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Course of recovery?

Posted by Peter A on 3/11/04 at 12:23 (146705)

Perhaps this has been done before, but I wonder if someone who has recovered from PF could describe the course of recovery. I've been dealing with this for an average time, I guess -- about 18 months now -- and I would like to hear what people have experienced in their recovery. Particularly interesting to me would be the way and timing of how they were able to return to normal activities, including workouts, biking, running, hiking, etc. I seem to be able to get better to a certain point but not beyond, and I am naturally getting frustrated, so hearing from someone who has gotten beyond that point would be inspiring & uplifting, if nothing else. Thanks in advance :-) .

Re: Course of recovery?

Carole C in NOLA on 3/11/04 at 15:39 (146728)

Peter, I'm pretty overweight and have always been out of shape, but I'd be glad to tell you how things went for me.

I was first aware of PF pain on September 22nd, 2001. I was diagnosed in late November, 2001, and by that time my PF was pretty severe. My doctor told me that it was due to my exercycle, which I had been riding barefoot and set at the highest tension since I bought it in Sept 2001, so I stopped riding it at that time. I began trying whatever I could to help, and within two weeks had custom orthotics and Birkenstocks and more, and I was reading this site daily and resting my feet a great deal.

By March, 2002, I had no problem with normal life activities such as grocery shopping, but still had to be careful not to over-do and I was icing after doing such things. I went to sea on a working cruise (I'm an oceanographer).

By June, 2002, I felt completely healed... no pain at all. That was nine months after getting PF. I stopped wearing my custom orthotics and still no pain. Later that year (I think? Or was it early 2003?) I decided to try riding my new exercycle again. I wore my Birkenstocks while riding at low tension, but apparently they were not a good choice of shoes to wear because I started getting very mild PF symptoms again.

I knew what to do, and did it, feeling 95% healed again but this time it took longer to completely recover. Then I waited for several months because I didn't want another setback. I waited until January, 2004, and started riding my exercycle yet again, but wearing my custom orthotics in tie-up SAS shoes for support, and this seemed to be what my feet needed. I also started walking and I currently walk a measured 1/2 to 1 mile course most days at as brisk a pace as I dare, in addition to the normal walking involved in normal life activities like shopping. I ride the exercycle 3.5 miles in 15 minutes. This is as much as I've done in 20 years, and it is enough to help while I follow Weight Watchers.

The limiting factor for me is no longer my feet. It feels great to be able to say that. :)

I still pay attention to my feet, and I am probably a little more careful and aware of my feet than I once was. But, they don't hurt and they don't slow me down. I wear high quality shoes; my SAS shoes with orthotics for biking, New Balance for my walking and sometimes for work, and Birkenstocks for work the rest of the time and around the house.

Carole C

Carole C

Re: Course of recovery?

Robert J on 3/11/04 at 16:44 (146734)

Peter --

My history has been similar to yours. I have bilateral, atypical PF,2+ years, meaning that I don't have first-step pain in the morning and my pain extends from the insertion point under the arch. At several points over the last two years it seemed that I was on the road to recovery. I have used most of the standard conservative techniques including icing, taping, stretching (being careful not to over-do it), heat, custom orthotics, and low-level PT strengthening exercises. I also have practiced 'relative rest' which, for me, means staying off my feet unless it's necessary for grocery shopping or going to my desk job. I have never been sure which of these techniques led me to improve but at several times I have reached the point where I could get through a limited-walking day without discomfort and, at one point, got to the point where I could also go for a 12-minute stroll. Ironically, during this period of greatest recovery I found it was most comfortable to walk without orthotics and it never seemed to produce a setback.

But oddly I could not get beyond that point. This period of recovery lasted for several months. I continued to do strengthening exercises and continued to take my short walk each day. I kept expecting the last barrier to fall where my feet would tell me that I could push things a bit further. But the twinges would appear whenever I tried to explore more activity. Finally, last December, I got foolish and pushed things too far and caused a major relapse. The relapse has now become a true conundrum and, as of yet, I have not recovered from it. This injury is like a maze were you wander around, trying to find the route of escape.

I don't know if my story is common or not. But I was struck by your remark that you had not been able to get beyond a certain point of recovery. That has been my experience also. Perhaps I was too impatient or perhaps I should have scaled back my activities, as modest as they were, rather than trying to scale up. If I can offer any advice, it would be to review the environment and therapies you were using when your recovery periods began, and try them again. And good luck.

Re: Course of recovery?

