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My Doctor's Advice

Posted by BrianJ on 8/05/03 at 17:46 (126309)

As many of you know, I've had bilateral PF for 5 years now, and I've tried virtually every treatment to no avail. Recently, I saw a very accomplished rehabilitative medicine doctor who gave me some interesting advice. He says I should TRY to irritate the PF insertion by slowly increasing my athletic activity and NOT using any ice or oral antiinflammatory drugs. His theory is that -- much like ESWT or prolotherapy -- this irritation will cause the PF to heal and strengthen itself.

I know this would be bad advice for an acute (rather than chronic) case of PF, and it might be bad for ANY case of PF. Nonetheless, I'm going to try it, as nothing else has worked.

I'll be interested to hear everyone's comments on this subject.

Re: My Doctor's Advice

Sharon W on 8/05/03 at 17:49 (126310)

Well -- what do you have to lose? If your doctor suggests it and you really want to know if it would work -- go for it!

Sharon
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Re: My Doctor's Advice

R C on 8/06/03 at 10:57 (126388)

I am not a health care professional, but since you asked for our reactions, let me voice my opinion. I am not convinced that this approach is worth trying. I don't see any essential difference between the activity that you are being asked to undertake as a cure and the activity that caused your PF to begin with. It seems to me that it will most likely make things worse.

Even if we accept that an increase in activity stimulates healing, it requires an extended, uninterrupted period of rest in order to recover from the damage. Where is that taken into account in your proposed program?

Beofre you try this, I strongly urge that you go to a different doctor and try to find a different approach.

Re: My Doctor's Advice

Dorothy on 8/06/03 at 14:28 (126409)

I think it is fascinating! I have actually wondered about this very concept ever since I read the description of how ESWT works - by creating the very kind of injury that it is treating, right? Brian J., I applaud your 'gutsiness' in your plan to experiment with this. You know, it is also in line with the information that was posted on this website a couple of months ago that pertained to using VIGOROUS exercise to address back pain and injuries, with the finding that it had successful outcomes.
I know I am pretty disenchanted with 'babying' the feet - and thereby the body - because we are meant to MOVE and we are designed to heal. Those 'heel spurs', after all, that people write about are supposedly one of the body's efforts to heal itself so that one can MOVE again.
Well, much much good luck, Brian J. Keep us posted. I think I may join you in this effort.

Re: My Doctor's Advice

Jen L on 8/06/03 at 16:42 (126415)

BrianJ, I would question further about the doctor's success rate with the advice he gave: how many patients have recovered by this method, and if you could talk to them directly.
As we know ESWT causes controlled injury to the specific location at a certain energy level and frequency. I would not say it's perfectly right location and energy level, since no one is sure for any particular patient. The key here I think is the CONTROLLED feature, and the result must be different from the accidental tear and wear caused by our daily activities.
Considering the length of time you have had the condition you can say it's chronic now, but I suspect the root cause would be the same for either acute or chronic PF. I guess you must have had flare ups in all these years, do you think they were caused by too little activities?
Just some thoughts. Thank you for bringing this up -interesting.

Jen

Re: My Doctor's Advice

john h on 8/07/03 at 10:30 (126471)

Jen over the past 8 years I have come to think there is no one root cause for PF and there is no one pain generator. I think the pain we perceive in our feet can result from multiple causes and the pain generator can be various things. To me, saying you have PF is like saying you have cancer in that there are many different kinds and different ways to treat. I think we greatly oversimplify PF when we say it is merely the inflamation of the fasica. I have posted this often and still think it to be true 'If you really knew what the pain generator was in any given individual diagonsed with PF you might be on the way to curing the problem'. These are just my thoughts based on no scientific studies but based on reading thousands of post on this board by patients and Doctors and my own life altering experience with PF or foot pain..

