exercise optionPosted by josh s on 2/14/03 at 12:11 (109151)
I just wanted to share some advice I received from my DPM recently that has helped me. It is an exercise method that some people may feel could aggravate pf, so be warned. My DPM recently attended a seminar where he met the foot doctor for the Montreal Canadiens hockey team. It seems that hockey players, due to the pronation/eversion stresses created by skates, are prone to foot problems - particularly later in their careers. This doctor has theses athletes doing some foot exercises that were dismissed by the mainstream podiatric tradition as ineffective. His opinion is that they are innefective - if not enough repetitions are performed.
The Canadian doctor prescribes 4000 toe grabs (towel grabs) per evening. He also recommends single leg toe raises to strengthen the invertor muscles of the lower leg - performing enough repetitions to reach fatigue daily.
Re: exercise optionCarole C in NOLA on 2/14/03 at 12:26 (109155)
Good heavens! That's utterly irresponsible if it was recommended for someone with PF.
I suspect that perhaps it was recommended for hockey players who DON'T have PF, as a preventative. At any rate, I do not believe such recommendations belong on this message board. It's not just 'some people' who 'feel' this could aggravate PF; this is widely known by most to be extremely harmful to those who already have PF.
Re: exercise optionjosh s on 2/14/03 at 13:38 (109167)
Re: exercise optionJulie on 2/14/03 at 13:56 (109169)
OK for healthy athletes.
Not ok for injured normal mortals.
Re: exercise optionJim C. on 2/14/03 at 23:36 (109197)
I don't understand the strong reaction against those particular exersices on this thread. I have reread the thread several times thinking I missed something. The toe grabs with the towel I've seen recommended numerous times as a PF freindly exercise for strengthening the foot! And I have been doing toe raises myself for the past six months with no ill side affects, though not the extreme amount of reptitions as mentioned in the original post. It seems to me these would be great exercises as both are mainly done with the foot in a planter flexed position, with neither stressing the fascia directly. Am I missing something here?
Re: exercise optionCarole C in NOLA on 2/15/03 at 08:41 (109211)
Yes, you are, Jim. A lot of things might seem like great exercises for PF, and indeed might be great exercises if it weren't for one thing; the fact that the tissues of the feet are injured and the objective is for them to heal. 4000 of anything at all would be frankly insane during acute PF, much less 4000 of exercises that, if overdone in the early stages of PF, have caused people to relapse.
Common sense is in order here. If your PF is just about gone, you might be able to do a few (5-10?) toe grabs with the towel (not 4000). But then again, you might not.
Julie and have both completely healed from PF by now, and able to do whatever exercises we want to do. We both used a lot of caution regarding re-injury during the time while we were in pain, and I attribute my healing to that caution. The nice thing is that if one can exercise the self discipline to protect your feet from any further harm at all, Mother Nature will heal them. Using common sense regarding foot exercises is a measure to protect the feet during healing.
You can do 4000 toe grabs or do the toe raises if you want, but I'd be very surprised if you could do that kind of exercise during the time when your PF pain is still severe and yet reach a pain free state without it taking years instead of months. I've not heard of anyone here having that experience, anyway. I would never in a million years recommend 4000 repetitions of these exercises to anyone suffering from acute PF pain.
As we heal, we can do more. You've probably become well aware of that. And let me also add (joyfully!) that when you recover completely from PF, you can do anything and everything you would have done before the PF monster hit you. When you are completely healed, the whole thing is like a bad memory. I discovered that using common sense, the amount of time that it took (after my PF had healed) to regain muscle strength and to return to my usual level of daily activity was nearly negligible.
There are some atheletes here who would say to go ahead, 'run through the pain', or do 4000 toe grabs a day, but so far I have noticed none of them who experienced severe disabling PF to begin with, have posted about doing these things despite the pain and recovering completely in less than a year.
Re: exercise optionMike W on 2/15/03 at 09:18 (109224)
The reason toe grabs are not very effective is because the muscles involved are already short and tight and the exercises promotes shortening and tightening them. What you really want to do is relax them!!
The toe drops place a great amount of stress on every tissue in the bottom of the foot. Also it is performed in a weight bearing position so the related muscles are automatically contracted prior to the stretch. Muscles should always be relaxed prior to performing any stretch.
It is not that you are missing something, the major problem is that the medical profession is teaching poor exercises to their patients.
Re: exercise optionEd Davis, DPM on 2/15/03 at 10:26 (109241)
The toe towel grabs are a way to strenghten the instrinsic muscles of the foot. Those muscles support the plantar fascia. Good exercise but few people can kkep them up.
The toe raises would benefit many but not if the midfoot is unstable or if tibialis posterior deficiency exists.
