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Addressing biomechanical problems after you heal, to prevent future PF

Posted by Carole C in NOLA on 12/08/02 at 18:05 (102279)

This is a follow-up to a post by Julie, which I cannot find again for the life of me! It got me to thinking while I was showering and washing my hair, and I want to say a few things.

First, here's what I thought Julie said (and pardon me if my summary is inaccurate; it's not meant to be). She expressed concern for those who are healed and no longer feeling symptoms, who didn't continue at least some of the conservative treatments. The reason for the concern is sound. For many or most, biomechanical problems contribute substantially to getting PF in the first place, and if they are just ignored then eventually PF will rear its ugly head again.

If the healed person continues to use orthotics and wear Birkenstocks, or tape, these conservative treatments hold the foot in a good position and help to correct biomechanical problems. However they do not allow as much natural stretching and motion as the unconstrained foot might get. This is desirable; because the feet don't bend around as much, they are not as likely to get strained and indeed that may be one way to help prevent PF.

My concern is this: if the healed person does continue to use orthotics and wear Birkenstocks or tape, due to the lack of the usual bending around and motility of the foot, the tissues could contract and shorten, and this might make the foot especially susceptible to PF. I feel that if the person does restrict the foot's motility in these ways, he/she should also continue to do gentle stretching just as they did during PF.

It seems to me that Julie's idea of continuing some of the conservative treatments, is an excellent one and probably especially urgently needed among those who got PF mostly from biomechanical problems. But I would argue that the continuation of gentle stretching logically should accompany any PF friendly footwear or orthotics, for safety's sake.

I know, I know. Personally I'm taking a risk, in that I'm not doing any of this stuff really right now. The reason for this is that I am essentially healed and I don't feel that my PF arose from a biomechanical problem so much as from an injury. However, if I did start wearing my orthotics all the time, to stay on the safe side, I'd be especially faithful in doing my stretches too and do them just as much as when my feet hurt before.

Carole C

Re: Addressing biomechanical problems after you heal, to prevent future PF

Julie on 12/09/02 at 03:09 (102315)

Hi Carole

The post was on the ESWT board and it was in the context of successful ESWT treatment: the point was, if ESWT resulted in tissue healing and healing of inflammation, but biomechanical problems remained, wouldn't PF be likely to recur if the patient didn't continue to address the biomechanical problem.

I absolutely agree with you that stretching should be a constant - but then I think everyone with or without PF, should move their toes and ankles and arches and stretch their calves regularly.

I don't think that using orthotics constrains the feet in a manner likely to lead to lack of motility and shortened tissues. My understanding is that correctly prescribed and well-made orthotics place the foot in a biomechanically sound position so that it moves as a biomechanically healthy foot moves. They limit potentially harmful movement, but if this can be considered constraint, I would say it's a healthy constraint.

I know that your assessment of why you got PF comes from your personal experience (and I'm certain you're right that going hell-for-leather barefoot at high tension on your exercise bike was a disaster!) But I'd still wonder if it wasn't the 'last straw' I talked of in my earlier post - albeit a very weighty straw! And I'd ask you: do you know for sure that you don't have a biomechanical problem? If you are, that's fine, but I remember rightly, you didn't have a full evaluation by a DPM (though you were lucky with your pedorthist) and so I've always been concerned for you.

Please please understand that my worry isn't a criticism of the decision you've made, it's a concern. I'm not saying that my personal decision, to continue with orthotics and Birks although I've long since healed, would be the right decision for everyone. (Most women wouldn't dream of clumping around, as I do, in hiking shoes whatever the weather or the occasion.) It may not be right for you. But since you've attributed your healing in large part to your soft orthotics, which presumably were prescribed to address a biomechanical problem, why take the risk? I would hate to see your PF recur, when you've healed so well and are enjoying life so much!

Re: Addressing biomechanical problems after you heal, to prevent future PF

Carole C in NOLA on 12/09/02 at 08:16 (102327)

Thanks - no wonder I couldn't find the article. I don't often read the ESWT board clear through though I sometimes scan through a few articles there.

I would expect to have problems and to have PF recur, if one were to cut back on gentle stretching while continuing with orthotics, taping, and/or shoes that limit motility, or with substantial amounts of rest which I suppose is the ultimate limitation on motility. I would urge those who continue to use these devices to continue with at least some gentle stretching.

