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Drs.- Not seeking legal advice, but pls educate me on this

Posted by Donna H on 1/13/03 at 02:11 (105330)

Ability to walk decreasing not by wk., now, but by days/hrs. New diagnosis on l. foot - PCP says I have PF; as if TTS & Achilles tendonitis wasn't enough!Pain Horrible upon arising. Used to be extremely difficult to walk if off feet longer than 2 hrs. Past several days -home or work, if off feet longer than 30 minutes, its as if heel area does not bend, severe pain 1st 30-50 steps. I thought it was the Achilles tendonitis, since also feeling like heel is accordian;like just above heel smashed to bottom of heel w/ walking;like nothing there but bone & nerves! ONLY diagnosis ever was psoriasis/eczema on soles (diagnosis depended on which dermatologist, podiatrist, full moon, etc). 4/17/02 -Driver who ran stop sign slammed into me just after I pulled into intersection, speeding,no attempt to stop prior to impact, tore off most of drivers' side, just in front of d. side door, hit so hard, police declared fire hazard, stated if I had been a few inches further into intersection, 'You wouldn't be here!'. Whiplash pain most severe then,so ER dr paid no attn.to my foot pain.I read that direct trauma can come from floorboard pushed up towards person,@ impact.I have never had a good day walking to bus stop - always in pain, nearly unbearable now. Is there proof re. the floorboard theory? What about how excessive walking causing/worsening my TTS, A.T., PF in l. foot? Rt foot only TTS.(EMG 7/02) No diagnostics since. New podiatrist next wk. What should be done to eval/treat? Thx very much

Re: Drs.- Not seeking legal advice, but pls educate me on this

Carole C in NOLA on 1/13/03 at 06:51 (105339)

Donna,

I'm not a foot doctor but I would like to address your severe pain and feeling as though your heel does not bend for the first 30-50 steps after you've been sitting longer than 2 hours. This is so painful but unfortunately it is not unusual with PF, and I just want to strongly suggest that you start doing gentle (non-weightbearing) stretching while you sit, before you stand up. The stretching should be gentle enough that it doesn't hurt, but long enough that you get some of your flexibility back before you stand up. This may keep you from injuring your feet even more. I hope this helps!

Carole C

Re: Drs.- Not seeking legal advice, but pls educate me on this

Donna H on 1/13/03 at 14:04 (105372)

Oh, thank you so much Carol. I can notice some difference when I do it. Not alot, but I think its Bcuz my feet (especially the left) are so traumatized! I tried moving my L. foot around twice today Bfore getting up from my desk @ work, and I probably was able to walk a few steps sooner. Sometimes I get up and nearly fall into walls, or look like I am staggering, because of balance problems. Even a LITTLE relief helps, as well as lessening the emotional stress and I really appreciate your feedback & suggestions. Donna H.

Re: Drs.- Not seeking legal advice, but pls educate me on this

Ed Davis, DPM on 1/13/03 at 14:06 (105373)

Donna:

The scenario you presented is not an uncommon one. Which foot was injured? Do you remember the position of your foot at the time of injury?

Dorsiflexion injuries (foot forced back on the ankle) can cause the following: achilles tendinitis, plantar fasciitis, tarsal tunnel syndrome, tibio-talar impingement syndrome... Hopefully your new doc will give you a thorough workup. At the very least, each of the 4 above potential diagnoses should be addressed.
Ed

Re: Drs.- Not seeking legal advice, but pls educate me on this

Carole C in NOLA on 1/13/03 at 16:51 (105391)

I'm so glad it helps!!! It helps me too. It will probably help more if you do more stretching before you stand, even if it takes several minutes. A brief stretch helps a little, and if you can stretch for a few minutes probably it will help more.

What I like to do while I'm sitting is to first straighten out my knee, by putting it on another chair if I can, or if not then just holding my foot out from my chair. Then I point my toe at my nose and try to find the best angle to stretch the tissues that need it, and then hold it for a few seconds. Then I also like to rotate my whole foot around the ankle making a complete circle, and to wiggle my feet a little to relax them. If anything hurts then I just do it more gently. Sometimes if I can keep working at it for a few minutes then things get loosened up a little and I will be able to stretch more without pain.

Some people here have found that a wedge shaped footrest at their desk helps, too.