Some of the diasagreement on this is derived from the fact that exercise programs often require some custom tailoring to the individual. It is not really possible to make blanket statements of which programs are appropriate for everyone.
Re: exercise optionEd Davis, DPM on 2/15/03 at 10:28 (109242)
I beleive that it was toe raises, not drops that were recommended.
Re: exercise optionCarole C in NOLA on 2/15/03 at 10:59 (109248)
Dr. Ed, I agree totally that no one exercise program is appropriate for everyone with PF. From my own experiences and from what I've read on this message board, I think that on this public message board it makes a lot more sense to recommend something along the lines of Julie's Yoga stretches (which seem to benefit most PF patients here), than to recommend 4000 towel grabs, stair stretches, wall stretches, or running 10 miles a day (all of which seem to harm most PF patients here).
Re: exercise optionJulie on 2/15/03 at 11:43 (109253)
I'd go further, and say that exercise programmes *always* need to be tailored to the individual, and this is why I have always been reluctant to describe any but the simplest of exercises on this public message board. In fact my foremost concern since joining this forum has been to help people avoid making their condition worse by performing exercises that could cause further injury (on the principle that 'Do No Harm' is the first obligation of a yoga teacher as it is of a doctor). If the yoga exercises I've described have helped make anyone better, I'm glad of that, but I'm gladder to know that I've helped some avoid being made worse.
Almost any exercise can cause injury if not done correctly, and you cannot tell whether or not an exercise is being done correctly if you don't know the person and can't see him or her doing it! These things need to be taught. I'm sure you give that kind of education in your practice, and that if you had a patient whom you judged would be helped by toe raises or wall stretches you would make sure that they knew how to do these things correctly and without risking injury. So would I.
But on a public forum, as Carole says, I think it is better not to counsel exercises that CAN hurt some people for whom they are not appropriate, even if they MIGHT (if done correctly) help some people for whom they are appropriate. That's why I take a conservative line here, and why posts of the 'wow, this wonderful hanging-off-the-stair stretch helped me, so why don't you all try it' kind will always get a response from me, even when I know that the exercise in question is a good exercise for fit people.
Sorry - this is too long-winded, but I haven't time to revise it. I admire your economy with words!
Re: exercise optionCarole C in NOLA on 2/15/03 at 11:59 (109258)
Thanks, Julie, for your articulate expression of what I was trying to say. You are not wordy; you just have a lot to express and you do it well.
I would also add the suggestion that there is a world of difference in exercise tolerance between someone in agony from PF and nearly disabled, and someone whose feet just ache to the point of inconvenience and casually perusing the message board... and that that is true no matter what the degree of fitness or lack of it.
Re: exercise optionMike W on 2/15/03 at 12:00 (109259)
Hello Dr. Ed,
Toe raises may be less dangerous than toe drops however from a physiological view they are both poor choices because the intrinsic weight bearing foot muscles will be automatically contracted prior to performance. They also both promote shortening and tightening intrinsic flexor muscles that are already short/tight.
If I had pulled my biceps muscle why would I perform biceps curls as an early rehab exercise?
I think one main reason PF can be hard to heal is because the intrisic weight bearing muscles do not get a chance to rest properly.
Re: exercise optionJim C. on 2/15/03 at 14:28 (109283)
I apologize, I didn't intend to come across as being combative. I simply didn't understand the strong reaction to exercies I seen as being realtively low risk in the movements themselves as opposed to something like the stair step heel drop.
I understand you point as being the risk far outweigh and possible benifits and that the amount of repetitions are asenine. That it would be irresponsible to promote that type of activity when rest would be far benificial.
I agree that people with acute PF should avoid any activty that increases the risk of further injury. I remember having a major setback putting my pants on one morning( lossed my balance and did the one hop thing to keep from falling) And a short trip to the bathroom could be perilous. But these things do improve with healing.
After hitting a plateau in my healing about 4months ago, I started a foot/leg strengthening regimone. Thinking that better blood flow and and stronger supporting tissue would improve my condition. But honestly I haven't noticed any benifit from my efforts, though my feet are much stronger and less easily fatigued. So I would agree with you that the risk outweigh any benifit.
One of the things I have noticed in my healing is a direct correlation in my weight and my heel pain. You could draw a gragh and they both would parallel each other perfectly. I have lost about 25# since my diagnosis and I'm close to 100% pain free. When I stopped losing weight my feet stopped getting better, and a breif 5 pound weight gain over the holidays resulted in more sensitivity in my heals. And now back to my pre-holiday weight I have noticed a difference. I think it's a no-brainer that there is a relatioinship between the two. Perhaps we should be promoting weight loss as aggressively as streching and good shoes.
Re: exercise optionJulie on 2/15/03 at 14:34 (109284)
Carole, that's absolutely right, and it's another reason why I like to err on the far side of caution. We don't know the people we're 'talking' to.