I do appreciate your concern a great deal, which I guess is why I was thinking about your post while showering barefoot (a real 'no-no' when my PF was symptomatic and not anything I'd recommend to PF sufferers ever). I will definitely think about it though my feet seem to be strengthening and doing fine at this point. I'm not sure that my need for orthotics to support and properly align damaged tissues immediately after my injury, is the same as needing them to address a biomechanical problem now that I'm healed. Perhaps it is, though during the past nine months I have continued to heal and improve without them. I did need them desperately last December, though, and they were indeed a huge factor in helping me to heal when my pain was so terrible.

Assuming that you are right about my PF possibly recurring, still at some point there's a trade off... to take an extreme example, if I could continue to enjoy going barefoot for the next 40 years and then on the 41st year had another case of injury-related PF, it would be worth it to me. On the other hand if that happened next year, it wouldn't.

Carole C

Re: Addressing biomechanical problems after you heal, to prevent future PF

Julie on 12/09/02 at 16:41 (102392)

Carole, I truly hope your PF will never recur!

But let me ask you: do you know for certain that you do not have problematic biomechanics?

I can't remember what evaluations your pedorthist did. I do remember your showing us a picture of you standing, and several of us discussing it, and thinking that there probably was a problem (I can't remember what it was). I also your saying you didn't know whether you pronated or supinated (and you would know that if you had been watched, walking).

So this is the root of my concern for you (and your feet). I greatly hope that you don't mind my asking. Just tell me to shut up and mind my own business if you want to!

Re: My own biomechanics

Carole C in NOLA on 12/09/02 at 17:23 (102407)

Well, my doctor watched me when I walked, said nothing and sent me to the pedorthist with a very vague prescription. My pedorthist watched me when I walk and told me that I pronate... or maybe she told me that I supinate... one or the other! I was in so much pain, and unfamiliar with the terms at that time since I had never had foot trouble before. So, I don't remember which she said.

Looking at my orthotics, I'd guess that she might have said I pronate since after she finished making them, she did some build-up on the medial side of the orthotics to adjust them. This build-up was generally in the arch area but she continued it down to include the front part of my heel and this build-up under the medial side of the front of the heel is what I like best about them. It feels really good and tips my heel in a good feeling way.

The discussion on the board of the pictures of my feet didn't really seem to result in anything conclusive. BGCPed said I might possibly have a subtle cavus foot since he thought he saw a peek-a-boo heel, but he said it was pretty hard to tell from the photos. What I took from the various photo discussions is that probably I don't have anything extremely bad wrong with my feet, or it would be so obvious that it would have hit people between the eyes.

My NB 991's which are for mild to moderate pronators, seem to work better for me than the 879's which are neutral or the 854's which are for those with more pronation problems.

My own observations are inconclusive but I *think* that just before my foot pushes off, my heel both tips medially and does a little quick twist at the same time. I think maybe that's pronating although I'm not sure. It occurs just at that one point in the cycle and I don't observe anything too odd during the rest of the cycle. This happens barefoot, but not so much with my shoes on.

And that's all i know about my biomechanics, other than that I haven't had any foot problems since my recovery. I'm completely asymptomatic on almost all days, and if I feel the slightest tenderness or twinge then I don't go barefoot quite so much for a day or two (but that has only happened a couple of times). Also, if I'm going to have a day that would be unusually tough on my feet, I am careful of what I wear on my feet.

Carole C

Re: My own biomechanics

Julie on 12/09/02 at 17:36 (102412)

I always enjoy it when I'm on line at the same time as the person I'm 'talking' to!

Everyone pronates - the word refers to the natural rolling-in movement of the foot after the heel strike. It sounds as though you over-pronate, or your pedorthist wouldn't have posted your orthotics on the medial side.

I am the same: I over-pronate, also not to any huge degree, but because I know it is a problem, and in all probability the root cause of PF for me, I shall stick to my orthotics and my Birks.

Let's talk again in 40 years time and compare foot-notes!

Now I'm going to bed. See you tomorrow.