Re: My Doctor's Advice

john h on 8/07/03 at 10:37 (126472)

R.C. I really have no idea but I do know that many circus performer such as acrobats,high wire artists,etc have a history of continuing to perform after serious strains,sprains,etc. Over time and through hundreds of years of experience they have found that they recovered faster if they continued to do their thing rather than rest. It has not been many years ago that when one had back surgery, knee surgery, etc that you were told to remain in bed and rest for a lengthy period of time. Now we get people up the next day after surgery and get them moving. i have considered just going out on the track and running a mile to see what would happen to my feet after having this problem for 8 years. I have not tried that (chiken) but may soon give it a few laps at least. I did hike up a very steep mountain about a year ago and was no worse than when I started (3 mile trip)

Re: My Doctor's Advice

john h on 8/07/03 at 10:50 (126473)

Brian: I have condidered this approach for some time but have not taken the step. You want to go first or me. Just before I broke my toe I had a mountain hike planned the next day us a mountain with a lot of rocks which you had to traverse. This would surely tax the fascia and foot. I think the real test would be to run a mile and see what happens. If the pain is not really bad run another mile the next day and so on to see if the pain might diminish over time. I do not think this would work with just a few runs because we have not used our feet in this activity for a long time and increased pain is to be expected. Professional athletes in basketball take the floor with PF on a regular basis as do dancers. Perhaps, we have so conditioned ourselves mentally that an activity will cause horrible results that we have boxed ourselves in to a life of pain in the feet. Having had back surgery about 25 years ago my back did very well as long as I continued to run 30 miles a week, play basketball at noon each day and exercise and lift weights but once PF set in and these activites were eliminated my back has done a lot worse. There is an old saying 'use it or lose it'. This applies to many things. Rest can be very important in the short term treatment of many things but generally speaking I think we have to get out of the sack, on our feet, and do the best we can or things can get worse.

Re: My Doctor's Advice

R C on 8/07/03 at 11:07 (126477)

Hmmmm... I'm still not convinced that increasing activity would work. Let me contrast this with two specific examples.

I am aware that there are cases in which seemingly aggravating a condition triggers a healing mechanism. For example, warts are often treated by adding a chemical or freeze irritation; the body responds to the second irritation thereby eliminating the wart as well. Another example of a different nature -- I know from talking to other swimmers that we have found our various joint injuries to actually get better if we keep to our daily swim (versus rest).

However, my mind keeps telling me that these two examples are different from the PF situation. The warts respond to this approach because the virus causing the wart doesn't irritate the body enough to trigger the immune response. Irritating the wart further (by chem or liquid nitrogen) alerts the body to the problem, and sets healing in motion. As for swimming, it is a low-impact activity (thus easier on the joints than weight-bearing), yet at the same time it greatly increases circulation (thus promotes healing). I cannot put together a similar argument why a PF patient should try weight-bearing activity as a cure. We all agree that weight-bearing activity will further irritate the condition. What additional curative element does this activity trigger that wasn't present before? If you intend to beat up your PF foot then (say) rest it in a cast, why not just go directly to the cast?

Re: My Doctor's Advice

john h on 8/07/03 at 14:19 (126495)

R.C. common sense would seem to say do not run if you have PF and for 8 years I have followed this but here I am still with PF. Sometimes soon I will have a go at running 4-5 laps on the indoor track and will report back my real world experience. If it really causes more pain fear not I will let you know.

Re: My Doctor's Advice

BrianJ on 8/07/03 at 14:36 (126497)

I appreciate everyone's thoughts on this subject, and will provide periodic updates on how my little experiment is going. For what it's worth, I think R.C.'s logic makes a lot of sense -- if doing something hurt me in the first place, how is it going to make me better now? Then again, some things in medicine and science are very counter-intuitive, so a certain amount of experimentation is needed.