Peter A on 3/12/04 at 09:03 (146773)

Robert -- yes, there seem to be several intersting parallels in our cases. In my case, I was doing ok -- or at least doing about the smae -- until I foolishly allowed myself to be talked into a pickup soccer game :-(. I have come back from that experience to about the point I was last year, but with a greater sense of fragility. I suspect that feeling better leads one to overdo, and with soft-tisse injuries, problems often don't show up until the next day. That was the case with the soccer game -- I stretched before playing, and never felt any pain during the game. But the next day I could hardly walk around the house. The main lesson here seems to be that the point of recovery may the be most dangerous time. When it hurts, you don't overdo it, but when it starts to feel better . . .

I like your image of the maze. I may be once again on a route out, but I'm not there yet. I recommend continuing the stretches, and massage. The thing that makes me feel best right now is a stretch John H mentioned on another thread: cross your foot over the opposite knee so there's no weight on it, and pull gently back on the toes and ball of the foot with one hand, while massaging the heel area and fascia with the other. I do that often during the day, use ice after use and sometimes at night, and use a night splint. I think heat helps too, stimulating blood flow & therefore recovery. For now it's working. Good luck!

Re: Course of recovery?

Carole C in NOLA on 3/12/04 at 12:40 (146793)

I was struck by your statement, 'perhaps I should have scaled back my activities, as modest as they were, rather than trying to scale up'.

I found personally that I had to always do less than I thought I could do, if I wanted to avoid setbacks.

So maybe you are right and that really IS the key to your recovery.

Carole C

Re: Course of recovery?

Lori W. on 3/12/04 at 21:55 (146832)

I have not spent much time at this sight since last summer, when I visited almost daily. My feet are much better, 2 years of diagnosis and untold time before that. I'm not entirely sure what made my feet begin to heel, because I was doing just about everything I could at the time (tips picked up here). However, I suspect it was a combination of finally really getting off my feet and wearing my custom orthotics with SAS shoes. I am a teacher and last summer I made the committment to rest my feet. About 6 weeks in, big difference and they started getting better from there. I was worried about going back to school in the fall, but I made sure I had many spots to 'perch' in my classroom. I listened to my feet. If they said 'ow', I got off. It's been successful so far. I do have days when I overdue it and I back off and rest. In January, I was able to start on the exercise bike again. It was great. I tried to go for a brisk walk like I used to and was not able to have a good speed, so I backed off. I plan on trying that in a few more months. I think the key is patience. I am so, so much better. I hope someday to wear a shoe other than SAS, but we'll see.

Re: a question you asked, Lori...

Suzanne D. on 3/13/04 at 07:15 (146847)

Hi, Lori! I read a good question which you posted on the 'Ask the Doctors' board which I wanted to address here. I noticed that you didn't receive a reponse (due to a heckler giving you a flippant response and then other messages directed to that.) I am not a doctor, and I don't like to post on that board, so I saw your name here and thought I'd continue the discussion.

You asked if it is possible to stop wearing orthotics after you feel you are healed and not having pain. There are two ladies who have posted many times here and who I respect highly who have different personal answers to that question.

I don't want to quote them unfairly, but I believe I am correct in understanding that one lady now feels she can wear other shoes than Birks, and without orthotics, due to her healed state. She is quite careful, though, and when exercising on her bike or walking or at times if she feels any twinges of pain, she wears the most supportive shoes or even her SAS shoes with the orthotics.

The other lady feels that whatever caused her to get PF in the first place needs to always be addressed, and so she continues to wear her custom orthotics in the shoes which help her most or her Birk Arizonas - all the time. I believe I understand her correctly in that she feels this is the 'safest' way to keep from having any relapses.

I have often wondered if it has something to do with what caused your PF in the first place. The first lady I described, who now does not feel the need to wear orthotics all the time, got PF from riding her exercycle barefooted and on the highest tension. Others, like me, gradually developed PF after many years of being on their feet (I'm also a teacher - 24 years) and not wearing shoes which were supportive enough. In my thinking, someone like me who decided to start wearing 'regular' shoes now that I'm better could get in trouble by doing so. The combinations of hard floors and not enough support could cause the same thing to happen again to me, I fear, and I don't want to go through all that pain again!

What does your podiatrist tell you about the need for continuing to wear your orthotics?

Have you perhaps tried to see if your orthotics might fit into another shoe besides the SAS? To me, SAS are great shoes, and I don't want to suggest you stop wearing the right combination for you. But there are some shoes that are deep and have removeable footbeds in which you might try your orthotics if your doctor feels they would be alright.

I wear the Birkenstock Annapolis shoes (a Mary Jane style) which is very deep and has the removeable footbed. Just a thought for you...

Your question is a good one. Good luck to you, and have a good end of the school year!

Suzanne :)

Re: a question you asked, Lori...

Lori W. on 3/14/04 at 11:09 (146936)

Thanks so much for your response. This is what I have been thinking. I find that for limited time I can wear other shoes successfully without any support. However, I believe for work purposes, I'm probably stuck with the SAS (tried Birks, they weren't for me). Enjoy the rest of your school year.