Carole C

Re: Julie's yoga foot exercises for PF

Sharon W on 1/13/03 at 17:20 (105398)

Donna,

I don't know if this will be helpful to you or not, but a lovely lady named Julie, who is a yoga instructor, has posted these 'Yoga foot exercises' to help those with plantar facaetis, and they really DO help. I suggest taking it VERY easy, as first, slowly building up the number of times you do these exercises and in any case do NOT do anything that causes a lot of pain.

Here are Julie's 'Yoga foot exercises' (I copied and pasted them from a recent post):

These are simple yoga exercises for the feet. They're part of a series for all the joints called Pawanmuktasana. That means 'energy-releasing exercises', and they release energy by speeding the removal of toxins from the joints. They work systematically and precisely on the joints and on their associated muscles, tendons and ligaments. They can be done sitting on the floor with the legs outstretched (a difficult position to hold, especially for people with low back problems), or lying down, or sitting in a chair, or standing on alternate legs (a non-no for folks with PF). Sitting in a chair and lying down are best.

These exercises can be helpful in cases of plantar fasciitis in several ways.

1. They improve circulation generally. In particular they increase blood flow to the areas being worked on, which promotes healing.

2. They gently stretch the calf muscles and achilles tendons, which in time reduces the strain on the PF.

3. They strengthen the entire musculature of the feet and ankles.

4. They improve range of motion, and help to avoid losing it during the 'down time' of decreased activity.

TOE BENDING AND STRETCHING

This one works the toe joints (all 28 of them) while holding a gentle stretch through the achilles tendons and calf muscles; and works the entire musculature of the feet.

Extend one heel forward and hold this gentle stretch while working on your toes.

Curl your toes forward, as if making fists of your feet. (Don't do this so enthusiastically that you give yourself a cramp.)

Then stretch the toes and spread them: make spaces between them.

Do this nine times, breathing out as you curl the toes, and breathing in as you stretch them.

Repeat with the other foot, then with both feet.

ANKLE BENDING

This one works on the ankle joints and on the achilles/soleus/ gastrocnemuis complex. It helps to increase ankle dorsiflexion, the essential thing for PF-ers who are generally tight in this area.

Bend the feet forwards at the ankles, and then bend them back, one at a time, then together.

Do each nine times on each foot, then both feet, breathing out as you bend forwards, in as you bend back.

ANKLE ROTATIONS

Circle the feet at the ankles, slowly and carefully, nine times in each direction, first one foot, then the other, then both. Breathe freely.

****

If you co-ordinate your movements with your breath it increases their effectiveness because it (a) slows you down and (b) makes you more aware of what you're doing.

I've practised and taught these exercises for many years. They are effective and powerful, and useful for people with PF because they're both non- weight-bearing and specific. And they're very energizing.

I do them in the morning before I get out of bed, and would recommend this to anyone with PF to help avoid the 'first step' pain.

They can be done as many times a day as you like: the more the better. It's good to do them before getting up after sitting for awhile.

I hope you will find these exercises helpful.

All the best for your healing.

Re: Drs.- Not seeking legal advice, but pls educate me on this

Donna H on 1/13/03 at 23:18 (105427)

Thanks so much for responding, Dr. Davis. The EMG shows bilateral (?) TTS in both feet, '...significantly worse in the left foot...' 7/02, and I'd estimate that symptoms were app. 55%-60% less severe than now. Achilles Tendonitis was present, NO PF.
Hit just in front of drivers' side door, while traveling straight ahead; hit me so hard, my car was thrown as if making a rt. turn,I was driving;just pulled into intersection @ 4way stop. I think my foot had same trauma as my neck/cervical spine. My entire upper body was thrown to right towards passenger door, then snapped back. Feet did same; so L. foot would have been thrown to right,up & back, then retn to original position. But symptoms not present immediately after MVA. Excessive forced walking further traumatizes me -but Disability Income is less than 1/2 my monthly income! What are risks of continued walking w/ TTS, PF, Achilles Tendonitis? My research only found sports/dance related causes & tmt. I will make sure I get thorough workup @ new doc. Donna

Re: Julie's yoga foot exercises for PF

Donna H on 1/15/03 at 21:26 (105565)

Sharon, thanks alot for this idea. I AM taking it very slowly. Its kinda difficult when co-workers (especially mgmt) @ the agency where I work scoff or roll their eyes or ask really stupid questions/make stupid comments as 1 of our mental health therapists did recently (her office is right across from me)when she heard me gasp from TTS electrocution, then groan with every step (PF) as I tried to hobble to the water fountain to take my neurontin 'Why do YOU have problems walking, when our clients walk a great deal - practically everywhere they go?!!' Well, that really helps alot when I am trying to still work & fight disability which is less than 1/2 my monthly income! So its really great to be able to get ideas, suggestions like yours. I can only do 3, for instance of the 9 'ankle rotations,' but just to know what to do from someone who's 'been there,done that' helps! Thanks again - Donna

Re: Julie's yoga foot exercises for PF

Julie on 1/16/03 at 02:02 (105575)

Hello Donna

I've just come home from a couple of weeks away and have read your posts. I'm so sorry for your injury!

