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THIS treatment is working & var. other thoughts

Posted by Lynn H. on 1/31/03 at 16:45 (107508)

I've looked in on this site for over a year now & am happy to say things are improving for my own PF . . it's been a VERY long 2 year haul. I'm late 40s, was casual runner, then step-aerobics, meanwhile encountering a case of the family arthritis. Onset of PF was serious 2 yrs. ago when we moved, & a bunch of stressful factors piled up: overload of stress at work (of course), purse got stolen & i.d. theft developed (nasty),moved from springy hardwood floor home to new concrete slab floor home, generally exhausted. Moving heavy boxes of books was ultimate culprit.

Pain became so bad I quit my career, could not walk, most activities out of the question. It's been a big hit, financially!!

I saw 4 pods & 1 accupuncturist. WHAT WORKED: The 'accuscope' avail. thru alternative medical clinic has worked the best for me. Its brass plates w/ mild elec. current running from ball of foot to heel. I have so much less pain, sometimes forget the anti-inflammatory, am able to walk & hike occasionally now! It's undescribable. . . what a relief. Had 1 mild setback since starting 6 mos. ago. Not 100% yet but improving!

Also, this regimen works: 1. Each a.m., before getting out of bed - stretch feet/arch by placing 'thera-band' (stretchy band like from the gym) under ball of foot. Stretch 10 min. each foot. 2. Using 'e-prin'. My stomach could NOT tolerate naprosyn, ibuprofen. Drink at least 10-12 oz. water w/ each dose. 3. Ice foot bath, not just ice, then elevate. I use a hot bath for legs & feet, then alternate w/ ice bath. 4. Custom orthotics & 2 neoprene liners. Am able to finally wear other shoes than tennis shoes, occasionally. 5. Whenever I can, a walk on soft sand (beach sand). This exercises everything in legs/feet w/ little pain.

Here's a website I just found, it confirms some of my thoughts re. excercise & the origin of the whole PF problem - - I'm going to start the exercises, glad to finally find a specific set for PF!!
http://www.sportsinjurybulletin.com/archive/1014-plantar-fasciitis.htm

What DID NOT WORK: cortisone (AWFUL), off the shelf orthotics, heavy stretching at first, listening to 1st pod. who diagnosed arthritis & would not pursue any further, accupuncture.

Looking forward to getting out of this whole thing . . . QUESTION: has anyone who's recovering tried x-country skiing?? I'd like to but am hesitant. Best of luck on coping & recovery to all . . . .

Re: THIS treatment is working & var. other thoughts

Pauline on 1/31/03 at 17:59 (107515)

Glad your getting better and thank you for posting the exercise link.
I think his last two points could be a good topic for discussion so I'm posting them here. I happen to agree with him and believe that orthotics are over prescribed. I hope you won't mind me throwing it out for discussion. Here is what he says. Inviting comments.

'3) If you have plantar fasciitis, should you (or should you let a doctor) slip orthotics into your shoes? Bear in mind that prescribing orthotics for plantar fasciitis is in effect saying that the key problem which produces plantar fasciitis must be in the feet. This is certainly not true. As we mentioned earlier, tight hamstrings can cause plantar fasciitis, and prescribing orthotics for taut hamstrings is nonsense! You've got to think of your plantar fascia as part of an interactive chain of muscles and connective tissues that runs from your hip down through your toes. If you want to stay away from plantar fasciitis, the whole system must be taken into account - and worked on! In addition, even if your plantar-fasciitis problem is truly the result of 'weak feet', does it make more sense to install appliances under your feet and forget about correcting the weakness - or work diligently on overall foot (and leg) strength?(!)

(4) Always remember that icing, anti-inflammatories, reduced training, massage, etc. are temporary palliatives for plantar fasciitis. They do not cure the problem! The only true plantar-fasciitis elixir is an increase in the overall resiliency and strength of your legs and feet - so that plantar fasciitis just can't come back.'

Owen Anderson (text)
Walt Reynolds (exercises)

Re: comments on just one sentence of this...

Carole C in NOLA on 1/31/03 at 18:13 (107518)

He has some interesting things to say and some of them are very consistent with Carmen's experiences with her hamstrings. One particular sentence distracts me from what I could get out of the article, and so I just want to comment on this one sentence that I felt was illogical:

'Bear in mind that prescribing orthotics for plantar fasciitis is in effect saying that the key problem which produces plantar fasciitis must be in the feet.'