Re: My Doctor's Advice

Dorothy on 8/07/03 at 15:07 (126502)

And to all you have said, I say: Amen! I think.... (being a bit of a chicken myself )~

Re: My Doctor's Advice

Dorothy on 8/07/03 at 15:25 (126503)

But what about the other side of this point which is that NOT doing those things STILL leaves you/us with pain, so the PAIN is consistent, no matter what you do. So, you move and exercise and breathe and sweat and have pain or you sit and rest and have pain. Therefore, what about other factors - such as simply 'driving on through' pain? Those of us who have dealt with back injury/back pain know that doing most anything known to humankind hurts like the dickens in that circumstance, sometimes beyond imagining, but we also learn that we HAVE to do them anyway. Isn't it possible that PAIN is not the only message we should be paying attention to?
I have been re-reading the Egoscue book lately and he/Pete Egoscue recalls being a wounded Vietnam vet and overhearing doctors examining another vet nearby who was extremely/severely wounded and in constant pain. One doctor said to the other, 'Think he will make it?' and the other responded, 'You either get well or you die.'
Now, I admit, I am not entirely sure what that means, but it meant a lot to Egoscue, who was also badly wounded. He determined to get well.
Lance Armstrong (my current hero!) continues to train and compete HARD and he certainly could have 'rested' for the rest of his 'life.'
I mean, if you think about it, if we did not have all these shoes, wheelchairs, orthotics, surgeries, etc etc etc and our feet were injured and in pain - what would we do? We would get well or die. I do not want to become attached to pain and to live with it in charge of everything and I know what I am capable of because of previous back experiences - but, yes, I am very afraid of doing something worse or new, and a whole new set of problems develops. So there it is, fear in action....
And it is fear, according to Dr. Sarno et al., that contributes mightily to our pain
I am currently dwelling in this endless 'debate loop' and hope to be arriving at some moment of change SOON! I am finding the discussion of this concept and related matters VERY interesting because I think the psychology and emotionality around pain is a huge part of the whole process.

Re: My Doctor's Advice

Suzanne D on 8/07/03 at 16:01 (126507)

Dorothy, a few weeks ago you might have read that my husband and I went to Buffalo, NY and visited friends. I ended up walking MUCH more than I had anticipated; it was one of those situations where there wasn't much way around it. We were seeing the Falls, etc., and our friend took us on a LONG walk. I wore my SAS shoes and orthotics, stretched for about 30 minutes before, and walked on grass rather than pavement every chance I got. I also rested on benches now and then when I could. During two days, we walked more than I had in two years. The second day was all on dirt trails. I was amazed that I did fine afterwards, and although my legs and feet got tired, I didn't have pain in the arches or any problems later on. In fact, I felt better for some time afterwards!

Contrast that to being back at school this week on the concrete and tile. I could walk all those steps in NY far easier than these concrete halls. My feet and legs have felt terrible both yesterday and this afternoon.

So, I wonder ~ does pushing oneself work only in more 'healthy circumstances' for lack of a better way to put it? I might really improve if I could walk on dirt trails on a regular basis, but I feel I could become crippled if I didn't take extra care on this concrete and tile.

Just thinking...
Suzanne :)

Re: My Doctor's Advice

BrianJ on 8/07/03 at 16:44 (126512)

John --

Just for the record, I'm going to call this new experiment 'Active Healing' (a very optimistic title, isn't it?). Each day, I walk about a quarter mile to a park with lots of grass, where I then do some light jogging, half-speed sprints, lateral motion drills, and squats. I then do more light jogging to cool down before walking home. The whole thing takes just 30-40 minutes right now, as I want to start slowly.

Re: My Doctor's Advice

Lori W. on 8/07/03 at 17:04 (126516)

You're point about walking on grass and dirt is a good one. I went to Zion earlier this summer. It is a beautiful national park, but small and crowded in the season. Many of the trails are paved. I just about died on those trails. My feet really hurt. However, when I was on a sandy trail, my feet felt great. I could go on and on. Same thing in Yellowstone. The boardwalks were great to walk on. Just having a little extra give makes a huge difference. I am really apprehensive about returning to school myself in a couple of weeks, but I will have ice at school and sit as much as possible. I have set up my classroom so that I have a good spot to sit in all areas. My plan is to stand and move when necessary, and sit as much as possible.