Re: My own biomechanics

Carole C in NOLA on 12/09/02 at 21:37 (102453)

Good night! I plan to be around in 40 years so I'll pencil it in on my calendar. (grin)

Carole C

Re: My own biomechanics

Julie on 12/10/02 at 01:47 (102486)

Carole, in 40 years you will be 93(?) and I will be 107.

See you around - glad you like the plan!

Re: My own biomechanics

dave r on 12/10/02 at 07:20 (102501)

Boy, and i have 40 more years to work:(((((((((

Re: My own biomechanics

Carole C in NOLA on 12/10/02 at 07:53 (102514)

I'll be 94. But right now, mother is 94 and she is still going strong.

In your case, I expect that all that yoga should add at least a few years to your life expectancy! See you in 2042. :)

Carole C

Re: My own biomechanics

Carole C in NOLA on 12/10/02 at 07:55 (102515)

I plan to spend 33 of those years working at being retired! Since my plans usually get messed up, realistically maybe 25-30 years at least.

Carole C

Re: My own biomechanics

john h on 12/10/02 at 09:47 (102536)

I believe Abraham lived to be 175.

Re: Addressing biomechanical problems after you heal, to prevent future PF

Julie on 12/09/02 at 03:09 (102315)

Hi Carole

The post was on the ESWT board and it was in the context of successful ESWT treatment: the point was, if ESWT resulted in tissue healing and healing of inflammation, but biomechanical problems remained, wouldn't PF be likely to recur if the patient didn't continue to address the biomechanical problem.

I absolutely agree with you that stretching should be a constant - but then I think everyone with or without PF, should move their toes and ankles and arches and stretch their calves regularly.

I don't think that using orthotics constrains the feet in a manner likely to lead to lack of motility and shortened tissues. My understanding is that correctly prescribed and well-made orthotics place the foot in a biomechanically sound position so that it moves as a biomechanically healthy foot moves. They limit potentially harmful movement, but if this can be considered constraint, I would say it's a healthy constraint.

I know that your assessment of why you got PF comes from your personal experience (and I'm certain you're right that going hell-for-leather barefoot at high tension on your exercise bike was a disaster!) But I'd still wonder if it wasn't the 'last straw' I talked of in my earlier post - albeit a very weighty straw! And I'd ask you: do you know for sure that you don't have a biomechanical problem? If you are, that's fine, but I remember rightly, you didn't have a full evaluation by a DPM (though you were lucky with your pedorthist) and so I've always been concerned for you.

Please please understand that my worry isn't a criticism of the decision you've made, it's a concern. I'm not saying that my personal decision, to continue with orthotics and Birks although I've long since healed, would be the right decision for everyone. (Most women wouldn't dream of clumping around, as I do, in hiking shoes whatever the weather or the occasion.) It may not be right for you. But since you've attributed your healing in large part to your soft orthotics, which presumably were prescribed to address a biomechanical problem, why take the risk? I would hate to see your PF recur, when you've healed so well and are enjoying life so much!

Re: Addressing biomechanical problems after you heal, to prevent future PF

Carole C in NOLA on 12/09/02 at 08:16 (102327)

Thanks - no wonder I couldn't find the article. I don't often read the ESWT board clear through though I sometimes scan through a few articles there.

I would expect to have problems and to have PF recur, if one were to cut back on gentle stretching while continuing with orthotics, taping, and/or shoes that limit motility, or with substantial amounts of rest which I suppose is the ultimate limitation on motility. I would urge those who continue to use these devices to continue with at least some gentle stretching.

I do appreciate your concern a great deal, which I guess is why I was thinking about your post while showering barefoot (a real 'no-no' when my PF was symptomatic and not anything I'd recommend to PF sufferers ever). I will definitely think about it though my feet seem to be strengthening and doing fine at this point. I'm not sure that my need for orthotics to support and properly align damaged tissues immediately after my injury, is the same as needing them to address a biomechanical problem now that I'm healed. Perhaps it is, though during the past nine months I have continued to heal and improve without them. I did need them desperately last December, though, and they were indeed a huge factor in helping me to heal when my pain was so terrible.

Assuming that you are right about my PF possibly recurring, still at some point there's a trade off... to take an extreme example, if I could continue to enjoy going barefoot for the next 40 years and then on the 41st year had another case of injury-related PF, it would be worth it to me. On the other hand if that happened next year, it wouldn't.

