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Update: The "Complete Rest" Approach

Posted by R C on 1/20/04 at 10:49 (142444)

Background: My PF came about 4 years ago. Right foot only. It was an acute injury, a result of moving heavy objects; I was probably predisposed due to daily running and very flat feet. None of the conservative measures helped. Looking back, I think I actually injured not just the PF, but a couple of other muscles that attach at the inside bottom of the heel; for simplicity, I'll just say PF.

Complete Rest: I did 4 weeks of hard cast + crutches a couple years ago, then did 4 weeks of crutches only before the recent holidays. During those periods, I did not bear weight on the injured foot. Between those 4 week periods I taped the foot daily to simulate the state of rest (at least in part). I believe that all of the injuries healed by the end of the second 4 weeks. For instance, there was no pain whatsoever, from standing, from the finger poke test, etc. However, the injury site still had an uncomfortable tightness.

Follow-up: I continued to tape the foot daily, in order to prevent re-injury. With respect to the tightness, I have done the following daily routine: 10 to 30 minutes exercise bike, 12 minute hot water soak, stretching out the foot and using fingers to vigorously massage the arch, 12 minutes of ice. (I did a number of other stretches.) This regimen seems to have been very successful in stretching out the tight but healed tissues.

Current status: I still tape the foot daily, but I can comfortably go hours at a time at home without tape. When taped, I can lead just about a normal life without discomfort (e.g., do eveything except stand for very long periods, or walk long distances). When it does get uncomfortable, it is because of the tape starting to dig in, and not because of re-injury. As time goes on, I expect to gradually wean off of tape. I don't think I can say the PF will ever be 100% healed, since I must constantly guard against re-injury (not carry heavy loads, go easy on long walks, etc.)

Setbacks: The only setback I had was a result of carrying a 25 pound load across a fairly long distance (half the length of a mall). This occurred before my second round on crutches, and has had no lasting effect.

The Stretch: The stretch I have been using is as follows. While sitting on the floor, grasp toes of right foot with right hand, pull back so as to tighten arch. Use fingers of left hand to pull arch inward, stretching arch further. I stress that I did this only after there was no pain, and I did this very carefully, with a good sense of what the tolerable limits were. I do not know if it is a good thing to try if you still have pain.

I hope this helps--

Re: Update: The "Complete Rest" Approach

anne on 1/21/04 at 20:06 (142580)

Hi RC,

I was wondering, how long after the pain started did you try the 4 weeks cast and the 4 weeks crutches? I have not tried the 'complete rest' approach because I was told by my podiatrist that it would not help the PF b/c the plantar fascia (spelling?!?) would tighten and the second i took my first step after the rest it would just tear again. He told me the plantar fascia needed a combination of use and rest to heal. What do you think of this reasoning?

Also, I'm a bit worried that whilst trying to heal my left foot i'll develope PF in my right foot!

But over a year and a half later i still can't spend more than 15 minutes on my feet without being in enough pain to want to sit down, so perhaps I should try it, although i am a bit worried that what he said will come true.

Re: Update: The "Complete Rest" Approach

R C on 1/21/04 at 22:32 (142603)

I tried the cast about 2 years after the conservative approaches failed. Your doctor is correct about the plantar fascia tightening as a result of disuse. In fact that is the reason I am having to do these stretches. After the cast came off the first time, I went immediately into physical therapy to start regaining flexibility. Looking back, I think that the therapist was generally pretty good, but did not include the stretches that I now find most helpful. The cast + crutch + therapy combination has a better than 90% success rate under the orthpaedic doctor I went to see.

You are also right that you must be super careful not to injure your other foot while you are on crutches. I came close to ordering one of those motorized wheelchairs toward the end of the 4 weeks. That is a risk that only you can assess.

I think casting gets a bad rap because most patients expect to be able to walk right after the cast comes off. This is generally not the case (again, I am relying on what my doc and his terrific nurse have passed on to me). Patients have to be directed to a very knowledgeable phys therapist who can help them with the side effects of the immobilization. And through out this, the patient has to be his/her own best advocate, questioning a stretch or an exercise that seems not quite right.
(E.g., weight bearing calf stretches, right out of the starting gate!)

I also emphasize that the first few steps you take after coming off crutches are your most vulnerable time. I would recommend having well selected orthotics lined up, or a taping regimen, or easing off crutches gradually (perhaps in combination) depending how those early steps feel. In my case I went to taping, and weaned off crutches over something like 3 weeks.

So, in sum, your doctor is right. But if you are informed and prepared, you can still make it work for you.

Right now, I can walk barefoot on a tile floor without discomfort (until I chicken out and slip back into tape and comfy slippers). There was a time when I thought I would never even reach that level of relief.I think that if I keep up the exercises and stretches, I'll attain alomst my normal life back (except for running - I would never risk it).

Re: Update: The "Complete Rest" Approach

jen on 1/22/04 at 09:36 (142622)

im currently in week 3 of my cast. i have stress fractures and PF. i am on crutches and acutally tried to step on my cast last week and it hurt realy bad.
im no where near the end yet. i will be casted 12 weeks of which at least 8 weeks will be non weight., i was told i will have significcant muscle loss in leg and foot, even toes. i expect at least another 3 months of therapy before i can walk after cast is removed. i so far feel its worth it as the foot feels greatin the cast, they use fiberglass these days and it hasnt really been itchy or smelly at all. also they come in colors., i got pink this time!! but cast is for sure complete rest!