Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Had first visit with Podiatrist - recommended physical therapy

Posted by IanJ on 12/17/02 at 19:42 (103435)

I have arch pain not heel pain. He recommended physical therapy and hot and cold treatments. Also recommended night splints which I'm already doing. He said he'd recommend orthotics after the physical therapy if I'm still having problems.

I'm not too optimistic about the physical therapy as I had it before in my 20's for achilles tendonitis and it didn't do much.

Anyone here have good success with physical therapy?

Re: Had first visit with Podiatrist - recommended physical therapy

nancy s. on 12/17/02 at 21:22 (103442)

ian, yes, i believe physical therapy did me a lot of good. i had it for about six months, for pf and for achilles, peroneal, and post tib tendonitis (you guessed it, i was blessed with them all at the same time). i had a great therapist, and of course a lot depends on who you get.

starting out, she did ultrasound and gentle tissue massage. no exercises at first. after ultrasound we switched to iontophoresis, and the massage gradually became deep-tissue. very painful at times, but since i did get a lot better it was worth it. also, coinciding with my sessions, after about six weeks she started me on very gentle, very gradual, nonweightbearing stretching and strengthening exercises to do at home. (i used alan k's acu-flex, which unfortunately is no longer available.)

after each pt session, she iced my feet with giant frozen wraps.

toward the end, she taught me to walk again -- i literally had to learn how to use my feet from heel to toe, how to climb up and down stairs, and so on. we used the treadmill and a couple of other pieces of equipment at first, and then i was walking like a semi-normal person, in halls and stairwells.

i hope you get a good therapist. good luck to you.

nancy
.

Re: Had first visit with Podiatrist - recommended physical therapy

IanJ on 12/17/02 at 21:48 (103447)

Thanks Nancy. Hopefully I'll get a good 'un.

Re: Had first visit with Podiatrist - recommended physical therapy

Lara T on 12/18/02 at 09:51 (103476)

Nancy is right about 'it depends on who you get' (and a few other things). I had physical therapy for my TTS (when with a doctor who thought it was PF until standard treatments didn't work and then decided it was in my head) and it didn't do any good (didn't do any harm either). HOwever, I have had PT for other reasons also. I'm having a bout with a chronic stiff neck, and initially I wasn't even going to go to a PT, as it seemed to me I would go, they gave me exercises for the acute problem, and sent me home. The exercises rarely were critical to the eventual recovery. However I eventually decided to bite the bullet for several reasons, including having a neighbor who worked in a physical therapy center who 1) agreed with my assessment of most physical therapy and 2) gave me some recommendations of people that wouldn't be like that. I go for my second visit tomorrow, but I'm already impressed. Instead of looking at the acute problem, she took a detailed history (took about 10-20 minutes), felt all around my back & neck, and gave me an explanation (that I can't do justice to cuz too many medical words but sounded like it made sense and she showed me pictures so I think I understand it at a basic level) as to why I was having periodic recurring problems over the years in my upper back neck area. She is now starting a program that will build up my entire back/neck structure so that I won't be so vulnerable to such problems in the future (she also told me that the thing another PT told me was a dowagers hump - which didn't make sense since no osterporosis showed up on a dexascan - we can substantially correct - if I do my exercises cuz it has to do with certain muscles being stronger and pulling my neck forward - etc, this is where I get lost with the technical explanation). She is also actively involving me in the process and relying on my weekly reports as to what happened with the exercises.

So I have decided that is now worth substantial research to find a good physical therapist as a good physical therapist can be terrific, and finding a good one can be difficult (at least where I live).

Re: Had first visit with Podiatrist - recommended physical therapy

Sharon W on 12/18/02 at 12:35 (103486)

Lara, Nancy,

I agree with you 100%. Physical therapy can be a waste of time and money, or the results can be almost miraculuous -- it depends on the skills, experience, and talents of the physical therapist(s). It's DEFINITELY worth doing your research and making sure you will be going to somebody really good! (Of course, the Dr. sends the 'prescription' for physical therapy to a specific facility, so you really need to do that research BEFORE you need PT, and then tell your Dr. where you would prefer to go.)

I have had physical therapy twice for TTS -- once (for 6 weeks) before my surgery, and again (for 4 months!) afterward. My experiences were VERY different; the first time didn't help at all, but the second time made a HUGE difference in my recovery.

The first time with physical therapy was immediately after I had been in a cast for 6 weeks. My pod had ordered iontophoresis and but had left it up to the discretion of the PT as far as exercises, stretches, etc. were concerned. The physical therapist (PT) did not work with me to develop an exercise program to strengthen the muscles in my leg that had gotten weak from lack of use while they were in the cast. She wanted me to do standing ankle/calf stretches, which clearly aggravated my PF worse and seemed to make the nerve problem worse too. I did those for about a week and stopped. When I told the PT my problem, she didn't suggest anything less strenuous or offer any other strategies. So I started doing Julie's Stretches on my own (THAT seemed to help!)

