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The next steps

Posted by Cristi R. on 11/29/02 at 13:50 (101421)

Hi everyone. Hope you all had a wonderful Thanksgiving! Just wanted to update you all on what is happening with my PF situation. My primary care doctor decided that 4 sessions of physical therapy might work for me. Went in for my first visit on Tuesday. The physical therapist did an iontophorosis treatment on my foot which was extremely painful! He told me that he'd be able to tell if the four visits were going to work at all after the first session. It didn't help at all and probably made my pain worse. So, my doctor has decided to cast me for a few weeks to totally immobilize everything and then see where we are after that. So, on Thursday (12/5) I will be getting the oh so lovely cast on my foot for a while. Wish me luck!

Cristi

Re: The next steps

IanJ on 11/29/02 at 20:46 (101449)

Sorry to hear that. I'm worried about going the next step from my family physician because of all the messages about how the PD doctor or physical therapist made things worse! Scary.

Re: The next steps

IanJ on 11/29/02 at 20:53 (101452)

(sorry about the triple post. server wasn't responding back.)

Re: The next steps

nancy s. on 11/30/02 at 06:38 (101472)

ian, try to learn from the posts by people who had bad experiences with a foot doc or physical therapist; take notes, even. from my involvement with this message board and from reading scott's heel pain book, by the time i reached my third doc i finally had an idea of what a good and thorough examination is; how to ask good questions; how much to expect of the doc in terms of his listening and comprehensive responses to my questions (expect a lot!); and how much experience and knowledge would inform his treatment plans for me and give me confidence.

use this message board to ask questions about any aspect of a doctor or pt visit that seems questionable to you. this place is a gold mine.

nancy
.

Re: The next steps

Carole C in NOLA on 11/30/02 at 07:06 (101478)

Sorry to hear that your PT isn't going to work and that you have to be in a cast during the holiday season. I hope it helps you to get better and that when you get it off, you are on your way to recovering.

Carole C

Re: The next steps

Carole C in NOLA on 11/30/02 at 07:17 (101479)

And Ian, if you don't get treatment from a foot doctor or PT right away, be sure to make your own self-treatment a top priority. If you don't seem to be making good steady substantial progress, then you may have no choice but to see a professional.

Then if you've taken Nancy's advice and learned what you can, you'll probably be able to gain more from seeing that professional.

The key is that you need to get effective treatment as soon as possible, whether it's self treatment or whether your treatment requires a professional 'kick in the behind' so to speak, to make some good progress. The sooner effective treatment is in place, the faster you will heal according to some of the doctors on this message board, and that makes sense to me too.

Carole C

Re: The next steps

IanJ on 12/01/02 at 00:43 (101529)

Thanks Carol. With the exception of custom orthotics (I'm using Powerfeet) I believe that my current self-treatment is very good based upon this site which I've spent alot of time on. However I am still in the acute stage and things are not getting better but, from what I've read about early stages of PF, that's somewhat normal.

I also know that losing weight (about 25-30lbs over) would really help me andI have to work on that.

Re: The next steps

Carole C in NOLA on 12/01/02 at 01:35 (101530)

Ian, I'm sorry that you are still enduring this pain. I'm trying to think of suggestions that might encourage you as you continue battling this 'PF Monster' as I sometimes call it.

I found that I had to keep trying different things to see what worked best for my feet. There are a lot of different treatments that we talk about on this site, and a lot of different ways a person can do most of them.

For example, I iced regularly for as long as I could stand it but I got no good out of that until I switched from ice in ziplocks to bags of frozen peas, and lengthened the time my foot was on ice to way more than what seemed reasonable (removing my foot periodically to avoid frostbite). This is just an example of how someone (me in this case) could think they were icing but could be doing it ineffectively. Other people might find my way of icing to be ineffectual, but have found their own way that works for them.

Another example is the way I had to learn at what point stretching was re-injuring my plantar fascia. I found I could even re-injure them by wiggling my toes if my tendons were tight, and I learned how to determine how gently to start stretching. This is an example of how someone like me could think they were doing gentle stretching but could be messing up their feet instead.