It's not saying that at all to me. To me it's saying that wearing orthotics will help you to heal faster, and whether or not your feet caused your PF would be a separate issue.

Carole C

Re: THIS treatment is working & var. other thoughts

IanJ on 1/31/03 at 19:56 (107533)

Was your PF in your heel or your arch?

Re: THIS treatment is working & var. other thoughts

Ed Davis, DPM on 1/31/03 at 20:07 (107535)

Lynn:

The article is fairly well written but has some innacuracies. The authors refer to heel spurs as a 'wad of calcium' deposited at the origin of the plantar fascia. That is very far from accurate. The 'spur' is actually a shelf of bone (not just calcium) that projects forward parallel and generally attached to the fascia. This projection of bone grows in the direction of tension in the fascia and is a physiologic response to excess, long term tension on the fascia. Since x-rays are two dimensional, one visualizes the shelf of bone from the side (lateral view) and it thus appears to be a 'spur.'

Plantar fasciitis and its treatment is multifaceted -- please refer to prior discussions on the 'treatment triad.' The three issues to be dealt with are inflammation, tissue quality and biomechanics. Patients are different in that they may have a predominance of one of the above components and as such, will respond differently to treatment. Certainly, from an athletic trainors perspective a focus on issues of muscle imbalance and tighness predominates. If that is the major etiology on a particular patient or group of patients, then that focus will lead to success. It sounds like that may have been your situation.

Nevertheless, other individuals with PF may have a predominance of other factors discussed in this site so the focus of treatment must shift. Stating that traditional PF treatments are 'weak' as these authors do is based on a very narrow focus and ignores the generally high success rate of such treatments. An individual who works on concrete/asphalt for 8 to 10 hours per day and is overpronated can stretch and exercise till the cows come home but will need a way to compensate for the occupational stresses and strains placed on the feet. That compensation can be provided via modified shoegear and/or orthotics. Othotics will not work properly if the calf muscle (gastrocnemius) is too tight so that must be looked at. Again, the point here is that patients with PF must be carefully examined and have a treamtment plan that takes into account all pertinent aspects that may contribute to the problem.
Ed

Re: THIS treatment is working & var. other thoughts

Lynn H. on 1/31/03 at 20:38 (107542)

Just one sentence, see orig. message:

'3) If you have plantar fasciitis, should you (or should you let a doctor) slip orthotics into your shoes?

This sentence also caught my attention; that's why I continued with the article. I think there's a lot of message buried within. However, I don't think it is the ONLY approach to this, and specifically, to my problem with PF.

I obtained orthotics from a private podiatrist, out of pocket expense; not avilable thru my HMO (!!) (one of the largest in Calif). The orthotics were a HUGE RELIEF to me, painwise, and started the healing process so I am not discounting the benefit of an orthotic - - don't know what I would've done without the orthotics.

However,I feel that there's a muscular-skeletal weakness in my feet, due to inactivity & lack of the usual exercise. I took dance classes from age 5, became a runner, a walker, hiker, bicyclist. As with a lot of people when you hit your 40s there's demands from work & all that, that prevents the usual maintenance exercise that keeps you tuned up. You undergo some injuries. That's what happened with me. I know that a combination regimen is what is necessary to get you back in a normal picture.

People who must work/live on concrete floors have to do what is necessary to mitigate their circumstances in order to have healthy feet. The human foot hasn't evolved yet to overcome the concrete floor, I believe. This includes (in my case) proper footwear, floor pads, orthotics, anti-inflammatories, EXERCISE, etc.etc.

For me, the situation was lack of muscular tone in feet/legs, with a buncha other factors coming in such as general physical condition & external conditions such as concrete floors & heavy weight loading.I believe this resulted in over-extension & stretching of fascia & then PF. I hope that the exercise regimen COMBINED with orthotics & all that I've described previously will do it, eventually! I haven't tested it out yet, but will report back when I've got some results on exercise.

thanks for your input & trained opinion!

Re: THIS treatment is working & var. other thoughts

Ed Davis, DPM on 1/31/03 at 21:15 (107548)

Lynn:

There had been studies back in the 'ol USSR in which Russian stimulation was used to cure PF. Russian stimulation is a form of electrotherapy in which many muscle fibers are recruited (somewhat painfully) by an electric current. It had some limited application for Soviet Olympic athletes but now is used primarily by PTs to prevent muscle atrophy in idnividuals with casts on or certain neuromuscular diseases.

