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Nothing seems to work

Posted by Rich on 11/02/03 at 16:22 (136206)

Hi
I have had PF for four months now. I caught it early, and was in the Podiatrist's office a week after symptoms started. Since then I have tried everything in an attempt to rid myself of this. I have had 4 cortisone shots (I know too many and absolutely no more), PT, acupuncture, custom orthotics, a night splint and NSAIDS. Sometimes I think I might be improving, nut the next day if feels as worse as ever. My patience is being tested, and I can honestly say that its really getting me down. It feels like it will never go away. Does anyone have any suggestions on what other things I can do? Does anyone have any suggestions on how to deal with the mental stress I am suffering from?

Re: Nothing seems to work

marie on 11/02/03 at 17:18 (136207)

Pain is really a drag. Everyone has been were you are right now. Talk to your doctor. Depression is a common side effect for those who suffer in chronic pain. A low dose of anti-depressants may help. You're not alone in this! Visit the social/support board you will get alot of support there.

Re: Nothing seems to work

nancy s. on 11/02/03 at 17:44 (136208)

hi rich: first of all, good for you for getting to the podiatrist's office within a week of the start of your pf symptoms. early treatment is half the battle. that said, even with early treatment pf can take as long as a year to heal, and longer for some.

you're right that 4 cortisone shots is plenty (probably too many), so i'm glad to hear you plan on no more. other than this, do you have confidence in your podiatrist and has he/she educated you in self-care for the pf condition? what kind of custom orthotics did you have made, who made them, and how? have they helped at all? the night splint is a good idea and the results may take some time to become apparent. what kind of splint are you using, and are you using it faithfully?

what kind of shoes are you wearing, and how much do you have to be on your feet each day? (i know: a lot of questions, but they're important.) you said nothing about rest -- have you given your feet a good rest and chance to begin the healing process? rest is absolutely crucial for many of us, though i know firsthand how difficult it is to carry it out.

i'm also wondering how long you went to physical therapy and what it consisted of.

Four months of pf is of course way too early to even consider surgery (if you ever want to consider it at all), and i believe it's a couple of months shy of considering ESWT as well. this means that continued conservative treatments -- ones that do help you, even if just a little -- are important for now. have you read scott's heel pain book and learned more about the conservative self-care that might help you, such as elevating and icing? different things help different people. part of finding what's right for you is trying a variety of treatments for long enough that you know whether or not they're helping you, and then winnowing out what doesn't help your particular case. just as an example, NSAIDS did absolutely nothing for me; and custom orthotics, which are great for some people, were too hard on my arches. but pt helped me a great deal. so did wearing birks (i'm a lifer), and so did plenty of rest and then a gradual resumption of activity beginning with slow and gentle non-weight-bearing stretching exercises. everyone is different.

i know that it feels like it will never go away, and that it's emotionally painful to feel like that. please keep in mind that you very likely will get better -- and that patience is key, because it probably will take longer than you'd like. (i still remember my pcp, even before referring me to a podiatrist, telling me that i would need patience, that pf takes a 'long time' to resolve. i thought she meant two or three weeks! it took a lot longer than that, but i'm much better now.)

pf does indeed cause much mental stress. many pf sufferers endure significant depression because of the limitations it forces on their lives, and i was one of them. please post about this on the social/support board, you are most welcome to -- many caring people here understand completely what you're going through and can help you cope. a few weeks ago i re-posted an entire thread of past messages addressing how to cope with the mental stress pf can bring on; please look for it, because it may help you. but regardless, people here either are going through it right now or have been through it, and can give you plenty of coping tips and support.

i hope you can give us more information so that individuals here can help you better. and i hope you'll stick around and gain as much from this site as i did. i don't know what i would have done without it!

best of luck to you, and please keep posting,

nancy
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Re: Nothing seems to work

Ellen J. on 11/02/03 at 18:03 (136213)

Hi Rich,
I know just what you mean, and I have gotten depressed and also anxious when I was in pain and couldn't walk. Those feelings came from wondering if it would ever go away. Are you able to figure out what caused the symptoms in the first place? Maybe that would help others on this board to give suggestions or have ideas. Were you a runner, or did you engage in some activity that caused it, or was it a new pair of shoes that did it? It's kind of a shot in the dark, but maybe knowing the cause might spark some thoughts from others.
I'm sorry you are feeling low at the moment and I hope others will have some good suggestions for you.
Ellen J.

Re: Nothing seems to work

Pauline on 11/02/03 at 18:04 (136214)

Rich,
First and formost know that you are not alone. All of us have been there at one time and some who post on this site are still having all the same symptoms and feelings of anger and despair that you are feeling.

P.F. is a condition that tries one's patience and doesn't go away in any specific length of time.

My personal advice and I'm not a doctor would be for you to continue doing all the conservative treatments provided in Scott's book which is on line here.

