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"Complete Rest" Update #3

Posted by R C on 3/26/04 at 12:45 (147839)

For those following the complete rest approach to treating PF.

To call my approach 'complete rest' is a bit of a misnomer. More precisely, I did 4 weeks cast + crutches, followed by 4 more weeks of crutches only. Once off the crutches, I taped my foot at all times weight-bearing. At that point all of the inflammation was gone, and only an extreme tightness in the arch remained (as expected).

I treated the tightness by an almost-daily routine of heat, exercises, stretching, and ice. For the stretches I included stretching the plantar fascia itself: pull back the foot by the toes, use the other thumb to vigorously massage the tendon.

Now 5 months after coming off crutches I have reached a milestone: I can walk around without tape. Today I walked about 15 city blocks without any discomfort (could have gone more, too). Even standing barefoot on concrete feels just fine.

My plan is to continue with the exercises and stretching (I can tell that a lot of tightness still remains), tape my foot occasionally as a precaution, and work hard to avoid re-injury.

Thus I believe that complete rest (followed by rehab) is something to consider if other treatments have not been successful.

Re: "Complete Rest" Update #3

JudyB on 3/26/04 at 13:10 (147844)

Has there been any studies done on 'complete rest' therapy? I would seem to make sense as it would give the fascia time to heal.

Re: "Complete Rest" Update #3

Karen on 3/26/04 at 13:37 (147853)

R.C. Now that is good news. I have some questions. Do you take any MEDS during the eight week period when you were off your feet? How did you know the inflammation was gone in 8 weeks? Did you stretch at any time during those eight weeks? Do use orthotics? I' m having a hard time getting rid of the inflammation in my left heel. Also, you should BE CAREFUL, you do not want a reinjury. GOOD LUCK

Re: "Complete Rest" Update #3

R C on 3/26/04 at 14:36 (147868)

In answer to Karen's questions:

I took no meds during the 8 weeks of rest; however, I got a cortisone shot to start things off (forgot to mention that). I can't say whether the cortisone was a major factor. The doc recommended it.

I can tell the inflammation is gone because there is no pain even when standing, and no pain when I poke the heel with my thumb. The only discomfort I had was a tightness in the arch (which probably would have reverted to inflammation, had I not taped and done the stretching). But now most of the tightness is gone.

I left the foot alone during the 8 week rest period. No stretching, no exercises. I kept it elevated, though.

I have never had even the slightest bit of success with orthotics. I tried 5 different approaches with 3 different doctors. Each attempt made things worse. I think it is because my feet are absolutely flat as a board. Any attempt to force an arch just stretched the aching tendon further.

I'll be super careful not to injure it again! Thanks--

Re: "Complete Rest" Update #3

Carole C in NOLA on 3/26/04 at 15:17 (147872)

RC, I am so glad to hear of your progress! It's especially good to hear that you have no pain when standing or when you poke the heel with your thumb, and that the tightness is gone in your arch area.

And yes... DO be super careful not to injure your feet again! Do less than you think you can do, at least for a few months. It is so tempting to overdo it immediately, but no sense in pushing things and suffering a relapse.

Carole C

Re: orthotics

sandy h. on 3/26/04 at 17:01 (147878)

don't give up on orthotics altogether. they made my problem worse during its worst stage but i had a pair made recently in which the guy kept asking me, where does it hurt and flattening that bit out. the main problem with orthotics is when they are too aggressive and causing a whole range of other problems i think. i'm not sure if they cause dependence and you can do without them but i find them useful for my very slow recovery after several terrible backward steps because of ill-fitting ones.

Re: "Complete Rest" Update #3

Robert J on 3/26/04 at 17:13 (147881)

Let me add my congratulations and ask a further question: when you first came off the crutches and began to walk with a taped foot, how much did you walk? And how fast you add more walking to your routine as you continued to heal? Thanks.

Re: "Complete Rest" Update #3

R C on 3/26/04 at 19:37 (147894)

Thanks for your kind words, all.

Robert:

When I first came off the crutches, I could hardly walk at all. The pain was gone, but the tightness was so severe that I was afraid to walk but for very short distances. (I think it is at this point a lot of people give up in despair -- as I would have, had the nurse not directed me to the necessary follow-up.) The stretching was noticeably making a difference after even a couple days. The progress during the first month was very rapid. I would say after that month I was able to do a full grocery run ( taped) with only minimal discomfort. In fact, I'd say most of the discomfort was from the tape digging in, rather than the injury itself.

I should emphasize though that I did not include walking in any kind of therapeutic routine. My exercises rather come in the form of a few elementary (non-weight-bearing) foot exercises using elastic band, plus swimming, cycling, and weight room. In all things I still try to stand and walk as little as possible. The only thing that prevents me from returning to full activity is fear of re-inury. So, as wisely advised by others, I am really going to take good care of my feet, and gradually ease back into a normal life.

Re: "Complete Rest" Update #3

Don l. on 3/28/04 at 18:45 (148016)

I was thinking of trying what you did. How long have you had PF and how bad was it? Could you walk at all before your rest period?

Re: "Complete Rest" Update #3

R C on 3/29/04 at 07:40 (148035)

In reply to Don I:

My PF started in February 2000. At its worst, the injury felt like my heel had been hit by a hammer. -Or- it felt like I had had a rock in my shoe for about 20 years. I walked as little as possible. Until I tried the cast and crutches, taping was the only thing that helped, but it didn't cure it.

Re: "Complete Rest" Update #3

Aly on 4/02/04 at 13:51 (148309)

Hi R C,

I've been reading your posts on complete rest with great interest. I would have done this long ago, but I have bilateral PF & post tib tendonitis, so if I used crutches one of my feet would be miserable while the other one rested. (Workplace isn't terribly wheelchair-easy).

When you're using crutches, how much abuse does the weight bearing foot take compared to regular walking? I'm sure it would get worse, but I'm trying to determine if it'd be worth it in the end. I'd obviously have to rest one foot, and later the other - if you were careful do you think your 'cured' foot would be able to handle being the weight bearer while the second foot was rested?

Thanks for any thoughts you might have...

Aly