Re: My Doctor's Advice

Dorothy on 8/07/03 at 18:07 (126520)

I take your point, Suzanne, and have experienced that myself and have read several posts from people who have also experienced what I think you are describing. It seems that standing, without full movement, for prolonged (or even shorter periods) seems to have more negative results that movement. Let's think that through and see if various heads can come up with possible causes for this. Thinking of the most involved systems - circulatory, musculoskeletal, nervous, emotional.... the answer(s) have to lie in there somwhere. Like the scarecrow, I feel like I should rub my chin now and start singing '...if I only had a brain...'

Do I understand your point correctly?

Re: My Doctor's Advice

Dorothy on 8/07/03 at 18:08 (126521)

Inserting myself into your note to John, I must say I really like the 'Active Healing' name for the experiment.

Re: My Doctor's Advice

BrianJ on 8/07/03 at 22:37 (126533)

Dorothy --

I speculate that the primary reason for pronounced pain upon standing in one place is lack of circulation/accumulation of fluids in heel tissue. Two possible reasons:

1. Feet, being far from the heart, have circulatory challenges to start with. Add to this the fact that gravity operates against the return of your blood from the foot to the heart.

2. Your veinous return system, which returns 'used' blood from your feet back up your leg, operates on a series of one-way valves. These valves need body motion in order to help move your blood properly. Thus, when you're standing still, your blood tends to pool in your feet and lower legs.

Of course, pressure on damaged heel tissue could also cause pain upon standing, but if that were the case, one would think you would feel pain every time your foot hit the ground while walking.

Just my thoughts.

Re: My Doctor's Advice

Andrue on 8/08/03 at 07:58 (126547)

Isn't it simple as saying that the human body is not well adapated to enduring static loads? That at least explains why standing is worse. In motion there will also be greater blood flow through the tissues. As long as you don't push your tissues beyond their current limits you can't be injuring yourself and the increased blood flow must be beneficial.

Re: My Doctor's Advice

marie on 8/08/03 at 09:31 (126553)

I had two points of view when I first started having problems with my feet two years ago.
My Podiatrist said stay off them as much as possible and my Physical Theropist said more stretching and exercise. He told me I needed to walk a little every day so I would be ready for school the following fall. He tended to overdue the exercising and I felt worse for several days.

I tended to agree that I needed to start exercising as all this sitting still was making mush out of my legs. I made up my own exercise plan that included stretching, walking and swimming. I took it slow and at my own pace. I let my body dictate when to stop. Iunderstood that this process would take several years and not to overdue it. Once I felt a little improvement i did a little more. I began swimming by just holding on to a raft and kicking my feet around. After slowly improving now I swim without a raft. I started walking around one block. Now I am walking 2-3 miles daily. I still don't bike outside but I have added my encombant bike to my routine. I added some floor exercises...like leg lifts. When I began I could only do three if I was lucky now I can do a 103. I think the key to my success was and is to go slow, tune into my body and what it was saying to me and don't stop if you don't see instant success.

Medication, vitamins, and exercise have been a part of my daily routine. I don't blow it off like I did the first year I was so bad. I have bilateral PF and TTS.

marie

Re: My Doctor's Advice

Kathy G on 8/08/03 at 09:41 (126556)

Having had PF for almost eight years, I've experimented a great deal. When I first got it, I continued to walk on the tread mill as I thought it was less painful than walking outside on concrete. I got to the point where I would take a Darvocet prior to exercising but then realized that I was getting worse so maybe it was a stupid idea. I've done all kinds of stupid things since getting PF. Figuring I have a pretty high pain threshold, I've tried ignoring it and working through the pain, even with nothing but a Vioxx. Not good -- I probably set myself back for months. The idea of mind over matter doesn't always work.

But I have reached the point where you, Brian, and John are. When it's severe, you rest; you ice; you stretch. Then you have to start moving again and return to a activity level that is acceptable to you alone. I am gradually working myself back to a more regular routine in my life. I still find standing to be the most difficult thing I can do, and that I avoid as much as possible. But I am walking more and yes, I am taking more pain meds, but if that's what it takes, I'll do it. My feet hurt all the time anyhow so if I can maintain a more normal level of activity, at least it may alleviate some of my stress due to worrying that I'm going to develop all kinds of other maladies because of lack of exercise.