If you have not already started to tape your feet begin doing that on a daily basis. Scott has also provided this information complete with pictures to make it easily understood. Taping can be done also while using orthotics if you've already had them made and are using them. If they work for you continue, if they cause you additional pain hang them up and begin taping. Rest, ice and do gentle message and stretches. Julie has several posted.

You can always go for a second opinion to a doctor that is doing ESWT and seek his advice and even try ESWT as a treatment. Find out the costs involved and if you have any insurance coverage. Canada is aways an option for treatment if you are close and with the exchange could be cheaper than seeking treatment in the U.S. Dr. Gordon in the Toronto area M.D. uses a high power machine and Sonny who posts often on this site uses low. I believe they are both listed on Scott's ESWT location page. There are also many U.S. doctors now providing ESWT so you can check Scott's list or the web sites of the manufacturers for names, addresses and phone numbers.

To help control your stress and depression a trip to your local physician or a psychiatrist maybe in order to get medication that will help. Never be ashamed to ask for help in this area. Many have gone before you and others will follow. For even the strongest willed person it may be just what the doctor ordered to help you through this difficult period of time.

Above all never give up and keep posting. The folks here will gladly provide ideas and support for you as long as necessary.

Hope this post helps you. I've been there 3 times and each P.F. episode lasted about 3 years then seemed to go away on it's own. I've never had ESWT or surgery and I'd be the first to tell you before you consider having P.F. surgery read the surgery board for about 3 months on a regular basis. Do your homework well, read everything and know your doctor. Sometimes the 'snip and go' surgery that your offered my not provide the 'sure' cure you were looking for. No surgery comes with a guarantee.

If you've read Scott's book already reread it and keep doing everything that it says whether you think it's working or not. It's far better to keep trying something, than to give up all hope and do nothing.

My secret, play with your feet. Everytime you sit down, ice, use a tennis ball, do gentle massage with foot stretches and as difficult as it will be put a smile on your face, ask the Lord for strength, and thank him that you don't have a catastrophic disease. I think there are a lot of people that would trade their condition for our P.F., but when we're in so much pain it's easy to forget about others who are traveling a much more difficult road.

Smile for you are loved, heard, and understood!

Re: Nothing seems to work

R C on 11/02/03 at 19:25 (136215)

I suggest taping as the next thing to try. Some amount of experimentation is necessary to determine how much tension there is. Too tight and it becomes irritating; not enough and there isn't enough support. Once you get the hang of it, see how it goes for two weeks. Tape every day, and don't bear weight without it.

I have had PF for about 3.5 years. It's almost all gone. I am trying to get rid of the last of it by using crutches to stay off my bad foot completely. After 4 weeks of crutches, I will go back to taping, and gradually wean myself off the tape. That would be the next thing I would recommend to you.

When PF would get me down, I would give myself a dose of perspective by repeating 'it's not rectal cancer..it's not rectal cancer...'

Re: Nothing seems to work

Suzanne D. on 11/02/03 at 19:44 (136219)

Rich, I, too, join the others who have posted to you in saying that I'm sorry and that I also understand the PF 'roller-coaster'! :) Don't give up, though. Keep reading and posting.

Try the taping that has been suggested. It's fairly cheap, non-invasive, and you can do it yourself. You might find it makes a real difference for you! It can't hurt.

Like Nancy asked, what shoes are you wearing? That can make a big difference in your recovery.

I really liked what Pauline said to you: 'Smile for you are loved, heard, and understood!'

Hang in there!
Suzanne :)

Re: Nothing seems to work

Ron B on 11/02/03 at 19:49 (136220)

RC
your right its NOT rectal cancer or anything else terminal !!! and I thank God EVERY day that its not!!!
I haven't been to the doc in eight months but I go in on Tues. I'm going to ask him about taping and to show me how. he has an ESWT machine. I'll ask him about that too. I know its $$$$ don't know if insurance will pick any of it up

Re: Nothing seems to work

wendyn on 11/02/03 at 22:10 (136234)

Rich, as someone who has been dealing with multiple foot problems for years - my best advice is to continue to come here and vent whenever you need to.

Your situation may be very difficult for your friends and family to understand, and sometimes it can make you feel worse if they're less than sympathetic.

Regardless of whatever else happens, you can always come here and dump your feelings. Sometimes it can make you feel better to post exactly how you feel.

I've been dealing with some pretty significant foot probelms for about 5 years now. Periodically I post just to tell everyone that my feet hurt, and life sucks. Then I get over it and get on with my life. If I couldn't come here to do that, I don't know what I would do.

Re: But something will - take heart

Julie on 11/03/03 at 02:14 (136240)

Hi Rich

You're lucky. You realised quickly that there was a real problem and went straight to a podiatrist. You have as good a chance of healing as there is.

