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Dr. Ed, your thoughts

Posted by elyse b on 5/23/04 at 17:07 (151085)

thanks again for your helpful information. Again I am new to this insidious PF and am trying to learn as much as I can as quickly as I can. I have read that this can become chronic. I was wondering on your thoughts about something. I have read the heel spur book many times and of course I end up with more questions and a bit of confusion. Here is the thing. I got PF at the end of March and I have really not not stopped running/walking. I have stopped running on concrete and really have mostly done walking. I have not really 'rested' my feet. What confuses me is that my calf muscles are really bothering me. I have been using hte 'pro stretch' to stretch my calf muscles but I cannot seem to get them loose. I know that I need orthotics but I wonder if it is a biomechanical issue that causes my calf muscles to tighten when I walk/run and ergo my feet hurt. So do the orthotics help prevent the calf muscles from tightening up? Also I have a bunch of different running sneakers, does it make a difference which pair of sneakers you put orthotics in., ie cushioning, motion control. Sorry for rambling but I am just more confused about this and I guess I am wondering if I should just quit running/walking until this thing goes away. After reading your posts I guess you believe that is the orthotics that will really be the most help. Again your help is most appreciated.

Re: Dr. Ed, your thoughts, 1 more thing

elyse b on 5/23/04 at 17:31 (151087)

I guess what I am asking is that is running/walking making this worse or more chronic without an orthotic device? Will rest be more beneficial.

Re: Dr. Ed, your thoughts, 1 more thing

Kristie on 5/24/04 at 08:46 (151102)

Elyse,

I too found my calf muscles very tight. I started Yoga and it has helped a grerat deal. Amazing actually. I also bought from Road Runners Sports (800) 551-5558 the Stick. The Stick is bascailly a 15 inch plaisic stick with little wheels. You use it on the back of your calf for a self massage. It seemes to work at lest for me. Good Luck.

Re: Dr. Ed, your thoughts, 1 more thing

Elyse B on 5/24/04 at 10:10 (151104)

are you taking yoga classes? I took a few classes and I was amazingly inflexible and it was not fun. I heard about the stick. Maybe I will give it a try

Re: Dr. Ed, your thoughts

Carlos N. on 5/24/04 at 10:41 (151106)

Elsye,

I would try to slow down and rest whenever you can. Take it from someone who didn't rest and got worse with chronic PF. If you have a low arch and overpronate then a good motion control shoe like Brooks or New Balance will help you. You should also see a podiatrist as soon as you can. If your problem is biomechanical then each step you take will only exacerbate your symptoms.

Stretching is also key. Yoga may be great for some people, but if your really tight then try and see a physical therapist who specializes in AIS and ART. It will really help you develop flexibility.

Good luck,
Carlos

Re: Dr. Ed, your thoughts

Elyse B on 5/24/04 at 11:24 (151107)

I have done ART and I think it might be too much for me and I don't think it does much for flexibility. It is more like deep tissue massage. I know about AIS but it is difficult to master on one's own, I even have the book and the Wharton guys are based in NYC. I have New Balance and Brooks sneakers but each model is very different and orthotics feel differently in each pair. I am going to bite the bullet and find another podiatrist as I was very unhappy with the first one. I am on day one of no running/walking, I do not want this to turn into something chronic. I cannot figure out if this is biomechanical.

Re: Dr. Ed, your thoughts

Dorothy on 5/24/04 at 11:39 (151109)

Not a doctor, just butting in. I don't think ART is necessarily supposed to 'help with flexibility'; I think it has other aims - even though EVENTUALLY improved flexibility will be/should be a result. If you do a search on this site under ART (and its variants) you will find a number of previous posts about people's experiences with it. One of the points made about it is that it does not often work immediately but takes a commitment of repeated treatments in most cases. I don't have personal experience with it, but wish I could. It may not be for you at all, as you said, but thought you would want to know what others here have said about it. As for AIS, I'm not sure I would agree with you about its being difficult to master on one's own. No doubt, the IDEAL would be to engage with the Mattes' on a personal one-to-one basis, but they do have tapes and books that are pretty clear and focused. (likewise the Whartons - books)
I'm not trying to convince you or persuade you one way or another; these all are YOUR decisions based on YOU - but would want you to have what info.is available here if you want to read it. Searches under terms you are wondering about will lead you to posters who have written here on those topics, with variety of outcomes. That leads to the ultimate point which is that nothing works for everybody all the time, as uniform and consistent and predictably 'cookie-cutter' as we all wish it to be - it just isn't. Most people even find that on one day/week/month one pair/brand/style/size of shoes or insoles are wonderful; on the next day/week/month, those are bad and another set is wonderful. It's a bummer, but it can get better. Then you'll get hives. :-) (Just kidding.) Good luck.