It's obvious that I'm always going to have foot pain. Some days, I'm pleasantly surprised that they don't hurt more, based upon the amount of walking I've done. I'm in a period of trial and error. I'm trying to find the right activity level for me. Sometimes I blow it and the pain level really gets up there and I have to back off, but I'm trying.

I have no idea if running is bad or good. My instincts say it's bad but if your PF is chronic and you've tried everything else, I say go for it! You'll find out soon enough if it was a good idea or not. As to it actually curing PF, we will all look forward to your results. If it works, we'll all become runners!

Re: My Doctor's Advice

john h on 8/08/03 at 10:02 (126562)

Kathy: I have reached the point where I accept the foot pain. If I can make it better then great if not it is there and I have to deal with it in the best way I can. This does not mean I will not continue to try all alternatives. I think all of us agree that standing really is bad. I wonder if part of this is when we stand we are usually not doing anything and our mind can focus on the pain more than we we are moving and involved? This must be at least part of it. If I am standing around with some friends having fun I do not really notice my feet like when standing in line at Sams. My family Doctor is of the opinion (like Brian) to take what ever meds that will help and not to be concerned about getting hooked as most people with pain rarely get hooked on meds they are taking for pain. I had been taking 1 ultram 50mg a day. She said if I need it and it helps take 6. She thinks people should not suffer pain if there are safe alternatives..Chronic pain really can be a worse alternative than most meds

Re: My Doctor's Advice

john h on 8/08/03 at 10:04 (126563)

Sounds like a winner to me Marie.

Re: My Doctor's Advice

john h on 8/08/03 at 10:07 (126565)

Brian in college football training which is now going on that sounds like what they call 'two a days'.

Re: My Doctor's Advice

Kathy G on 8/08/03 at 12:15 (126577)

What a smart doctor, John! It is so enlightening when one finds a doctor who understands the treatment of pain. I quite agree with you about standing although my feet seem to hurt just as much when I'm standing talking as when I'm just standing in line. And you all know how much I love to talk!

I'm going to sign off and take two Ultram. One doesn't do it for me but the doctor said to try two and see if it helps. Well, I'd better not do it right now. I need to drive and it may make me loopier than usual. But just as soon as I get home. So many of you have good luck with it; maybe I just need to take the stronger dose.

Re: wild idea

CLCinNOLA on 8/08/03 at 13:45 (126581)

John, here's an idea right off the top of my head, which might apply or maybe not. So I'll throw this baby bird of an idea out of the nest, to see if it will fly:

When I'm standing it seems like the muscles in my feet relax, which causes more strain on my arches and plantar fascia than when I'm walking.

When walking, I think my foot muscles tend to guard my feet a bit more, and the strain isn't in one part of my foot very long before it goes elsewhere due to the various stages in my gait.

Well, it was just a thought. LOL

Carole C

Re: Physics?

marie on 8/08/03 at 19:37 (126612)

Suzanne,

I concur with you. I walk well in the grass and in the woods. I began walking on the grass last year when I started my exercise routine to get ready for the MS walk. I slowly worked my way into walking around the block on the sidewalk. I am at my worst when I am on pavement. I do well at home and at the cabin because we have wood floors that absorb the shock. I do well on my stairs at home because they are wood. My legs and feet are sore after I walk or stand on concrete floors....the concrete stairs at school are tough. I can walk around Super Walmart now and stand in a short line as long as I have a cart to help bear weight when I need it.

The stronger I get the better I do....mind you I have no intetion of being like I was 10 years ago I just want to have enough physical strength to help me through the tough times.

As far as walking verses standing I would guess that to be a matter of physics. Since I am no expert on physics I will guess that it is similar to a car accident. The faster moving car fairs better than the one sitting still. Are there any physics geniouses around here?