You say you've 'tried everything', but the treatments you mention are by no means 'everything'. Nancy asked 'how much do you have to be on your feet?' and that is probably the most important question. If your work involves being on your feet, you have got to think about how that can be changed. If you have a sitting down job that's good, but you'll still need to think about limiting the time you spend weight-bearing (standing/walking - I'm sure you're not running). Remember the simple truth that every time you experience pain from something you're doing, it means that the PF is being re-injured.

So - rest is a treatment. If you haven't really tried it, give a lot of thought to how you can limit the time you spend on your feet.

My PF lasted five months - with immediate help from a podiatrist and this website, and with what I think of as 'relative rest' ('relative' because you obviously can't stay off your feet completely, but every little helps). The other treatment that was an enormous help was the taping that others have already mentioned. Taping helps because it provides the support for the arch that the injured, weakened fascia can't give. Do ask your podiatrist about it - but better still, have a look at the taping section of Scott's book. There are a couple of extremely simple methods that are easy to use on your own - my favourite was the 'two-strip technique'. It was just as effective as the much more complicated, tape-intensive wrapping technique my podiatrist used. I think most people here who have found taping helpful would agree. You need a strong, good-quality tape. Leuko tape is very good. Come back here for more help if you want to try it.

Finally, Pauline mentioned the stretches I posted. They are simple yoga exercises for the feet that you can do sitting or lying down. Click on the blue word yoga and you'll be taken to them.

All the best for your healing - and don't despair, it WILL happen.

Julie

As one who has had breast cancer as well as PF, I can tell you that PF was a lot more painful and the symptoms more long-lasting! Of course I'm not saying that there is no comparison between the seriousness of the two ailments (and certainly having had cancer helped me to keep PF in perspective) - just that you are entitled to your feelings!

Re: Nothing seems to work

Rick R on 11/03/03 at 07:51 (136245)

Rich,

You just got more solid advice and information in one day than I got in my first 10 years of PF(no internet plenty of big hair). There isn't much if anything more that need be said. I'm another proponent of taping, but above all I'm a proponent of researching this site and finding what's going to work for you. By the way before I alarm you with the 10 year comment, I did get back to running but only after taking measures I didn't know were options. The things I independently discovered the hard way are here at your disposal.

Rick

Re: Nothing seems to work

LARA on 11/03/03 at 07:55 (136246)

Tarsal Tunnel Syndrome is often misdiagnosed as PF. Chances are you have PF (a fairly common ailment) and not TTS (a much less frequent ailment - and less well understood). However, if PF continues to not respond to treatment, you might try looking in to TTS - although finding a knowledgeable treating physician can be a trick. I figured out my symptoms were nerve-related (TTS is compression of the tibial nerve in the Tarsal Tunnel, but I didn't know that much at the time) but when I asked about a referral to a neurologist cuz it sounded like nerve pain, the podiatrist told me to quit reading so much and worrying my (pretty little head, er)-self and told me it was in my head. Finding someone who knows TTS can be a search - but they are out there.

Many treatments work for both ailments - rest, ice, NSAIDS, taping. You might try compression hose (the things people wear for varicose veins.) It's a treamtent for TTS, not PF (TTBOMK), but if it works, you have more information. They're relatively inexpensive (under $20.00). When I got compression hose it took several weeks/months to get to where I stabilized, but I could tell within a week that they were helping.

Also, lately I've heard several people, with different ailments, swear by MSM (sold where vitamins are sold).

As to the mental stress, we all come to terms with our feet sooner or later. There really isn't much other choice, but the timetable is very individual. It's much easier after you have a treatment that works, and some sense of what the future looks like and how you can accommodate it and still have a reasonable life (and many people have found a fulfilling life with worse problems.) I'm not sure what the 'trick' is, and it's hard while dealing with pain on a daily basis. Talking to someone (like on this board) helps some people. If you find yourself getting clinically depressed, I would see a psychologist. My understanding is that the 'cognitive behavioral' approach is very effective with depression (which IMHO is a very normal response to chronic feet problems.)

Good luck.

Re: Nothing seems to work

Rich on 11/03/03 at 08:10 (136249)

Hi Nancy

Thanks so much for the graet advice. I have been trying to rest as best I can. I have 2 small children, so putting my feet up is not always an option. I ice my feet every night and use the night splint faithfully. I wear my Saucony motion control shoes w/orthotics all the time. The orthotics were made by my Podiatrist. They are a little hard, but I was told by my PT that they are good quality. Deep down, I do have confidence in my Dr, but I do wonder a little about the 4 shots. In PT, I doultrasound, massage, and some stretching. I have never been able to get a reallt good calf stretch, but the Dr is not concerned because I have good dorsal flection and I wear the night splint. I have used the night splint for 7 weeks now, and the morning pain seems less.