The exercises Sharon posted for you have certainly been helpful for a number of people here who have PF and some who have TTS. But I would advise you not to do them until you have seen the doctor and had a thorough evaluation. It sounds as though your foot was severely traumatised in the accident, and you need to be correctly diagnosed and treated. My feeling - confirmed by your observation that even the simple ankle rotations are painful - is that any exercise at this point could exacerbate the injury.

As for work, can you not take some sick leave on full pay? I know one's inclination is always to be brave and soldier on, but you have an injury, and you need to take care of it. Please see if you can't get some time off, at least until you've seen the doctor, who may then be able to sign you off for a sufficient time to enable you to heal.

Best of luck to you.

Re: Julie's yoga foot exercises for PF

Donna H. on 1/16/03 at 13:56 (105618)

Thanks Julie - I really appreciate your response! The problem is that all my 2 wks vacation last yr AND every single minute of sick leave I had was used up! I have had some weeks where I have lost 3 days pay (beginning of Dec., for instance)in 1 pay period. In August, I was off a week & a half. It all depends on whats' going on, as far as the seriousness of the symptoms (I have a herniated disc, 2 bulging discs, sclerosis on the left, per neck MRI). I appreciate your reminder that no exercises should be done w/o first consulting a dr. I guess, in the pain I am in, along w/ the frustration, I forgot. Altho' I have TTS in both feet, its 5x worse in my L. foot, plus the Achilles Tendonitis and PF ALL @ the same time, I am just about willing to try anything for my feet. (Anybody got an axe?)
It was not until post-wreck, that I found out my job does not have Disability benefits! Even my atty didn't believe it, & asked to see 1 of my pay stubs. So I soldier on mostly because Disability benefits r something like $545 mo.! Uh - the 16 yr old has a hidden shovel for a mouth & his favorite words are, 'We got anything to eat?' Needless to say, $545 mo. just won't get it.
I did not try anything except the rotations, and altho' it hurt the 1st time, this morning,I did 3, & it was MUCH easier to walk, & was able to do so in fewer steps (maybe 20 instead of 50). But I will hold off until appt w/ the new podiatrist/new eval. Thanks again so very much for your concern & response. I have found that it is only those who have had these conditions, or treat them, who are really able to relate to the pain,numbness, weakness, torture, frustrations, and depressing moments. It just doesn't click with family, co-workers, etc... For instance I have yet to get some family to understand that the TTS is due to the compressed 'nerve' & is NOT a 'nervous' condition!! (LOL) - Donna

Re: Drs.- Not seeking legal advice, but pls educate me on this

Carole C in NOLA on 1/13/03 at 06:51 (105339)

Donna,

I'm not a foot doctor but I would like to address your severe pain and feeling as though your heel does not bend for the first 30-50 steps after you've been sitting longer than 2 hours. This is so painful but unfortunately it is not unusual with PF, and I just want to strongly suggest that you start doing gentle (non-weightbearing) stretching while you sit, before you stand up. The stretching should be gentle enough that it doesn't hurt, but long enough that you get some of your flexibility back before you stand up. This may keep you from injuring your feet even more. I hope this helps!

Carole C

Re: Drs.- Not seeking legal advice, but pls educate me on this

Donna H on 1/13/03 at 14:04 (105372)

Oh, thank you so much Carol. I can notice some difference when I do it. Not alot, but I think its Bcuz my feet (especially the left) are so traumatized! I tried moving my L. foot around twice today Bfore getting up from my desk @ work, and I probably was able to walk a few steps sooner. Sometimes I get up and nearly fall into walls, or look like I am staggering, because of balance problems. Even a LITTLE relief helps, as well as lessening the emotional stress and I really appreciate your feedback & suggestions. Donna H.

Re: Drs.- Not seeking legal advice, but pls educate me on this

Ed Davis, DPM on 1/13/03 at 14:06 (105373)

Donna:

The scenario you presented is not an uncommon one. Which foot was injured? Do you remember the position of your foot at the time of injury?