The second time around with PT (AFTER the surgery) I told my pod I wanted to go somewhere else for PT, and explained why. That time she sent me to Health South where a team of excellent professionals put together a program for my rehab. They helped me to GRADUALLY recover full motion in my foot and ankle joints, without over-stressing the healing tissues. They did (increasingly) deep massage on the surgical scar to reduce the risk of scar tissue making things stick together. Once I was able, they helped me to gradually begin putting weight on my ankles and feet again (walking with a railing and taking 'baby steps' at first), and then they put me on exercise machines to help build back the muscles in my ankles, calves, and legs. They helped me a LOT! I was very pleased and I would recommend these guys to anyone in the same situation.

Sharon

Re: Had first visit with Podiatrist - recommended physical therapy

IanJ on 12/27/02 at 15:12 (104115)

I just had my first visit with the physical therapist. He seemed very good to me and he was optimistic we could cure this in a few months.

He spent quite a bit of time evaluating my flexibility and gait. He found that my hamstrings are too tight and recommended stretches. I never stretch those. He also recommends we work on building up my inner ligament (forget the name) which runs from my inner ankle to my arch. We'll do that after a couple of visits to first reduce inflamation.

He treated me with cortizone iontophoresis. I would have resisted cortizone shots but this seems pretty non-invasive since it's absorbed. I'd never heard of this but have since done a search on this site. He said I wouldn't notice any difference in inflammation until a few treatments.

I'm also to do hot/cold treatments and will now go looking for a foot spa! I'll try to find one that heats but I already see that they don't typically heat water from cold.

All in all, I'm more optmistic about the physical therapy and my Podiatrist did state that my type of PF (arch pain vs heel pain) responds well to physical therapy.

Re: Had first visit with Podiatrist - recommended physical therapy

nancy s. on 12/27/02 at 19:28 (104132)

your pt session sounds very promising, ian! this guy definitely sounds better than run-of-the-mill. when you say you'll be working on building up the inner ligament, do you mean the posterior tibial tendon? i'd be curious to know what the building up entails, when you find out. (that's one of my tendonitises.)

i had iontophoresis, too, for many weeks and believe it helped me.

good luck. i hope your pt goes really well throughout and gives you great improvement. how long will you be having it, do you know?

nancy
.

Re: Had first visit with Podiatrist - recommended physical therapy

IanJ on 12/27/02 at 19:35 (104134)

Yes I think it was the posterior tibial tendon.

I have 6 treatments over 3 weeks then I have to go back to my Podiatrist. I'll let you know the exercise he gives me for the tendon.

Re: Had first visit with Podiatrist - recommended physical therapy

nancy s. on 12/17/02 at 21:22 (103442)

ian, yes, i believe physical therapy did me a lot of good. i had it for about six months, for pf and for achilles, peroneal, and post tib tendonitis (you guessed it, i was blessed with them all at the same time). i had a great therapist, and of course a lot depends on who you get.

starting out, she did ultrasound and gentle tissue massage. no exercises at first. after ultrasound we switched to iontophoresis, and the massage gradually became deep-tissue. very painful at times, but since i did get a lot better it was worth it. also, coinciding with my sessions, after about six weeks she started me on very gentle, very gradual, nonweightbearing stretching and strengthening exercises to do at home. (i used alan k's acu-flex, which unfortunately is no longer available.)

after each pt session, she iced my feet with giant frozen wraps.

toward the end, she taught me to walk again -- i literally had to learn how to use my feet from heel to toe, how to climb up and down stairs, and so on. we used the treadmill and a couple of other pieces of equipment at first, and then i was walking like a semi-normal person, in halls and stairwells.

i hope you get a good therapist. good luck to you.

nancy
.

Re: Had first visit with Podiatrist - recommended physical therapy

IanJ on 12/17/02 at 21:48 (103447)

Thanks Nancy. Hopefully I'll get a good 'un.

Re: Had first visit with Podiatrist - recommended physical therapy

Lara T on 12/18/02 at 09:51 (103476)