The plantar fascia has, deep to it, 4 layers of what are called 'intinsic' foot muscle which, for the most part run parallel to the fascia. If those muscles were sufficiently strong they could effectively decrease plantar fascial tension. Intrinsic muscles of the foot are considerably atrophied in modern man - few exceptions. The above type of stimulation, applied long enough can build the intrinsic muscles and significantly reduce plantar fascial tension. Individuals in cultures who spend a lifetime going barefoot on soft surfaces can have good intrinsic musculature. (I have often been asked by runners-- Why do I have to wear a particular shoe or orthotic while Olympic champion runners from Kenya run barefoot?) Practically speaking, this is not likely to become a popular treatment though. There is a tendency to prefer 'passive' treamtents -- pills, inserts, even surgery than to place a strong effort on treatments that involve a lot of active participation.
Health care providers certainly act to accomodate that tendency. Sometimes orthotics are overused as they can be viewed as a 'magic bullet' to correct biomechanical deficiencies.
Ed

Re: cross country skiing, rollerblading

sandy h on 1/31/03 at 21:50 (107559)

I did cross country skiing for a couple of weeks and I don't think it made it much worse. I just started rollerblading and I'm getting a bit of pain in the front of my foot but nothing too dramatic considering. The general goal of all of this is to strengthen the leg. I think the danger of muscles atrophying is quite a big one for deskbound people. We need to find some type of exercise that we can do. I don't think I will ever run again in my life so....

Re: THIS treatment is working & var. other thoughts

Julie on 2/01/03 at 04:41 (107577)

The author's description of the plantar fascia as part of a hip-to-toe continuum is accurate, and of course he is right that tight hamstrings - or tightness anywhere along that continuum (lower back, hamstrings, calf muscles, achilles tendon etc) CAN be a cause of plantar fasciitis. But like most specialists with a point to make he is presenting only a part of the picture.

As Ed says, PF and its treatment are mutifaceted, and if the whole picture isn't perceived and taken into account, treatment may be skewed and ineffective.

I come to all this from the perspective of yoga practice and teaching, so I'm fully aware of the contribution tight muscles make to various conditions, including PF. But it certainly isn't the whole story, and for some people it may not even be part of it. To take my own body and my own case of PF as an example, tight hamstrings and calf muscles had nothing to do with it. Abnormal biomechanics did. Taping, good shoes, and custom orthotics - well-casted, well-made - all helped. Aggressive 'stretching' of my already optimally-lengthened hamstrings and calf muscles did not: it wasn't necessary, and put more strain on my PF until I (very quickly) stopped.

It's never easy to see the 'whole picture', but it's important to try.

Re: comments on just one sentence of this...

AndrueC on 2/01/03 at 06:42 (107588)

I'd agree with that. Strengthening is surely a major key but you can't strengthen badly damaged tissue. I'd say the first step (where orthosis help) is in repairing damage. Then you can move onto strengthening.

Re: cross country skiing, rollerblading

Ed Davis, DPM on 2/01/03 at 12:01 (107624)

Sandy:

A good rule of thumb is to see how your feet feel the day after any type of exercise. If they don't feel worse, the exercise you had performed has not aggravated your PF. Definitely keep up the conditioning.
Ed

Re: cross country skiing, rollerblading

Leon S. on 2/01/03 at 18:43 (107649)

I've been downhill skiing 3 times so far and thanks to the taping there have been no after-effects. It's at the point where I don't even think about it anymore.

Re: cross country skiing, rollerblading

IanJ on 2/02/03 at 12:18 (107708)

Wow cross country skiing? I, personally, think that would be one of the scariest of all sports (running also) to do since it stretches the fascia and achilles tendon abruptly.

I have arch pain and I used a Concept II rowing machine and that agravated my PF.

I haven't been doing anything but I noticed that the PT has me ride a stationary bike for 12 minutes and that doesn't seem to bother me. I'm going to try a mild (no hills) outside bike ride today.

Re: cross country skiing, rollerblading

sandy h on 2/03/03 at 03:51 (107783)

Well the thing about cross country skiing and rollerblading is that there is very little impact compared with running and even walking. The problem is the push off. It is like doing a lot of toe raises, doing too many too soon and it can make things worse. I'm still trying on the rollerblading. Been about 7 times now and the 30 minute sessions were OK but I did it for two hours one Sunday and that was a mistake.

