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change of symptoms

Posted by Peter A on 3/07/04 at 20:21 (146392)

I have been lurking here for a while and have found this a very helpful source of information & help. Thanks to everyone who posts here! Now I'd like to pose a question, to see if anyone else has had an experience like mine, and would have a suggestion.
I have had PF for about 18 mos. I' m not sure what caused it: we hike & backpack a lot, and I may have stressed the PF during our hikes the summer of '02. The first year there was little change. I iced my foot, did some exercises, used limited NSAIDs, and put in otc supports in all my shoes. This helped a little -- I used to have arch supports all the time for my pronation, and I think forgetting to keep them in the shoes I wore most of the time contributed to the onset of PF. But I think some of my exercises hurt as much as helped (heel raises off the stairs), and I was often barefoot at home. Last summer I was still backpacking & climbing, with minor and essentaiilly unchanged pain.
This fall it got much worse after getting into a pickup soccer game (I know, my mistake). Around that time I discovered this web page and started doing better exercises & many stretches, I now wear sandals at home with good arch suport, and purchased a night splint. This new regimen helped a great deal. I just took a week off from work and stayed mostly off the foot most of the time, which also helped. Now my foot feels really good in the morning when I take off the splint. Initially I am almost pain free, and can walk short distances comfortably. After walking some distance, however, I have a new pain that seems to run up the outside of my ankle. It's still not intense, but it seems to me there is more change with use than in the past. So basically, the pain is less to start with, but there is more INCREASE in pain from walking than before. In the evenings I can feel a knot where the PF attaches under the heel (it's not there in the morning), and presure there and just outside and behind the knot produces quite a bit of pain. I am concerned this may be something new. We again have family trips planned this summer, and I would hate to have to cancel these, since I was able to do LONG hikes last summer (14 mi roundtrip in one case) without serious consequences. Has anyone else experienced something like this? Could the knot have been there all along, but I didn't notice it until I started massaging my foot more? Is it time to see a doctor?

I'd appreciate any ideas. Thanks folks.

Re: change of symptoms

wendyn on 3/07/04 at 20:33 (146395)

Peter, I doubt that it's anything serious...but it sounds like you have had these symptoms quite a while. A trip to your doctor is certainly in order. I've had some simalr pain in my ankle, but I don't know what it's from. Maybe it is from a change in the way that you're walking.

Are you wearing artch supports or orthotics now?

Re: change of symptoms

Peter A on 3/07/04 at 21:00 (146398)

Yes, I have kept them, all OTC. (You may have seen: one survey showed a HIGHER rate of satisfaction for otc inserts than for expensive custom orthotics!)

My doctor, who is a GP, acknowledges that he doesn't know a lot about pf -- as I said, he admits that I know more about some apsects of pf than he does. We generally have a good relationship, since he appreciates that I do a lot of reading on my own, and can often teach him things he doesn't know. Not all doctors appreciate that! In any case, if I went back to him it would be to ask if I should see a specialist -- I suppose a podiatrist, although I don't know if any in this area specialize in pf.

Re: change of symptoms

wendyn on 3/07/04 at 21:36 (146403)

Peter, you are fortunate to have a doctor who respects you doing your own research. As you said, there are many doctors who don't approve of patients taking such an active interest in their conditions (although I suspect this will have to change - the internet is here to stay).

You're also right that sometimes the OTC orthtotics are actually better - but it may depend on whether or not you have a structural problem that needs to be corrected.

Probably a trip to a podiatrist or an orthepedic surgeon wouldn't be a bad idea. It may be helpful to at least get a different perspective. Sometimes a sports medicine doctor can be good as well.

Keep us posted!

Re: change of symptoms

Kathy G on 3/08/04 at 09:37 (146427)

Peter,

You got good advice from Wendy. I'd try a Podiatrist. They deal with PF on a regular basis.

Did you see the discussion further down the Board about heel raises on the stairs? When I went for PT, that's what they had me do. Up until that time, I had only arch pain, but thanks to them, I developed heel pain as well! You were right; those exercises probably did make you worse.

