Carole C in NOLA on 11/28/02 at 09:34 (101323)

Conservative use of night splints is supposed to be very helpful. My C.Ped who is quite a 'foot guru' suggested that I should consider getting one. I just never did.

Julie is our local expert on stretching, and knows what works for most people with PF.

I thought that post about aggressive use of night splints was pretty shocking, though I'm glad that Jason has managed to recover from PF. It hurt my PF just to read the post! I'd suggest that people try more conventional PF treatments before resorting to something like that.

Carole C

Re: Alternate Calf Stretch/night splinting

Julie on 11/28/02 at 16:36 (101349)

Good, Doug. Conservative is generally best. I have no idea why such painful stretching worked for Jason, but I wouldn't risk emulating him even if I were a mailman.

Re: Alternate Calf Stretch/night splinting

Julie on 11/28/02 at 16:37 (101350)

Carole, being thought of as a 'local' expert tickles me! :)

Re: Alternate Calf Stretch/night splinting

Carole C in NOLA on 11/28/02 at 17:57 (101355)

Well you are our international expert on stretching, too! But you are also our 'local' expert, in the sense in which I meant it... which is to say, our expert here within the boundaries of the heelspurs.com message board 'world'.

Carole C

Re: Alternate Calf Stretch/night splinting

Julie on 11/29/02 at 02:45 (101381)

I know. It was a sort of joke.......:o) anyway, everything out here in cyberspace is local, isn't it?

Hope you had a lovely Thanksgiving, Carole!

Re: Alternate Calf Stretch/night splinting

Carole C in NOLA on 11/29/02 at 07:02 (101386)

The internet sure has made our world smaller! :)

Yes I did have a good time on Thanksgiving, and I hope you did too.

Carole C

Re: Alternate Calf Stretch

josh s on 12/10/02 at 12:24 (102564)

With 27 degrees of motion in dorsiflexion you do NOT need to stretch (Unless you like to walk up very steep hills constantly). Stretching the bottom of foot is BAD. I will go on the record with this opinion: any device designed to 'stretch' the plantar fascia (night splints, etc.) is a terrible idea- if your lengthen the plantar fascia you thereby weaken the ability of the foot to support itself with the 'windlass mechanism' while walking and with the 'reverse windlass mechanism' while standing. If you damage your foot's ability to support itself you will eventually have much worse trouble than plantar fasciitis. With 27 degrees, if you feel you must stretch, 'stretch' to 26 degrees and hold for a while. Be assured that you are thereby doing everything that needs to be done in this regard.

Re: Alternate Calf Stretch

Julie on 12/10/02 at 17:18 (102600)

Josh, I don't know if Doug will see your post, as two weeks have passed since he asked the question and he may not even be around any more. If you're concerned, re-post yours on a new thread, which he probably will see - if he's still with us.

The night splint isn't meant to stretch the plantar fascia, but to hold the foot in a gently dorsiflexed position to avoid the inevitable overnight plantar flexion. If it stretches anything, it stretches the gastro/soleus/ achilles complex. I don't think the fascia itself can stretch. But if it could, I agree that it would be a very bad idea to try.

And I agree too that with that degree of dorsiflexion Doug doesn't need to stretch. and could easily overdo it if he does.

Re: Alternate Calf Stretch

Doug S on 12/11/02 at 17:10 (102750)

Josh thanks for that info.

It may be of interest to note that I took part in a heel pain study at the University of Rochester, where they teach physical therapy to Cornell students. Their suggestion was that the preferred stretch was to stretch the bottom of the foot by using your hands to bend the foot back. (I don't recall how gentle they said to be)

I have stopped this practice recently, but don't notice any difference.

BTW I almost missed your reply, thought the thread was dead (and haven't been checking the board), but I recognized Julie's name in my junk filled email box. (thanks again Julie)

Re: Alternate Calf Stretch

josh s on 12/12/02 at 09:01 (102802)

Well, if you read this Julie:

The night splint is actually used by some to stretch the pf. The idea is that in plantar fasciitis the pf is being stretched with every step - in this case stretching is actually microtearing, whereas with muscles stretching=reseting resting length. Anyway, during sleep the foot usually assumes a plantarflexed position which allows the pf to heal in a slightly contracted position. The night splint disallows this by gently stretching the pf. This has the cummulative effect of maintaining the plastic deformation that has occured during a day of microtearing.

Re: Alternate Calf Stretch

Julie on 12/12/02 at 09:13 (102804)

I've read it, Josh, but I don't think I've anything more to contribute. I've no personal experience of the night splint, and have garnered such understanding as I have from the doctors here and from people who have experienced it and found it helpful. If you're saying that you think it's harmful, well, to me that's just another piece of information to fit into the jigsaw, but it could discourage someone from using one who might be helped by it. As many have been helped by it, and as the doctors recommend it, that might be a shame.

The question of whether or not the PF 'stretches' has been much discussed. I've come to the conclusion that, being a ligamentous structure, it probably doesn't. (I would not call microtearing 'stretching'.)

Re: Alternate Calf Stretch

josh s on 12/12/02 at 09:50 (102813)

Well yes, maybe it does help some, but I'm saying in the long run it's probably not such a good idea. As to whether the pf stretches, it's a matter of semantics. Ligaments (and tendons) have an elastic threshold beyond which they tear. When torn, under most conditions (especially if bearing weight during healing) they will heal to the length they've been torn (stretched) to. Like I said, they don't stretch in the same way we stretch muscles (although many people think when stretching that they are actually altering the structure of a muscle - i.e. making it longer)- that is by resetting the resting length - an neurologic alteration.

The point is that when we stretch a muscle, if we overstretch odds are we'll tear the muscle and luckily avoid deforming the attached tendon. However, when we 'stretch' a ligament there is no muscle to stretch and our efforts go directly into the ligament.

Some doctors actually place a wedge beneath the toes in the nightsplint to encourage the pf to heal in a longer postition (the Strassbourg sock will do this as well since the toes are dorsiflexed by the way leverage is applied here). The logic here is the same which prompts doctors to cut the pf: Since the pf is being stretched, microtorn and thereby inflamed by daily activity, if we make the pf longer it will be too long to be stressed by daily activity. The problem here is that the pf length is crucial to the autosupport of the foot structure. If you remove that pf's ability to support the truss (arch) of the foot, other structures will have to pick up the slack. In turn these other structures will be stretched, etc. The pf release surgery will go down as one of the ten most idiotic surgeries of the 20th century.

Sorry to rant at you Julie, I know you are not in the least argumentative, but the fact that these surgeries are still being perfomed burns me, and it seems that many professionals don't understand or are not communicating this basic fact.

Re: Alternate Calf Stretch

Julie on 12/14/02 at 02:32 (103023)

Don't worry, Josh, I don't feel ranted at. I'm aware of how muscles, ligaments and tendons stretch/don't stretch, and I certainly agree with you about the illogicality of surgical solutions that cut the plantar fascia.

But my understanding of the night splint is, still, this: it holds the foot in a gently dorsiflexed position, avoiding overnight plantar flexion, with the aim of lengthening (i.e. restoring to optimum resting length) the gastrocnemius, soleus and achilles complex, thereby increasing the angle of dorsflexion, with the ultimate result that the strain on the PF is reduced. I don't see how this can be compared to the aggressive surgeries we both have such grave doubts about.

Now: I'd love to know your candidates for the other nine most idiotic surgeries of the century! This would make a great topic for the social board, so if you feel inclined to take up the idea let's move it over there.