Nice short post, eh? :)
Re: exercise optionEd Davis, DPM on 2/15/03 at 16:30 (109302)
Taking what you are saying one step further you may note that in a large number of posts, an individual makes a statement of what worked or did not work in his or her case, then proceeeds to make that the basis of a general recommendation. That, again, is one of the main things that gets a response from me in terms of attempting to place that individual's experience in perspective..
Re: exercise optionjohn h on 2/16/03 at 10:49 (109373)
Your comments are well taken Dr. Ed. I generally try to note that what works for me may very well make someone else worse. There is no one size fits all for this disease or as a matter of fact very few diseases. We all have to experiment.It does help to find out what people are trying and what is working for them as every once in a while someone comes up with something I have not tried. Actually that is sort of the way ESWT came on this board. Many people were very skeptical at first. When Dr. Z first appeard he was greeted with a round of boos because of his spelling. He was the only guy who spelled nearly as bad as me. Actually it is not our spelling. We are in a hurry and do not bother to spell correct and maybe we both are not the greatest type guys.
Re: exercise optionjohn h on 2/16/03 at 10:57 (109374)
Jim: when I developed bi-laterial PF 8 years ago I was at the weight I was at 21 (162 lb) and in the best condition of my life. I worked out 7 days a week including running 5-6 days a week. My weight was no factor. A friend who owned a sandwich shop was 150 lbs overweight and on his feet all day. His feet were so bad he had to sell his business. I did not see him for about three years until a few months ago he walked in and had lost 150lbs. I hardly recoginzed him. He looked like Jarred of Subway fame. His feet were now cured. Of course PF can be brought on by sudden injure repetived injury, probably overweight, job conditions (basketball-football), and probably some things we do not even know about such as bad footware, genetics,etc.
Re: exercise optionEd Davis, DPM on 2/16/03 at 11:50 (109386)
Thank you for your comments.
I too was very skeptical of ESWT at first - sort of a radical new concept. I am not from Missouri but always take the 'show me' attitude. Show me that something works and why and I will go with it. I respect our authorities (FDA) and researchers but will usually go with practical experience and what works out in the field.
Re: I would like to know whyDr. Z on 2/16/03 at 11:56 (109389)
Good morniing. New Jersey is getting our first blast of snow today. Ok. Dr. Ed made me think of this topic. Why do you think that a plantar fascia release cures heel pain ? Anyone give their opinion
Re: exercise optionCarole C in NOLA on 2/16/03 at 12:52 (109398)
You have a good point, John. As Dr. Ed mentioned, different people have different experiences with different factors and the weight issue is one of those factors. I'm thinking of Elliott, and Mahatmelissama, both of whom posted that they felt losing weight was helping them. Yet you and I have not found weight to be a factor.
I had just lost 80 pounds during the year before I got PF.
I stayed the same for a year while I had PF.
Now that I'm done with PF, I've gained 30 pounds back and although I feel heavy, cumbersome, and un-beautiful, my feet feel great. (Yes, I've GOT to get busy and lose it! and I'm starting today, by gosh! again)
My graph would show the level of PF pain being correlated with having LOST weight rather than with having gained weight! LOL Which is not to contradict the others. It's just that PF is affected by multiple factors and people respond differently to them.
Re: I would like to know whyMarty on 2/16/03 at 17:07 (109414)
This is a great Question and I hope many will post... as for me I gon't know why, does it do the thing to the foot that eswt does?
Re: I would like to know whyDr. Z on 2/16/03 at 18:02 (109419)
Let's see what other posters think and say especially doctors . I have my opinion which if no one move with this thread I will give . For now let's see what others think and have to say about this
Re: exercise optionJulie on 2/17/03 at 01:30 (109435)
A delayed response: I missed this post yesterday in all the excitement over on the Social board. I agree completely. It's understandable that people get enthusiastic about whatever helped them, and want to share it with others, but it's vital that individual experience, whether it be about exercise, surgery, injections, or whatever, be placed in perspective. One size never fits all!
Re: I would like to know whyJulie on 2/17/03 at 01:33 (109436)
Does it? :)
But, giving it the benefit of the doubt for the sake of the question, presumably PF release cures heel pain because it reduces the tension on the fascia. But it also deprives the foot of crucial support, so....
Re: I would like to know whyD.Thomas on 2/17/03 at 11:41 (109469)
I really looked into this becuase I was at the point of surgery. I had seen 8 doctors (5 pods and 3 orthos) and all of them (except for one) suggested PF release if all other methods didn't work. None of them thought ESWT was an option because my pain is in the arch of both feet.