Can you tell me more about Birk shoes?

What was the timetable for your recovery? Thanks again for the support!

Re: Nothing seems to work

Rich on 11/03/03 at 08:16 (136251)

Hi Ellen

I am (or at least was) an avid walker. I walked miles a day. I didn't pay attention to my worn shoes. I walked on sidewalks and never warmed up or stretched beforehand. That and the fact that I am 40+ seemed to bring on the PF. I never had a single foot problem before this. It seemed to come out of the blue.

Re: Nothing seems to work

nancy s. on 11/03/03 at 12:04 (136258)

rich: most of us had/have lives at work or home that make resting of the feet difficult. countless posters here have had the challenge of dealing with small children and pf at the same time, and i know it isn't easy. but take very seriously what julie said: rest is a treatment. in most cases it's a crucial treatment, so do whatever you can, even if it seems small and in too-short doses, to get off of your feet.

you must be savvy, mentioning 'motion control shoes' . . .

in your first post you sounded as though pt were in the past and hadn't worked. now you speak of it in the present tense. if you're still having pt, you might ask your therapist about iontophoresis.

use the search feature here to learn about people's experiences with birks, or birkenstocks. (type 'birkenstock' first, then 'birk' for more posts.) they've been a great help to many, especially to those who can't tolerate orthotics.

i first developed pf in early 1999; saw a lousy podiatrist for too long; developed achilles, peroneal, and post tib tendonitis as well; found this site and through what i learned here, plus various treatments including 6 months of pt, reached what i call a 75% recovery almost 3 years from onset. life is good now.

nancy
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Re: Nothing seems to work

Carole C in NOLA on 11/03/03 at 12:42 (136262)

Also, the sooner one begins treatment for PF, the faster the recovery.

Glad to hear that you are able to run again, Rick!

Carole C

Re: Nothing seems to work

Rick R on 11/03/03 at 13:28 (136268)

I might add that it isn't without ups and downs not to mention a great deal of precaution, tape, stretch, massage, and scheduling enough and not too much running. The time thing is killing me now.

Rick

Re: Nothing seems to work

Laura on 11/03/03 at 13:40 (136269)

Try reading Peter Egoscue's book called Pain Free. It has really helped me. Do the section on feet. As simple as the exercises seem, they work.

Re: question for Lara

Pam S. on 11/03/03 at 19:54 (136292)

Hi Lara:
I was wondering how your TTS burning is now. Do you have any burning at the end of the day? The compression hose have helped me and I thank you for that great suggestion. Some days for no reason I have more burning than others. I wondered if you do too or has your totally dissipated. Hope so. Thx, Pam ps. Do you take any meds?

Re: question for Lara

LARA on 11/04/03 at 07:13 (136319)

The burning has definitely not totally dissipated. After a few months of compression socks I found a life that involved mild burning - and mild-moderate activity. That was a few years ago. I could go grocery shopping, clean the house (sort of). I didn't take walks, or go to the mall, or play sports. AFter trips like shopping I had to rest when I got home, but I have enough things to do sitting down (sewing, balancing checkbook, catching up on Law & Order) that it isn't a problem. I substituted painting for tennis and moved on. I believe I have, to some extent, developed a 'sixth sense' as to how to budget the steps in my feet for a day, week-end.

Recently I've tried a few different things that I think have helped, although I'm not sure which ones were most helpful. I now can do much more (including a massive housecleaning in preparation for out-of-town guests, doing reasonably well on college visits, including a couple hours of walking and several hours of driving (although I've learned tricks to make driving less aggravating to the TTS), walks around the block, all with some, but not as much, additional burning. I've been thinking I should try tennis just to test my limits, but I've developed a new life that accommodates TTS and it's just as full as the life I had when I was more active - just different stuff. I doubt I could play tennis regularly - I enjoy the competitive part of sports so playing once in awhile, without playing regularly and getting better, doesn't hold much appeal for me).

So that's where I am. The burning is still there, although generally mild. If I do feel the burning and rest, it also recedes fairly promptly. Most people would never know I have TTS these days unless I told them, and I suspect some of them think I'm malingering.

These are the things I've tried recently (in addition to the compression socks):
1. diuretic pills (I think these help - I noticed a correlation between eating salty foods and the burning getting worse so the doctor agreed to a trial - which we've continued)
2. magnesium (someone posted about that, I have no idea if it helps)
3. MSM (same as Magnesium)
4. Trigger Point Therapy. (I went for a different ailment at the other end of my body and after we'd addressed my shoulders we tried my feet. Apparently Janet Travell (the guru of TPT) has a section on TTS!1 I still have more sessions to attend before knowing if it helped. I chose TPT instead of ART because I was in a TPT office, highly recommended for other issues that I had, and because I don't know of any ART providers in the area.