Re: cross country skiing, rollerblading ETC.

Lynn H. on 2/03/03 at 12:40 (107818)

This is my first time posting & I'm not sure of etiquette, but I'm replying to some of the previous messages, along w/ Sandy h's.

Sandy, I agree about the little impact feature of x country skiing & rollerblading. Skiing involves your arms as well in the push .. . I'll strenghten my calves a bit before the attempt. good to hear your're doing rollerblading, I found my feet were always so sore afterwards, tho. Too much asphalt, I'll take soft snow!!

I also agree w/ what Sandy said about 'deskbound atrophy of muscles' that's exactly what took place with me.

Julie mentioned encountering tight hamstrings on clients- I believe I have those along w/ tight calf muscles. I've had a partial tear on one calf muscle, two times. Stretching used to be part of my routine, I'll have to commit to doing it consistently.

Dr. Ed Davis mentioned the electrotherapy w/ USSR athletes - this has worked well, in other locations like my calf & shoulder (electrostim.) during recovery from exercise or repetitive motion injury. Massage is great, but electrotherapy of some form is what has usually been provided by the PT w/ my insurance. I am so thankful I found this, it turned the corner for my feet. The constant pain is gone.

Now to lick the ugly shoe part!!

Re: THIS treatment is working & var. other thoughts

Mar on 2/03/03 at 16:48 (107842)

Ed -

I found this very interesting. This fits my situation very well. The pain I have is not only the fascia, but the muscles parallel to it. They are as painful or more so than the fascia. Other than Russian Stimulation (??) what else can be done to help strengthen and heal these? Mar

Re: THIS treatment is working & var. other thoughts

Mar on 2/04/03 at 05:31 (107900)

What surprised me in this article is that almost all of the exercises recommended require you to STAND and many of them BAREFOOT!! How many PF sufferers can do this??? Or should??? I have to do a search yet to find out all about 'accuscope' and what is 'e-prin.' -- my stomach cannot tolerate ibuprofen or naprosyn, etc. Mar

Re: Mar

Julie on 2/04/03 at 06:44 (107902)

Mar, your instincts are good. I've now read the whole article and had a good look at the exercises. They're good exercises for athletes trying to avoid PF (remember that it's a sports injury website and the article is addressed to coaches and physios) but I certainly wouldn't counsel them for non-athletes who are suffering PF. They're extreme;y strong - and, as you've pointed out, they're all weight-bearing, some of them in bare feet.

What really lets the article down is the failure to provide illustrations which would show people who are attempting them the correct body positions for them. They're quite complicated, and not easy to follow, and if someone who is used to following written instructions finds them difficult, I can imagine others, who aren't, finding them even more difficult. The risk then is that they'lll be done incorrectly, and cause further problems.

Exercise 1 is a good example. I doubt that more than one person in a hundred (apart from professional athletes in training) can put one leg up on a waist-high table and keep both legs straight without twisting the pelvis and straining the lower back. Twisting the leg-on-the-table to the left and right from that skewiff position could do serious damage to the lower lumbar sacro-iliac joints.

Re: Correction

Julie on 2/04/03 at 06:45 (107903)

That should have read 'lower lumbar AND sacro-iliac joints'. Bad proof reading.

Re: THIS treatment is working & var. other thoughts

Bev N on 2/04/03 at 13:15 (107940)

Lynn H. What is accuscope? You said it really helped your PF. Is it something the Drs. are familiar with? Thanks

Re: THIS treatment is working & var. other thoughts

Pauline on 1/31/03 at 17:59 (107515)

Glad your getting better and thank you for posting the exercise link.
I think his last two points could be a good topic for discussion so I'm posting them here. I happen to agree with him and believe that orthotics are over prescribed. I hope you won't mind me throwing it out for discussion. Here is what he says. Inviting comments.

'3) If you have plantar fasciitis, should you (or should you let a doctor) slip orthotics into your shoes? Bear in mind that prescribing orthotics for plantar fasciitis is in effect saying that the key problem which produces plantar fasciitis must be in the feet. This is certainly not true. As we mentioned earlier, tight hamstrings can cause plantar fasciitis, and prescribing orthotics for taut hamstrings is nonsense! You've got to think of your plantar fascia as part of an interactive chain of muscles and connective tissues that runs from your hip down through your toes. If you want to stay away from plantar fasciitis, the whole system must be taken into account - and worked on! In addition, even if your plantar-fasciitis problem is truly the result of 'weak feet', does it make more sense to install appliances under your feet and forget about correcting the weakness - or work diligently on overall foot (and leg) strength?(!)