Since these new symptoms started while you were using the night splint, perhaps you are pulling it too tight? Maybe you should loosen it or stop wearing it altogether and see how you do. I know I couldn't use the night splint because it aggravated a problem I have in my ankle from a severe sprain I had a while back. The pain was on the outside of my ankle and up my leg.

Good luck and let us know how you make out!

Re: change of symptoms

john h on 3/08/04 at 13:11 (146452)

Was reading my wife's latest copy of Prevention magazine last night. For PF they advised: while sitting in a chair place one leg over the other and grasp all your toes and upper portion of your foot and pull up and hold for 5 seconds. Repeat 4-5 times and do this 5 or 6 times a day. If you are doing it right you are stretching or putting tension on the fasia and the fascia band will protrude. Sort of a not weight bearing stretch comparable to hanging off stairs on your toes. You have more control. One respondant wrote she cured herself after 1 year of severe PF.

Re: change of symptoms

Peter A on 3/08/04 at 17:52 (146478)

Kathy,
Thanks for the confirmation on the exercises! Based on several things I've read -- all linked off these pages -- I am convinced that noone should do those heel-dropping stretches.

I don't think the Night Splint is the problem. If it were, my foot would not be better in the morning than after I've been up and around. In fact, it's better in the morning than it has been for some time, so I think it is gradually getting better. I did try for one or two nights increasing the angle and found that uncomfortable, and so I immediately went back to the lower angle position for the splint.

As for progress -- I was able to walk a couple of miles today -- I had to go see someone on the opposite side of the campus where I work -- and had very little discomfort. Later this afternoon there is a bit more pain, but clearly no worse than at this time last year. After reading of the more severe cases, I know I have little to complain of, that I should be grateful that I am doing so well.

Re: change of symptoms

Peter A on 3/08/04 at 17:54 (146479)

Thanks, John -- this sounds like a very good way to stretch the fascia. I will definitely be using this. Let's hope it leads to a . . . well, I don't like to say cure, let's say a full recovery.

Re: change of symptoms

Ed Davis, DPM on 3/10/04 at 23:35 (146659)

Peter:
The 'knot' you speak of is not uncommon and represent an area of thickening in the fascia.
Ed

Re: change of symptoms

Rachael T. on 3/11/04 at 11:16 (146696)

Dr. Davis - I am asking about the thickening of the fascia that you are noting to the previous poster....as I too, have knots in my heel (more at day's end.) I must say though, that I had knots throughout my foot for the past 3 years of PF - but one by one (oh so SLOWLY) they've disappeared. I ask will this knot also disappear or shall it be there as a 'scar' forever? I am guessing that it will disappear - slowly as the others; but your thoughts would be appreciated. Thank you!

Re: change of symptoms

Peter A on 3/11/04 at 12:01 (146702)

John: Another follow-up to your post: Obviously it is too soon to talk about cure or healing after two days, but the stretch you recommend certainly provides short-term relief. Done cautiously it does, as you suggest, allow stretching of the fascia without the weight that could cause further injury. Combined with massage of the heel, I find it really does provide relief whenever the fascia or my foot feels tight. I will certainly keep using this daily, and maybe it will lead to or facilitate the eventual recovery that was reported in the article. Thanks for sharing this. Is it worth posting as its own thread on this board? I think others would want to try this.

Re: change of symptoms

Peter A on 3/11/04 at 12:04 (146703)

Thanks -- I suspected that, and guessed that it might have been there all along and not noticed by me until I started massaging my foot. Do these eventually go away? Is it an indicator of the overall condition of the fascia? It does seem much smaller in the morning or when my foot is feeling better.

Re: change of symptoms

john h on 3/11/04 at 12:39 (146708)

Peter: It is certainly easy to do at almost any time during the day as all you have to do is slip your she off. I to massage the fascia when I have it in the stretched position. Anything such as this that is easy to do will make it more likely you will do it as opposed to some of the more elaborate stretches.