When I tried to ask about the complications of the surgery, all of them bascially laughed at me saying that it was a well respected technique. They all said that it would lower the tension on the fascia, but when I asked about creating higher stress in other areas of the fascia that are still attached, they all looked at me like I was making stuff up.
In my opinion, alot of doctors really don't know about the success of this technique. And if one of their patients has a problem with it afterwards, I got the feeling they would just shrug it off and say to themselves, 'aw, that person was just an outlier, and they never really question if the surgery caused it.'
I have to say with what I have read and seen, I am very surprised that it isn't debated more in the field than it is. I personally know Dr. Manoli is trying to show the benefits of a gastroc slide over a fascia release, but I don't think many doctors are paying attention.
Re: I would like to know whyDr. Z on 2/17/03 at 12:26 (109477)
PF release won't help arch pain. It is only for insertional pf. PF release will create additional stresses on other tendon, ligament and joints in the foot.
Re: I would like to know whyD.Thomas on 2/17/03 at 12:51 (109483)
Interesting that you see PF release for insertional PF only. All the foot doctors I have met to date (8 of them) did not make that distinction at all. I just don't think many foot doctors are experts around PF. They certainly know about it, but they don't recognize the subtle differences and how to treat them accordingly – just like understanding how stretching can affect people differently with PF.
Re: Re:I would like to have other doctors opinion on what I just statedDr. Z on 2/17/03 at 13:36 (109493)
Some doctors will do pf releases for other type of pain. I won't . The pf release for chronic plantar fasciitis has always be used for JUST insertional pf pain. It is my opinion that you can make the foot worse if you expand the indications. Why. Well you have pain from a structure that is trying to support the entire foot and now you cut this structure with hopes of getting rid of the pain and at the same time the pf has to heal back to it original strenght. This is alot of ask for a procedure.
Re: I would like to know whyEd Davis, DPM on 2/17/03 at 14:16 (109503)
The theory behind a plantar fascial release is a relief of tension on the plantar fascia. I would have to go with that, particularly with the MIS technique. One common reason for pain relief with SOME of the open procedures is that the medial calcaneal nerve branches are cut causing an area of anesthesia on the heel.
Re: I would like to know whyEd Davis, DPM on 2/17/03 at 14:20 (109504)
About 50% of my plantar fascial releases are combined with a gastrocnemius recession or achilles lengthening, although with ESWT those numbers are now very small. I beleive that most doctors understand the need for a gastroc slide although the numbers are insufficient to support the idea that isolated gastroc slides can be used in lieu of plantar fascial releases.
Re: I would like to know whyDr. Z on 2/17/03 at 14:55 (109505)
Ok so I guess what I am going to say may be new because it is something that I believe is what works. The attachment to the plantar aspect is injured and damaged to the point where the healing has
stopped . It is similiar to a boney non-union or mal-union. So when there is cutting, scrapping etc to that specific area there is a new chance for healing. Cutting produces inflamation and a new chance for healing. I called this a soft tissue non-union that has been injured by surgery and thus new cycle of healing.
This is the same principle for ESWT, so why would surgery do the same thing, except that you are proceduring alot of trauma that may not be needed to get the area to heal
Re: Re:I would like to have other doctors opinion on what I just statedD.Thomas on 2/17/03 at 19:21 (109560)
That is exactly what I heard from Dr. Manoli and why he said he will never do a PF release again.
Re: I would like to know whyjosh s on 2/18/03 at 12:20 (109667)
If that were the case it would seem that a schlerotherapy (prolotherapy) injection to the attachment point would produce the same result (renewed healing) without jeapardizing the structural integrity and functionality of the medial band of the pf.
Re: Re:I would like to have other doctors opinion on what I just statedjosh s on 2/18/03 at 12:23 (109668)
I'm not a doctor but I've read my share of biomechanical literature and I like to say this: The plantar fascial release procedure will go down in history as one of top ten most idiotic surgeries of the 20th century. And it should not have survived into the 21st.
Re: I would like to know whyDr. Z on 2/18/03 at 13:11 (109684)
I agree. Maybe it isn't strong enought to produce an inflamatory effect in this specific area.
Re: Re:I would like to have other doctors opinion on what I just statedjohn h on 2/21/03 at 09:19 (110163)
josh there are at least a few people on this board who will agree with you. I think Brian might be one of them.
Re: exercise optionRose M. on 2/24/03 at 12:15 (110596)
Has anybody ever heard of the Egoscue method? He has a pain clinic and has written a number of books. he also has a radio program. I have his book Pain Free which is excellent. There are specific exercises for the feet. They are gentle and work very very well, especially if you do them each morning before getting up.
Re: I would like to ...PF release?Lolly O on 3/06/03 at 09:27 (111987)
You said ' Why do you think that a plantar fascia release cures heel pain/'
What is a plantar fascia release?