I guess what I'm saying is that you say 'things are not getting better', but you don't need to accept the status quo or to accept your own self treatment as OK if it is not working for your particular feet. It is well worth the effort to re-examine your conservative treatments and try to find the combination that works for you. It was especially helpful to me to try to figure out everything that was causing me set-backs, and then eliminate those causes one by one. Eventually one gets to the point where there are no set-backs for a few weeks, and then healing can really set in quickly.

Yes, it's normal for people to find their self treatment to be inadequate at first, but generally that is because they haven't had time to learn what works for their feet, and to learn to sense what is causing them set-backs. At least that is the way it was for me. I started by healing slowly and then gained momentum as I got better at it. As you find out more and more about how your own feet respond to things, I'm pretty sure you'll start healing more and more rapidly.

Finding good orthotics that work for you can be pivotal. They really helped me a lot (though they don't seem to help everyone). Some people do report that losing weight has helped them (though my weight doesn't seem to make much difference to my PF). Let's hope that either orthotics or weight loss or both are the 'missing factor' that will help you to start feeling better.

If you don't, and you feel you have tried everything possible, then maybe it's time to start saving for ESWT.

Carole C

Re: The next steps

Julie on 12/01/02 at 03:27 (101531)

Ian, I don't know how long you've had PF, but I'm sure you know from your reading of this site how important it is to get the right treatment for your condition in place as quickly as possible.

In first post you expressed fear about seeing anyone apart from your family doctor. I urge you to start looking for a good podiatrist who will examine you thoroughly, evaluate the way you walk, identify any biomechanical or other problems that are contributing to your PF, and advise you on treatment. Yes, one can learn a great deal about conservative self-treatment here at heelspurs; I did, and it was certainly a big factor in my own healing. But I believe that professional advice is a must.

The problem of course is that in any branch of medicine there are good and less good and bad doctors. Look for a good one. A way to start is to post a question on the Ask the Foot Doctors board, saying where you live: one of the doctors may be able to recommend someone in your area. You may need to see more than one foot doctor before you settle with one who can give you the help you need, so the sooner you start looking the better.

The other problem is that there are many conservative treatments, and unless you know what has caused your PF, you can't really know which to use and in what combination. It becomes a matter of trial and error, which can lead to the injury/inflammation becoming worse (e.g. if the wrong stretching techniques are used) or at the very least waste precious time.

Re: The next steps

IanJ on 12/06/02 at 01:10 (101924)

Update: I have an appointment with a Podiatrist in a week. We'll see how that goes.

Re: The next steps

Julie on 12/06/02 at 02:26 (101931)

Good, and do let us know how it goes, Ian.

Re: The next steps

IanJ on 11/29/02 at 20:46 (101449)

Sorry to hear that. I'm worried about going the next step from my family physician because of all the messages about how the PD doctor or physical therapist made things worse! Scary.

Re: The next steps

IanJ on 11/29/02 at 20:53 (101452)

(sorry about the triple post. server wasn't responding back.)

Re: The next steps

nancy s. on 11/30/02 at 06:38 (101472)

ian, try to learn from the posts by people who had bad experiences with a foot doc or physical therapist; take notes, even. from my involvement with this message board and from reading scott's heel pain book, by the time i reached my third doc i finally had an idea of what a good and thorough examination is; how to ask good questions; how much to expect of the doc in terms of his listening and comprehensive responses to my questions (expect a lot!); and how much experience and knowledge would inform his treatment plans for me and give me confidence.

use this message board to ask questions about any aspect of a doctor or pt visit that seems questionable to you. this place is a gold mine.

nancy
.

Re: The next steps

Carole C in NOLA on 11/30/02 at 07:06 (101478)

Sorry to hear that your PT isn't going to work and that you have to be in a cast during the holiday season. I hope it helps you to get better and that when you get it off, you are on your way to recovering.

Carole C

Re: The next steps

Carole C in NOLA on 11/30/02 at 07:17 (101479)

And Ian, if you don't get treatment from a foot doctor or PT right away, be sure to make your own self-treatment a top priority. If you don't seem to be making good steady substantial progress, then you may have no choice but to see a professional.

Then if you've taken Nancy's advice and learned what you can, you'll probably be able to gain more from seeing that professional.

The key is that you need to get effective treatment as soon as possible, whether it's self treatment or whether your treatment requires a professional 'kick in the behind' so to speak, to make some good progress. The sooner effective treatment is in place, the faster you will heal according to some of the doctors on this message board, and that makes sense to me too.