(4) Always remember that icing, anti-inflammatories, reduced training, massage, etc. are temporary palliatives for plantar fasciitis. They do not cure the problem! The only true plantar-fasciitis elixir is an increase in the overall resiliency and strength of your legs and feet - so that plantar fasciitis just can't come back.'

Owen Anderson (text)
Walt Reynolds (exercises)

Re: comments on just one sentence of this...

Carole C in NOLA on 1/31/03 at 18:13 (107518)

He has some interesting things to say and some of them are very consistent with Carmen's experiences with her hamstrings. One particular sentence distracts me from what I could get out of the article, and so I just want to comment on this one sentence that I felt was illogical:

'Bear in mind that prescribing orthotics for plantar fasciitis is in effect saying that the key problem which produces plantar fasciitis must be in the feet.'

It's not saying that at all to me. To me it's saying that wearing orthotics will help you to heal faster, and whether or not your feet caused your PF would be a separate issue.

Carole C

Re: THIS treatment is working & var. other thoughts

IanJ on 1/31/03 at 19:56 (107533)

Was your PF in your heel or your arch?

Re: THIS treatment is working & var. other thoughts

Ed Davis, DPM on 1/31/03 at 20:07 (107535)

Lynn:

The article is fairly well written but has some innacuracies. The authors refer to heel spurs as a 'wad of calcium' deposited at the origin of the plantar fascia. That is very far from accurate. The 'spur' is actually a shelf of bone (not just calcium) that projects forward parallel and generally attached to the fascia. This projection of bone grows in the direction of tension in the fascia and is a physiologic response to excess, long term tension on the fascia. Since x-rays are two dimensional, one visualizes the shelf of bone from the side (lateral view) and it thus appears to be a 'spur.'

Plantar fasciitis and its treatment is multifaceted -- please refer to prior discussions on the 'treatment triad.' The three issues to be dealt with are inflammation, tissue quality and biomechanics. Patients are different in that they may have a predominance of one of the above components and as such, will respond differently to treatment. Certainly, from an athletic trainors perspective a focus on issues of muscle imbalance and tighness predominates. If that is the major etiology on a particular patient or group of patients, then that focus will lead to success. It sounds like that may have been your situation.

Nevertheless, other individuals with PF may have a predominance of other factors discussed in this site so the focus of treatment must shift. Stating that traditional PF treatments are 'weak' as these authors do is based on a very narrow focus and ignores the generally high success rate of such treatments. An individual who works on concrete/asphalt for 8 to 10 hours per day and is overpronated can stretch and exercise till the cows come home but will need a way to compensate for the occupational stresses and strains placed on the feet. That compensation can be provided via modified shoegear and/or orthotics. Othotics will not work properly if the calf muscle (gastrocnemius) is too tight so that must be looked at. Again, the point here is that patients with PF must be carefully examined and have a treamtment plan that takes into account all pertinent aspects that may contribute to the problem.
Ed

Re: THIS treatment is working & var. other thoughts

Lynn H. on 1/31/03 at 20:38 (107542)

Just one sentence, see orig. message:

'3) If you have plantar fasciitis, should you (or should you let a doctor) slip orthotics into your shoes?

This sentence also caught my attention; that's why I continued with the article. I think there's a lot of message buried within. However, I don't think it is the ONLY approach to this, and specifically, to my problem with PF.

I obtained orthotics from a private podiatrist, out of pocket expense; not avilable thru my HMO (!!) (one of the largest in Calif). The orthotics were a HUGE RELIEF to me, painwise, and started the healing process so I am not discounting the benefit of an orthotic - - don't know what I would've done without the orthotics.

However,I feel that there's a muscular-skeletal weakness in my feet, due to inactivity & lack of the usual exercise. I took dance classes from age 5, became a runner, a walker, hiker, bicyclist. As with a lot of people when you hit your 40s there's demands from work & all that, that prevents the usual maintenance exercise that keeps you tuned up. You undergo some injuries. That's what happened with me. I know that a combination regimen is what is necessary to get you back in a normal picture.

People who must work/live on concrete floors have to do what is necessary to mitigate their circumstances in order to have healthy feet. The human foot hasn't evolved yet to overcome the concrete floor, I believe. This includes (in my case) proper footwear, floor pads, orthotics, anti-inflammatories, EXERCISE, etc.etc.

