hard casts?Posted by Jennifer M. on 11/09/03 at 22:36 (136908)
Hi. I've had pf for 3 1/2 months now, have custom orthotics, was on several NSAIDS for 2 months, have done taping, and still cannot walk or stand without pain. It is constant. I've just started ART with a chiropractor and know it may take many visits to see if it will work. But my chiropractor says he doesn't feel a lot of adhesions and wonders if it's right for me (?). My podiatrist has said if my new orthotics don't work (so far, they haven't), he'd like to put me in hard casts for 4-6 weeks to immobilize and rest the fascia.(it's bilateral). I don't have issues with missing work - I'll do anything to feel better, but I worry about atrophy, and wonder if it will really do me any good. I've been working so hard to regain flexibility I lost when my doctor told me to immobilize after the pain popped up 3 months ago. I try to stay off my feet as much as possible, but still go to work everyday, and try to stretch during the day. I've been unable to do anything ,except sit, without pain. Has anyone been in a hard cast and had it help?
Re: hard casts?Julie on 11/10/03 at 02:06 (136918)
I can't offer any comment on the hard cast question, but a little warning bell rang for me when I read 'I've been working so hard to regain flexibility'. I am wondering what stretching you are doing. It is possible to overdo stretching, as many people here have found. For most people with PF, weight-bearing stretches, like the classic 'wall stretch' and the hanging-off-a-stair stretch, are too strong. If you're doing these, that could be a major clue to your failure to progress. You could try the yoga foot exercises that I've posted here - click on the word yoga here. They're non-weight-bearing, safe for most people, and will maintain and increase your flexibility while strengthening your foot musculature.
I am trying to think of other explanations for your lingering PF. A possibility to explore would be your work. You don't say what you do, but if it involves standing, that will also be a factor, and you might try to negotiate a shift of duties. If you're on your feet a lot of the time, the condition is almost certainly being aggravated. A good rule-of-thumb to keep in mind is that whatever hurts is re-injuring the fascia.
You say taping hasn't helped? Of course it doesn't necessarily help everyone, but it has proved so effective for so many people, that I'd want to know more about how you are taping before abandoning hope for it.
Do you tend to go barefoot? Don't - not even in the shower. Keep a pair of slip-on shoes beside your bed and put your feet in them as soon as you swing your legs over the side.
Others will think of other things that might help, and you should certainly read the heel pain book here, which you'll find packed with information and ideas.
Re: hard casts?Pauline on 11/10/03 at 07:45 (136927)
I think you have good reason to worry about atrophy after being immobilized in hard casts. I tried it on one foot for 6 weeks, achieved no result, had continuted pain while wearing the cast when walking on it (walking cast), and definitely loss a lot of flexibility which required physical therapy afterward.
Would I ever consider it again. No, not even the removable boot type cast which I also tried. For all my effort using both, at different times, the pain in the arch of other foot increased creating extensive bilateral P.F., & it also created new pain in my hips & lower back.
Scott posted some stats. on how helpful casts were to people and if I remember correctly the numbers were quite low compared to other treatments. You can check his list on this site.
This was my experience. You have to do what you think is best for you.
Re: hard casts?Rick R on 11/10/03 at 09:34 (136945)
I think if there is an art to this whole ailment it's the balance between rest and some form of activity be it stretching massage other exercise. I have a hard enough time finding my own balance let alone tell others what to do. What I can tell you is at one time my doctor had me do the wall stretch with devistating results. Now while I'm doing much better it's a major part of prevention. I also have suffered from too little activity. While taking it easy after surgery for the left heal, the right one went bad. I had no idea how vulnerable the period of inactivity had made it. As far as the left heal goes I returned to running quite successfully after surgery. I had to stop in March of 01 due to work schedule. I have to be much more careful of PF now while out of shape.
I would also suggest you not give up on taping. I took me quite a while to develop a technique, but once I did it was my breakthrough.
Re: hard casts?Jennifer M. on 11/10/03 at 09:59 (136946)
Hi, Julie, thanks for your advice. I'm doing most of the stretches my physical therapist advised - the towel stretch, and using a 30 degree wedge board. My chiropractor advised using a golf ball to massage the fascia, but I don't know if that is aggravating it. I also use the therabands she gave me to increase my ankle strength. I stopped taping when I got my hard orthotics, which I never go without, even from the first time I step down on the floor in the morning I have them in my shoes - I have extremely hypermobile feet and ankles and really bad pronation (Im only 31), to the point my legs and ankles don't line up at all. I'm going to try taping again. I'm a teacher, but teach from a stool, don't do standing duties, and ice my feet during lunch. I've wondered if even being at work sitting, is too much, but, honestly I sometimes feel more pain on the weekends. I will try the yoga excercises.
Re: hard casts?cherlyn Z on 11/10/03 at 13:31 (136961)
Jennifer, I had bilateral hard casts on for three weeks in September. It was not worth it. When they came off I had lost 3 inches in the circumference of my calf. The muscle tone was poor and I was so weak I could hardly stand as I would shake. This after only three weeks. The one good thing to come out of the experience was that I found this board and ESWT. If you can afford it,(most insurance does not cover it) I would highly reccomend it. If I had known about it I would NEVER have been casted. The improvement after just three weeks post ESWT has been amazing. I really believe I would have been even better if I had not messed around with muscle mass prior to ESWT.
Re: hard casts?Sher A on 11/10/03 at 19:57 (136996)
Geez, the hard casts sound kind of drastic at this point, especially since there are still other options. I agree with Pauline. My own experience is similar, when part of your body is immobilized then other parts compensate for the loss, and new aches/pains can develop. Some of us here (like me) also feel that nothing works much. Taping has helped tremendously, it just takes awhile to get it right. Since my right heel hurts more than the left I tape from the right bottom of the heel to the just before the big toe, then from the left bottom of the heel to just before the little toe like a V, then a strip from the middle of the heel straight up to the ball of the foot. It doesn't completely remove the pain, it just reduces it. My own opinion is that you should check out another podiatrist or a couple of them - see what they have to say, before doing the casts.
Re: I had success with castR C on 11/10/03 at 22:06 (137007)
I had success with a cast. My PF went from moderately severe to almost cured, primarily from 4 weeks in a hard cast followed by taping. The key to success was whispered to me by the nurse after she finished laying on the fiberglass strips: She told me to use crutches (even though it was a walking cast), and not to put any weight on my foot for that whole period. I think that is why I had great improvement, while others who walk in their cast do not.Yes, I needed physical therapy to rebuild strength and flexibility in my ankle after the cast came off, but that (looking back) was not a great sacrifice.
I was very nearly symptom-free for about a year and a half after that. I went to my doctor and asked what could be tried to eliminate that last bit of discomfort, and he suggested 4 more weeks of crutches (without the cast), preceded by cortisone. I am now halfway through this ,and will report back in a few weeks.
So don't give up on the cast idea. If you try it though, maximize your odds by using crutches, too. I think if you give your foot 4 weeks where it never touches the ground, it will have a long uninterrupted period in which to heal. Walking in a cast just defeats the purpose -- each painful step is a little setback.
Re: Taping techniqueJulie on 11/11/03 at 02:03 (137019)
Sher, have you tried applying the tape from the ball of the foot to the heel? I'm wondering, because that's the instruction in the taping section of the heel pain book, and that's what worked for me. I imagine it would be harder to get the tension right, working in the other direction.
Just a thought.
Re: Taping techniqueSher A on 11/11/03 at 11:13 (137042)
Yes, sure did. I don't know why, but I can't get it right that way. I'm probably dislexic. But I think I'll go try it again now since it's time anyway.