Carole C

Re: Addressing biomechanical problems after you heal, to prevent future PF

Julie on 12/09/02 at 16:41 (102392)

Carole, I truly hope your PF will never recur!

But let me ask you: do you know for certain that you do not have problematic biomechanics?

I can't remember what evaluations your pedorthist did. I do remember your showing us a picture of you standing, and several of us discussing it, and thinking that there probably was a problem (I can't remember what it was). I also your saying you didn't know whether you pronated or supinated (and you would know that if you had been watched, walking).

So this is the root of my concern for you (and your feet). I greatly hope that you don't mind my asking. Just tell me to shut up and mind my own business if you want to!

Re: My own biomechanics

Carole C in NOLA on 12/09/02 at 17:23 (102407)

Well, my doctor watched me when I walked, said nothing and sent me to the pedorthist with a very vague prescription. My pedorthist watched me when I walk and told me that I pronate... or maybe she told me that I supinate... one or the other! I was in so much pain, and unfamiliar with the terms at that time since I had never had foot trouble before. So, I don't remember which she said.

Looking at my orthotics, I'd guess that she might have said I pronate since after she finished making them, she did some build-up on the medial side of the orthotics to adjust them. This build-up was generally in the arch area but she continued it down to include the front part of my heel and this build-up under the medial side of the front of the heel is what I like best about them. It feels really good and tips my heel in a good feeling way.

The discussion on the board of the pictures of my feet didn't really seem to result in anything conclusive. BGCPed said I might possibly have a subtle cavus foot since he thought he saw a peek-a-boo heel, but he said it was pretty hard to tell from the photos. What I took from the various photo discussions is that probably I don't have anything extremely bad wrong with my feet, or it would be so obvious that it would have hit people between the eyes.

My NB 991's which are for mild to moderate pronators, seem to work better for me than the 879's which are neutral or the 854's which are for those with more pronation problems.

My own observations are inconclusive but I *think* that just before my foot pushes off, my heel both tips medially and does a little quick twist at the same time. I think maybe that's pronating although I'm not sure. It occurs just at that one point in the cycle and I don't observe anything too odd during the rest of the cycle. This happens barefoot, but not so much with my shoes on.

And that's all i know about my biomechanics, other than that I haven't had any foot problems since my recovery. I'm completely asymptomatic on almost all days, and if I feel the slightest tenderness or twinge then I don't go barefoot quite so much for a day or two (but that has only happened a couple of times). Also, if I'm going to have a day that would be unusually tough on my feet, I am careful of what I wear on my feet.

Carole C

Re: My own biomechanics

Julie on 12/09/02 at 17:36 (102412)

I always enjoy it when I'm on line at the same time as the person I'm 'talking' to!

Everyone pronates - the word refers to the natural rolling-in movement of the foot after the heel strike. It sounds as though you over-pronate, or your pedorthist wouldn't have posted your orthotics on the medial side.

I am the same: I over-pronate, also not to any huge degree, but because I know it is a problem, and in all probability the root cause of PF for me, I shall stick to my orthotics and my Birks.

Let's talk again in 40 years time and compare foot-notes!

Now I'm going to bed. See you tomorrow.

Re: My own biomechanics

Carole C in NOLA on 12/09/02 at 21:37 (102453)

Good night! I plan to be around in 40 years so I'll pencil it in on my calendar. (grin)

Carole C

Re: My own biomechanics

Julie on 12/10/02 at 01:47 (102486)

Carole, in 40 years you will be 93(?) and I will be 107.

See you around - glad you like the plan!

Re: My own biomechanics

dave r on 12/10/02 at 07:20 (102501)

Boy, and i have 40 more years to work:(((((((((

Re: My own biomechanics

Carole C in NOLA on 12/10/02 at 07:53 (102514)

I'll be 94. But right now, mother is 94 and she is still going strong.

In your case, I expect that all that yoga should add at least a few years to your life expectancy! See you in 2042. :)

Carole C

Re: My own biomechanics

Carole C in NOLA on 12/10/02 at 07:55 (102515)

I plan to spend 33 of those years working at being retired! Since my plans usually get messed up, realistically maybe 25-30 years at least.

Carole C

Re: My own biomechanics

john h on 12/10/02 at 09:47 (102536)

I believe Abraham lived to be 175.