For me, the situation was lack of muscular tone in feet/legs, with a buncha other factors coming in such as general physical condition & external conditions such as concrete floors & heavy weight loading.I believe this resulted in over-extension & stretching of fascia & then PF. I hope that the exercise regimen COMBINED with orthotics & all that I've described previously will do it, eventually! I haven't tested it out yet, but will report back when I've got some results on exercise.

thanks for your input & trained opinion!

Re: THIS treatment is working & var. other thoughts

Ed Davis, DPM on 1/31/03 at 21:15 (107548)

Lynn:

There had been studies back in the 'ol USSR in which Russian stimulation was used to cure PF. Russian stimulation is a form of electrotherapy in which many muscle fibers are recruited (somewhat painfully) by an electric current. It had some limited application for Soviet Olympic athletes but now is used primarily by PTs to prevent muscle atrophy in idnividuals with casts on or certain neuromuscular diseases.

The plantar fascia has, deep to it, 4 layers of what are called 'intinsic' foot muscle which, for the most part run parallel to the fascia. If those muscles were sufficiently strong they could effectively decrease plantar fascial tension. Intrinsic muscles of the foot are considerably atrophied in modern man - few exceptions. The above type of stimulation, applied long enough can build the intrinsic muscles and significantly reduce plantar fascial tension. Individuals in cultures who spend a lifetime going barefoot on soft surfaces can have good intrinsic musculature. (I have often been asked by runners-- Why do I have to wear a particular shoe or orthotic while Olympic champion runners from Kenya run barefoot?) Practically speaking, this is not likely to become a popular treatment though. There is a tendency to prefer 'passive' treamtents -- pills, inserts, even surgery than to place a strong effort on treatments that involve a lot of active participation.
Health care providers certainly act to accomodate that tendency. Sometimes orthotics are overused as they can be viewed as a 'magic bullet' to correct biomechanical deficiencies.
Ed

Re: cross country skiing, rollerblading

sandy h on 1/31/03 at 21:50 (107559)

I did cross country skiing for a couple of weeks and I don't think it made it much worse. I just started rollerblading and I'm getting a bit of pain in the front of my foot but nothing too dramatic considering. The general goal of all of this is to strengthen the leg. I think the danger of muscles atrophying is quite a big one for deskbound people. We need to find some type of exercise that we can do. I don't think I will ever run again in my life so....

Re: THIS treatment is working & var. other thoughts

Julie on 2/01/03 at 04:41 (107577)

The author's description of the plantar fascia as part of a hip-to-toe continuum is accurate, and of course he is right that tight hamstrings - or tightness anywhere along that continuum (lower back, hamstrings, calf muscles, achilles tendon etc) CAN be a cause of plantar fasciitis. But like most specialists with a point to make he is presenting only a part of the picture.

As Ed says, PF and its treatment are mutifaceted, and if the whole picture isn't perceived and taken into account, treatment may be skewed and ineffective.

I come to all this from the perspective of yoga practice and teaching, so I'm fully aware of the contribution tight muscles make to various conditions, including PF. But it certainly isn't the whole story, and for some people it may not even be part of it. To take my own body and my own case of PF as an example, tight hamstrings and calf muscles had nothing to do with it. Abnormal biomechanics did. Taping, good shoes, and custom orthotics - well-casted, well-made - all helped. Aggressive 'stretching' of my already optimally-lengthened hamstrings and calf muscles did not: it wasn't necessary, and put more strain on my PF until I (very quickly) stopped.

It's never easy to see the 'whole picture', but it's important to try.

Re: comments on just one sentence of this...

AndrueC on 2/01/03 at 06:42 (107588)

I'd agree with that. Strengthening is surely a major key but you can't strengthen badly damaged tissue. I'd say the first step (where orthosis help) is in repairing damage. Then you can move onto strengthening.

Re: cross country skiing, rollerblading

Ed Davis, DPM on 2/01/03 at 12:01 (107624)

Sandy:

A good rule of thumb is to see how your feet feel the day after any type of exercise. If they don't feel worse, the exercise you had performed has not aggravated your PF. Definitely keep up the conditioning.
Ed

Re: cross country skiing, rollerblading

Leon S. on 2/01/03 at 18:43 (107649)

I've been downhill skiing 3 times so far and thanks to the taping there have been no after-effects. It's at the point where I don't even think about it anymore.