Nancy is right about 'it depends on who you get' (and a few other things). I had physical therapy for my TTS (when with a doctor who thought it was PF until standard treatments didn't work and then decided it was in my head) and it didn't do any good (didn't do any harm either). HOwever, I have had PT for other reasons also. I'm having a bout with a chronic stiff neck, and initially I wasn't even going to go to a PT, as it seemed to me I would go, they gave me exercises for the acute problem, and sent me home. The exercises rarely were critical to the eventual recovery. However I eventually decided to bite the bullet for several reasons, including having a neighbor who worked in a physical therapy center who 1) agreed with my assessment of most physical therapy and 2) gave me some recommendations of people that wouldn't be like that. I go for my second visit tomorrow, but I'm already impressed. Instead of looking at the acute problem, she took a detailed history (took about 10-20 minutes), felt all around my back & neck, and gave me an explanation (that I can't do justice to cuz too many medical words but sounded like it made sense and she showed me pictures so I think I understand it at a basic level) as to why I was having periodic recurring problems over the years in my upper back neck area. She is now starting a program that will build up my entire back/neck structure so that I won't be so vulnerable to such problems in the future (she also told me that the thing another PT told me was a dowagers hump - which didn't make sense since no osterporosis showed up on a dexascan - we can substantially correct - if I do my exercises cuz it has to do with certain muscles being stronger and pulling my neck forward - etc, this is where I get lost with the technical explanation). She is also actively involving me in the process and relying on my weekly reports as to what happened with the exercises.

So I have decided that is now worth substantial research to find a good physical therapist as a good physical therapist can be terrific, and finding a good one can be difficult (at least where I live).

Re: Had first visit with Podiatrist - recommended physical therapy

Sharon W on 12/18/02 at 12:35 (103486)

Lara, Nancy,

I agree with you 100%. Physical therapy can be a waste of time and money, or the results can be almost miraculuous -- it depends on the skills, experience, and talents of the physical therapist(s). It's DEFINITELY worth doing your research and making sure you will be going to somebody really good! (Of course, the Dr. sends the 'prescription' for physical therapy to a specific facility, so you really need to do that research BEFORE you need PT, and then tell your Dr. where you would prefer to go.)

I have had physical therapy twice for TTS -- once (for 6 weeks) before my surgery, and again (for 4 months!) afterward. My experiences were VERY different; the first time didn't help at all, but the second time made a HUGE difference in my recovery.

The first time with physical therapy was immediately after I had been in a cast for 6 weeks. My pod had ordered iontophoresis and but had left it up to the discretion of the PT as far as exercises, stretches, etc. were concerned. The physical therapist (PT) did not work with me to develop an exercise program to strengthen the muscles in my leg that had gotten weak from lack of use while they were in the cast. She wanted me to do standing ankle/calf stretches, which clearly aggravated my PF worse and seemed to make the nerve problem worse too. I did those for about a week and stopped. When I told the PT my problem, she didn't suggest anything less strenuous or offer any other strategies. So I started doing Julie's Stretches on my own (THAT seemed to help!)

The second time around with PT (AFTER the surgery) I told my pod I wanted to go somewhere else for PT, and explained why. That time she sent me to Health South where a team of excellent professionals put together a program for my rehab. They helped me to GRADUALLY recover full motion in my foot and ankle joints, without over-stressing the healing tissues. They did (increasingly) deep massage on the surgical scar to reduce the risk of scar tissue making things stick together. Once I was able, they helped me to gradually begin putting weight on my ankles and feet again (walking with a railing and taking 'baby steps' at first), and then they put me on exercise machines to help build back the muscles in my ankles, calves, and legs. They helped me a LOT! I was very pleased and I would recommend these guys to anyone in the same situation.

Sharon

Re: Had first visit with Podiatrist - recommended physical therapy

IanJ on 12/27/02 at 15:12 (104115)

I just had my first visit with the physical therapist. He seemed very good to me and he was optimistic we could cure this in a few months.

He spent quite a bit of time evaluating my flexibility and gait. He found that my hamstrings are too tight and recommended stretches. I never stretch those. He also recommends we work on building up my inner ligament (forget the name) which runs from my inner ankle to my arch. We'll do that after a couple of visits to first reduce inflamation.

He treated me with cortizone iontophoresis. I would have resisted cortizone shots but this seems pretty non-invasive since it's absorbed. I'd never heard of this but have since done a search on this site. He said I wouldn't notice any difference in inflammation until a few treatments.

I'm also to do hot/cold treatments and will now go looking for a foot spa! I'll try to find one that heats but I already see that they don't typically heat water from cold.

All in all, I'm more optmistic about the physical therapy and my Podiatrist did state that my type of PF (arch pain vs heel pain) responds well to physical therapy.

Re: Had first visit with Podiatrist - recommended physical therapy

nancy s. on 12/27/02 at 19:28 (104132)

your pt session sounds very promising, ian! this guy definitely sounds better than run-of-the-mill. when you say you'll be working on building up the inner ligament, do you mean the posterior tibial tendon? i'd be curious to know what the building up entails, when you find out. (that's one of my tendonitises.)

i had iontophoresis, too, for many weeks and believe it helped me.

good luck. i hope your pt goes really well throughout and gives you great improvement. how long will you be having it, do you know?

nancy
.

Re: Had first visit with Podiatrist - recommended physical therapy

IanJ on 12/27/02 at 19:35 (104134)

Yes I think it was the posterior tibial tendon.

I have 6 treatments over 3 weeks then I have to go back to my Podiatrist. I'll let you know the exercise he gives me for the tendon.