Dorsiflexion injuries (foot forced back on the ankle) can cause the following: achilles tendinitis, plantar fasciitis, tarsal tunnel syndrome, tibio-talar impingement syndrome... Hopefully your new doc will give you a thorough workup. At the very least, each of the 4 above potential diagnoses should be addressed.
Ed

Re: Drs.- Not seeking legal advice, but pls educate me on this

Carole C in NOLA on 1/13/03 at 16:51 (105391)

I'm so glad it helps!!! It helps me too. It will probably help more if you do more stretching before you stand, even if it takes several minutes. A brief stretch helps a little, and if you can stretch for a few minutes probably it will help more.

What I like to do while I'm sitting is to first straighten out my knee, by putting it on another chair if I can, or if not then just holding my foot out from my chair. Then I point my toe at my nose and try to find the best angle to stretch the tissues that need it, and then hold it for a few seconds. Then I also like to rotate my whole foot around the ankle making a complete circle, and to wiggle my feet a little to relax them. If anything hurts then I just do it more gently. Sometimes if I can keep working at it for a few minutes then things get loosened up a little and I will be able to stretch more without pain.

Some people here have found that a wedge shaped footrest at their desk helps, too.

Carole C

Re: Julie's yoga foot exercises for PF

Sharon W on 1/13/03 at 17:20 (105398)

Donna,

I don't know if this will be helpful to you or not, but a lovely lady named Julie, who is a yoga instructor, has posted these 'Yoga foot exercises' to help those with plantar facaetis, and they really DO help. I suggest taking it VERY easy, as first, slowly building up the number of times you do these exercises and in any case do NOT do anything that causes a lot of pain.

Here are Julie's 'Yoga foot exercises' (I copied and pasted them from a recent post):

These are simple yoga exercises for the feet. They're part of a series for all the joints called Pawanmuktasana. That means 'energy-releasing exercises', and they release energy by speeding the removal of toxins from the joints. They work systematically and precisely on the joints and on their associated muscles, tendons and ligaments. They can be done sitting on the floor with the legs outstretched (a difficult position to hold, especially for people with low back problems), or lying down, or sitting in a chair, or standing on alternate legs (a non-no for folks with PF). Sitting in a chair and lying down are best.

These exercises can be helpful in cases of plantar fasciitis in several ways.

1. They improve circulation generally. In particular they increase blood flow to the areas being worked on, which promotes healing.

2. They gently stretch the calf muscles and achilles tendons, which in time reduces the strain on the PF.

3. They strengthen the entire musculature of the feet and ankles.

4. They improve range of motion, and help to avoid losing it during the 'down time' of decreased activity.

TOE BENDING AND STRETCHING

This one works the toe joints (all 28 of them) while holding a gentle stretch through the achilles tendons and calf muscles; and works the entire musculature of the feet.

Extend one heel forward and hold this gentle stretch while working on your toes.

Curl your toes forward, as if making fists of your feet. (Don't do this so enthusiastically that you give yourself a cramp.)

Then stretch the toes and spread them: make spaces between them.

Do this nine times, breathing out as you curl the toes, and breathing in as you stretch them.

Repeat with the other foot, then with both feet.

ANKLE BENDING

This one works on the ankle joints and on the achilles/soleus/ gastrocnemuis complex. It helps to increase ankle dorsiflexion, the essential thing for PF-ers who are generally tight in this area.

Bend the feet forwards at the ankles, and then bend them back, one at a time, then together.

Do each nine times on each foot, then both feet, breathing out as you bend forwards, in as you bend back.

ANKLE ROTATIONS

Circle the feet at the ankles, slowly and carefully, nine times in each direction, first one foot, then the other, then both. Breathe freely.

****

If you co-ordinate your movements with your breath it increases their effectiveness because it (a) slows you down and (b) makes you more aware of what you're doing.

I've practised and taught these exercises for many years. They are effective and powerful, and useful for people with PF because they're both non- weight-bearing and specific. And they're very energizing.

I do them in the morning before I get out of bed, and would recommend this to anyone with PF to help avoid the 'first step' pain.

They can be done as many times a day as you like: the more the better. It's good to do them before getting up after sitting for awhile.

I hope you will find these exercises helpful.

All the best for your healing.