Carole C

Re: The next steps

IanJ on 12/01/02 at 00:43 (101529)

Thanks Carol. With the exception of custom orthotics (I'm using Powerfeet) I believe that my current self-treatment is very good based upon this site which I've spent alot of time on. However I am still in the acute stage and things are not getting better but, from what I've read about early stages of PF, that's somewhat normal.

I also know that losing weight (about 25-30lbs over) would really help me andI have to work on that.

Re: The next steps

Carole C in NOLA on 12/01/02 at 01:35 (101530)

Ian, I'm sorry that you are still enduring this pain. I'm trying to think of suggestions that might encourage you as you continue battling this 'PF Monster' as I sometimes call it.

I found that I had to keep trying different things to see what worked best for my feet. There are a lot of different treatments that we talk about on this site, and a lot of different ways a person can do most of them.

For example, I iced regularly for as long as I could stand it but I got no good out of that until I switched from ice in ziplocks to bags of frozen peas, and lengthened the time my foot was on ice to way more than what seemed reasonable (removing my foot periodically to avoid frostbite). This is just an example of how someone (me in this case) could think they were icing but could be doing it ineffectively. Other people might find my way of icing to be ineffectual, but have found their own way that works for them.

Another example is the way I had to learn at what point stretching was re-injuring my plantar fascia. I found I could even re-injure them by wiggling my toes if my tendons were tight, and I learned how to determine how gently to start stretching. This is an example of how someone like me could think they were doing gentle stretching but could be messing up their feet instead.

I guess what I'm saying is that you say 'things are not getting better', but you don't need to accept the status quo or to accept your own self treatment as OK if it is not working for your particular feet. It is well worth the effort to re-examine your conservative treatments and try to find the combination that works for you. It was especially helpful to me to try to figure out everything that was causing me set-backs, and then eliminate those causes one by one. Eventually one gets to the point where there are no set-backs for a few weeks, and then healing can really set in quickly.

Yes, it's normal for people to find their self treatment to be inadequate at first, but generally that is because they haven't had time to learn what works for their feet, and to learn to sense what is causing them set-backs. At least that is the way it was for me. I started by healing slowly and then gained momentum as I got better at it. As you find out more and more about how your own feet respond to things, I'm pretty sure you'll start healing more and more rapidly.

Finding good orthotics that work for you can be pivotal. They really helped me a lot (though they don't seem to help everyone). Some people do report that losing weight has helped them (though my weight doesn't seem to make much difference to my PF). Let's hope that either orthotics or weight loss or both are the 'missing factor' that will help you to start feeling better.

If you don't, and you feel you have tried everything possible, then maybe it's time to start saving for ESWT.

Carole C

Re: The next steps

Julie on 12/01/02 at 03:27 (101531)

Ian, I don't know how long you've had PF, but I'm sure you know from your reading of this site how important it is to get the right treatment for your condition in place as quickly as possible.

In first post you expressed fear about seeing anyone apart from your family doctor. I urge you to start looking for a good podiatrist who will examine you thoroughly, evaluate the way you walk, identify any biomechanical or other problems that are contributing to your PF, and advise you on treatment. Yes, one can learn a great deal about conservative self-treatment here at heelspurs; I did, and it was certainly a big factor in my own healing. But I believe that professional advice is a must.

The problem of course is that in any branch of medicine there are good and less good and bad doctors. Look for a good one. A way to start is to post a question on the Ask the Foot Doctors board, saying where you live: one of the doctors may be able to recommend someone in your area. You may need to see more than one foot doctor before you settle with one who can give you the help you need, so the sooner you start looking the better.

The other problem is that there are many conservative treatments, and unless you know what has caused your PF, you can't really know which to use and in what combination. It becomes a matter of trial and error, which can lead to the injury/inflammation becoming worse (e.g. if the wrong stretching techniques are used) or at the very least waste precious time.

Re: The next steps

IanJ on 12/06/02 at 01:10 (101924)

Update: I have an appointment with a Podiatrist in a week. We'll see how that goes.

Re: The next steps

Julie on 12/06/02 at 02:26 (101931)

Good, and do let us know how it goes, Ian.