Re: cross country skiing, rollerblading

IanJ on 2/02/03 at 12:18 (107708)

Wow cross country skiing? I, personally, think that would be one of the scariest of all sports (running also) to do since it stretches the fascia and achilles tendon abruptly.

I have arch pain and I used a Concept II rowing machine and that agravated my PF.

I haven't been doing anything but I noticed that the PT has me ride a stationary bike for 12 minutes and that doesn't seem to bother me. I'm going to try a mild (no hills) outside bike ride today.

Re: cross country skiing, rollerblading

sandy h on 2/03/03 at 03:51 (107783)

Well the thing about cross country skiing and rollerblading is that there is very little impact compared with running and even walking. The problem is the push off. It is like doing a lot of toe raises, doing too many too soon and it can make things worse. I'm still trying on the rollerblading. Been about 7 times now and the 30 minute sessions were OK but I did it for two hours one Sunday and that was a mistake.

Re: cross country skiing, rollerblading ETC.

Lynn H. on 2/03/03 at 12:40 (107818)

This is my first time posting & I'm not sure of etiquette, but I'm replying to some of the previous messages, along w/ Sandy h's.

Sandy, I agree about the little impact feature of x country skiing & rollerblading. Skiing involves your arms as well in the push .. . I'll strenghten my calves a bit before the attempt. good to hear your're doing rollerblading, I found my feet were always so sore afterwards, tho. Too much asphalt, I'll take soft snow!!

I also agree w/ what Sandy said about 'deskbound atrophy of muscles' that's exactly what took place with me.

Julie mentioned encountering tight hamstrings on clients- I believe I have those along w/ tight calf muscles. I've had a partial tear on one calf muscle, two times. Stretching used to be part of my routine, I'll have to commit to doing it consistently.

Dr. Ed Davis mentioned the electrotherapy w/ USSR athletes - this has worked well, in other locations like my calf & shoulder (electrostim.) during recovery from exercise or repetitive motion injury. Massage is great, but electrotherapy of some form is what has usually been provided by the PT w/ my insurance. I am so thankful I found this, it turned the corner for my feet. The constant pain is gone.

Now to lick the ugly shoe part!!

Re: THIS treatment is working & var. other thoughts

Mar on 2/03/03 at 16:48 (107842)

Ed -

I found this very interesting. This fits my situation very well. The pain I have is not only the fascia, but the muscles parallel to it. They are as painful or more so than the fascia. Other than Russian Stimulation (??) what else can be done to help strengthen and heal these? Mar

Re: THIS treatment is working & var. other thoughts

Mar on 2/04/03 at 05:31 (107900)

What surprised me in this article is that almost all of the exercises recommended require you to STAND and many of them BAREFOOT!! How many PF sufferers can do this??? Or should??? I have to do a search yet to find out all about 'accuscope' and what is 'e-prin.' -- my stomach cannot tolerate ibuprofen or naprosyn, etc. Mar

Re: Mar

Julie on 2/04/03 at 06:44 (107902)

Mar, your instincts are good. I've now read the whole article and had a good look at the exercises. They're good exercises for athletes trying to avoid PF (remember that it's a sports injury website and the article is addressed to coaches and physios) but I certainly wouldn't counsel them for non-athletes who are suffering PF. They're extreme;y strong - and, as you've pointed out, they're all weight-bearing, some of them in bare feet.

What really lets the article down is the failure to provide illustrations which would show people who are attempting them the correct body positions for them. They're quite complicated, and not easy to follow, and if someone who is used to following written instructions finds them difficult, I can imagine others, who aren't, finding them even more difficult. The risk then is that they'lll be done incorrectly, and cause further problems.

Exercise 1 is a good example. I doubt that more than one person in a hundred (apart from professional athletes in training) can put one leg up on a waist-high table and keep both legs straight without twisting the pelvis and straining the lower back. Twisting the leg-on-the-table to the left and right from that skewiff position could do serious damage to the lower lumbar sacro-iliac joints.

Re: Correction

Julie on 2/04/03 at 06:45 (107903)

That should have read 'lower lumbar AND sacro-iliac joints'. Bad proof reading.

Re: THIS treatment is working & var. other thoughts

Bev N on 2/04/03 at 13:15 (107940)

Lynn H. What is accuscope? You said it really helped your PF. Is it something the Drs. are familiar with? Thanks