Re: Drs.- Not seeking legal advice, but pls educate me on this

Donna H on 1/13/03 at 23:18 (105427)

Thanks so much for responding, Dr. Davis. The EMG shows bilateral (?) TTS in both feet, '...significantly worse in the left foot...' 7/02, and I'd estimate that symptoms were app. 55%-60% less severe than now. Achilles Tendonitis was present, NO PF.
Hit just in front of drivers' side door, while traveling straight ahead; hit me so hard, my car was thrown as if making a rt. turn,I was driving;just pulled into intersection @ 4way stop. I think my foot had same trauma as my neck/cervical spine. My entire upper body was thrown to right towards passenger door, then snapped back. Feet did same; so L. foot would have been thrown to right,up & back, then retn to original position. But symptoms not present immediately after MVA. Excessive forced walking further traumatizes me -but Disability Income is less than 1/2 my monthly income! What are risks of continued walking w/ TTS, PF, Achilles Tendonitis? My research only found sports/dance related causes & tmt. I will make sure I get thorough workup @ new doc. Donna

Re: Julie's yoga foot exercises for PF

Donna H on 1/15/03 at 21:26 (105565)

Sharon, thanks alot for this idea. I AM taking it very slowly. Its kinda difficult when co-workers (especially mgmt) @ the agency where I work scoff or roll their eyes or ask really stupid questions/make stupid comments as 1 of our mental health therapists did recently (her office is right across from me)when she heard me gasp from TTS electrocution, then groan with every step (PF) as I tried to hobble to the water fountain to take my neurontin 'Why do YOU have problems walking, when our clients walk a great deal - practically everywhere they go?!!' Well, that really helps alot when I am trying to still work & fight disability which is less than 1/2 my monthly income! So its really great to be able to get ideas, suggestions like yours. I can only do 3, for instance of the 9 'ankle rotations,' but just to know what to do from someone who's 'been there,done that' helps! Thanks again - Donna

Re: Julie's yoga foot exercises for PF

Julie on 1/16/03 at 02:02 (105575)

Hello Donna

I've just come home from a couple of weeks away and have read your posts. I'm so sorry for your injury!

The exercises Sharon posted for you have certainly been helpful for a number of people here who have PF and some who have TTS. But I would advise you not to do them until you have seen the doctor and had a thorough evaluation. It sounds as though your foot was severely traumatised in the accident, and you need to be correctly diagnosed and treated. My feeling - confirmed by your observation that even the simple ankle rotations are painful - is that any exercise at this point could exacerbate the injury.

As for work, can you not take some sick leave on full pay? I know one's inclination is always to be brave and soldier on, but you have an injury, and you need to take care of it. Please see if you can't get some time off, at least until you've seen the doctor, who may then be able to sign you off for a sufficient time to enable you to heal.

Best of luck to you.

Re: Julie's yoga foot exercises for PF

Donna H. on 1/16/03 at 13:56 (105618)

Thanks Julie - I really appreciate your response! The problem is that all my 2 wks vacation last yr AND every single minute of sick leave I had was used up! I have had some weeks where I have lost 3 days pay (beginning of Dec., for instance)in 1 pay period. In August, I was off a week & a half. It all depends on whats' going on, as far as the seriousness of the symptoms (I have a herniated disc, 2 bulging discs, sclerosis on the left, per neck MRI). I appreciate your reminder that no exercises should be done w/o first consulting a dr. I guess, in the pain I am in, along w/ the frustration, I forgot. Altho' I have TTS in both feet, its 5x worse in my L. foot, plus the Achilles Tendonitis and PF ALL @ the same time, I am just about willing to try anything for my feet. (Anybody got an axe?)
It was not until post-wreck, that I found out my job does not have Disability benefits! Even my atty didn't believe it, & asked to see 1 of my pay stubs. So I soldier on mostly because Disability benefits r something like $545 mo.! Uh - the 16 yr old has a hidden shovel for a mouth & his favorite words are, 'We got anything to eat?' Needless to say, $545 mo. just won't get it.
I did not try anything except the rotations, and altho' it hurt the 1st time, this morning,I did 3, & it was MUCH easier to walk, & was able to do so in fewer steps (maybe 20 instead of 50). But I will hold off until appt w/ the new podiatrist/new eval. Thanks again so very much for your concern & response. I have found that it is only those who have had these conditions, or treat them, who are really able to relate to the pain,numbness, weakness, torture, frustrations, and depressing moments. It just doesn't click with family, co-workers, etc... For instance I have yet to get some family to understand that the TTS is due to the compressed 'nerve' & is NOT a 'nervous' condition!! (LOL) - Donna