Re: Dr. Ed, your thoughts

Carlos N. on 5/24/04 at 11:42 (151111)

Elsye,

Like anything in life it takes patience. AIS is really helpful if you do it regularly. Over time you will see a gradual improvement. But yes, find out if your problem is biomechanical. Orthotics and AIS has helped me a lot in a short period of time. I'm still recoverying and will take several more months before I'm pain free.

Re: Dr. Ed, your thoughts

Elyse B on 5/24/04 at 11:43 (151112)

thanks again Dorothy. I have been doing ART for about 4 sessions. I do like it but it is inconvenient for me to get to and very expensive. I think all of the things you mentioned eventually increases flexibility. It is a combination of deep tissue massage and stretching and you need a really good practitioner. I will take out my AIS book again and look at it, I tried one of the stretches the rope ended up around my neck!!! Well hives sounds better than PF at this point!! Since I am pretty new at this, I am completely stopping all running/walking before it becomes chronic and will try and stretch and take some classes. I will look up the Mattes thing that you mentioned.

Re: Dr. Ed, your thoughts

Elyse B on 5/24/04 at 11:44 (151113)

Carlos, again how does one find out if it is biomechanical, a podiatrist? I actually have a friend who is certified in AIS and maybe I can 'hire' her to help me out with it.

Re: Dr. Ed, your thoughts

Elyse B on 5/24/04 at 11:46 (151114)

Dorothy, which Mattes video would you recommend, AIS Part I?

Re: Dr. Ed, your thoughts

Carlos N. on 5/24/04 at 13:04 (151122)

Yes, a podiatrist--competent and experienced--can help you in a proper diagnosis. If he can't keep looking for a doctor who can. Good idea to hire your friend so you can learn AIS. Remember, most cases of PF don't go away overnight. You need consistent stretching, rest, ice, and any other conservative methods to assist you.

Good luck,
Carlos

Re: Dr. Ed, your thoughts

Elyse B on 5/24/04 at 13:06 (151123)

thanks Carlos. Unfortunately I am learning that PF does not go away overnight. Of course we all want instant gratification. What have you heard of slant boards?

Re: Dr. Ed, your thoughts

Ed Davis, DPM on 5/24/04 at 17:43 (151145)

Elyse:
The best way to judge if the activity you did today was harmful or helpful is to see how you feel tommorrow.
Many individuals with PF also have equinus, that is, a short heel cord. We speak of the gastrosoeus-achilles complex because we are looking a structure in back of the leg that is composed of the calf muscle (gastrocnemius), the soleus muscle (a smaller muscle below the calf muscle), the aponeurosis of the gastrocnemius which is a broad area right below the calf muscle that comes together to form the achilles tendon. The aponeurosis is the area that is usually tight. With the knee straight, one should be able to pull their foot back about 15 degrees from the perpendicular.

The Pro-Stretch may be good for warming things up but may be too vigorous a stretch on the gastroc. to achieve actual lengthening of the 'complex.'
If one forcefully pushes the foot back on the leg, a spinal reflex arc is activated. It is a protective reflex which actually causes some tightening-- for the purpose of preventing a tear. In order to actually gain length in the gastrosoleus-achilles complex a long, slow stretch is needed. The idea is to allow the fibers of the aponeurosis to elongate without elliciting reflex contraction of the muscle. One must stretch with low intensity for long duration in order to achieve this. This is where the night splints have a distinct advantage since they maintain a prolonged passive stretch, used at night while sleeping but also usable during the day if one has a desk job.
Ed

Re: Dr. Ed, your thoughts

Carlos N. on 5/24/04 at 17:49 (151146)

Elsye,

Slant boards? I have no experience with them. However, there are plenty of exercises you can do without the use of special devices. Please read Scott's Heel Pain Book. It's packed with great exercises and other things that will help you find some relief. Also, if your calves are tight also make sure that you stretch your hamstrings, too. Take your time and stretch everyday as often as possible. Hang in there.

Re: Dr. Ed, your thoughts, 1 more thing

Kristie on 5/24/04 at 19:33 (151158)

I tave taking yoga classes and use video both our good. But I seem to like the classes better. More room to move around. I also found a couple of instructors that I like a lot. Give it another try. I started with beginning yoga. It's not for everyone but I seem to feel a lot better after I take a class. Definelty look into the stick.

Re: Dr. Ed, your thoughts

Michael on 5/24/04 at 21:47 (151168)

Carlos what do you mean when you say biomechanical problems. My walking is not normal due to ankle clonis. I developed foot pain in both feet in 10-02 that has not stopped. Dr.'s have not been able to diagnois me. The foot Dr. told me to treat as PF. I have seen a neuoligist who doesn't think it is a nerve problem. He seems to think it has to do with my walking over the years and the foot being so complicated. Well let me tell you I am about to go crazy with the pain and no help or dianosis. Only pain pills which don't work that well and put me on a roller coaster ride. I am seeing another pain specialist this wk. Maybe I will have some luck. This is no life. All activies are non-existant. I live in southern CA. If anyone knows of any good food Drs. let me know. I have an HMO and I am limited. I may have to pay myself for a good Dr. who at least can diagnois me. Thank you for any info. Michael

Re: Dr. Ed, your thoughts

Dorothy on 5/25/04 at 01:14 (151171)

Other schools of thought from people whose profession this is are saying that stretches of shorter duration - about 2 seconds - are more effective. This is the principle as I understand it behind AIS and MRT stretching. AIS/Aaron Mattes certainly has pretty remarkable credentials. I realize that the kind of stretching that you are describing is what we usually think of as 'stretching' but apparently that thinking has some reputable alternatives. I am not the expert in this, but there are experts in it - maybe other people here are. I am just learning about these methods...

Re: Dr. Ed, your thoughts

Elyse B on 5/25/04 at 07:20 (151179)

thanks Dr. Ed, I appreciate your response.

Re: Dr. Ed, your thoughts

Carlos N. on 5/25/04 at 10:31 (151184)

Michael,

First, so sorry to hear about your pain. I know it's horrbile and limiting. I'm no stranger to the chronic pain and agony and bouts of depression. However, to answer your question, biomechanical is your skeletal structure and how it pertains to the forces exerted by muscles and gravity. In other words, if your foundation (feet) is off a little or a lot then that will affect the rest of your body in how you walk, stand, or run. I started off with PF and then problems slowly crept into my ankles, shins, knees, etc.

Here's a link worth looking at since you live in So. Calif.
http://www.scoi.com/index.html

Good luck,
Carlos

Re: Dr. Ed, your thoughts

Ed Davis, DPM on 5/25/04 at 13:05 (151205)

Dorothy:
They may be looking at a different objective, that is, stretching of the plantar fascia so we are looking at somewhat different things. The specific objective of this issue is to try to lengthen the gastrosoleus achilles complex. This is a means to treat equinus, provided that is present. Again, with ART, the focus is on the PF, not on the gastrosoleus-achilles complex to the best of my knowledge.

The mechanical influence of equinus is a major issue, especially with the orthopedic foot and ankle community and that is the reason many of their opinion leaders like Sig Hanson, MD of Seattle do a lot of gastrocnemius recession procedures. I find that many gastro recessions can be avoided if patients spend enough time with a night splint and with a physical therapist knowledgeable in treatment of equinus, usually a manual therapist. My goal, conservatively, is to gain 3 to 5 degrees of ankle dorsiflexion range of motion per month so I reserve my gastroc. recessions for the more severe cases.
Ed