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Curious, what comes first?

Posted by Elyse B on 5/24/04 at 07:45 (151098)

I am just curious about something. My calf muscles are actually killing me. What comes first the chicken or the egg syndrome? Do my feet hurt becuase my calf muscles are tight and will the right orthotics make the calf muscles not be so tight when I walk?

Re: Curious, what comes first?

Dorothy on 5/24/04 at 11:25 (151108)

I am not a doctor, nor a pedorthist. I'm just a fellow foot, etc problem person here. In fact, I currently have hives and so my credibility may be even more suspect! However - I have been reading your posts and especially your reports that your calves/legs are increasingly painful/tight. In addition to all the other avenues you are pursuing here, I think you should be seriously considering a stretching/strengthening program right away. Several approaches to that have been/are now helpful to people with similar issues: The Personal Foot Trainers (www.foottrainer.com); Active Isolated Stretching program with the highly regarded trainer/therapist Aaron Mattes ( tapes, books available; also clinic in Florida (http://www.stretchingusa.com/); Michael Young and Muscle Release Therapy (he often refers to Aaron Mattes as his guide, as well as the Wharton Stretch book/program - the Whartons are also quite well known/respected; http://www.mrtherapy.com/) - those are some very good places to start. Also, you might want to look for a good, comprehensive, smart and careful yoga program either in person or using video tapes/books. Yoga and Pilates are both helpful.
You have been posting with Dr. Ed Davis and he referred to you as a 'professional' so I am not sure what kind of 'professional' you are and, therefore, you may already know this information. If so, consider this redundant. If not, consider it an offer of additional ideas. These ideas will very likely help your PF and leg problems, but they will also likely help your overall physical condition. Good luck.

Re: Curious, what comes first?

Elyse B on 5/24/04 at 11:40 (151110)

Thanks Dorothy, I listen to what everyone has to say. I have to totally admit that my stretching is suspect and my flexibility is awful and that I just hate to do it and it hurts!!! I am very aware of the Whartons as I have their book and they are based in NYC but it is very complicated to do on your own at least for me. I have been doing ART but not sure that that is the key. It is painful and I am not sure how that increases flexibility and it is EXPENSIVE. I have taken some yoga programs but am pretty awful at it, there many,many yoga programs in NYC but not sure even where to start. As for being a professional, the only thing I really am a professional at is having PF!!! I have read posts on The Foot Trainers, do you recommend them?

Re: Curious, what comes first?

lauriel on 5/24/04 at 12:21 (151118)

Elyse my new orthodics have made my calf muscles so tight, they are very painful my perthodist tells me to work thru the pain. No I am not, it is making my pf worse. I am going to chekc out the ART. I have somehting called footsavers that I work with my feet every day and i Just saw the foot trainers stretching tool. I think I may give that a try since I am getting desperate.

laurie

Re: Curious, what comes first?

Elyse B on 5/24/04 at 12:23 (151119)

thanks Laurie, what I am seeing from this Board is what works for one may not work for another. I have ordered the SDO's from Dr. Kiper and I await them and I am sure with every step I take my calf muscles are just getting tighter and tighter. The Foot Trainers look like a good thing. What are footsavers? I think ARt works for some, but you have to be careful, I think my practitioner was too rough on me and he did use the thing called The Stick which I may purchase as well and do it on my own.

Re: Curious, what comes first?

Robert J on 5/24/04 at 14:13 (151125)

Elyse--

A number of runners (or maybe I should say former runners) on these boards have reported PF symptoms that puts them in the atypical category. I'm one of those, by the way. I've noticed from your posts that you were a runner also. Do you have first-step pain in the morning, or does your pain come on gradually and produce a dull ache throughout the arch? I ask because I am coming to believe that atypical PF may be a somewhat different injury than classic PF and may require a different treatment approach.

Re: Curious, what comes first?

Elyse B on 5/24/04 at 14:17 (151127)

Hi Robert. I guess I have the atypical variety as I never ever had first step pain in the morning. My pain is basically a throbbing and I would say 90% is in the arches, you describe it pretty accurately. What do you think the different treatment approach would be for atypical PF at least in your experience? Right now my head is spinning with everyone's advice. I know everyone is different that is why this is so difficult. I have had this since the end of March and have not stopped running/walking. Today is the first day I have stopped everything, I am afraid this is going to become chronic. Thanks

Re: Curious, what comes first?

lauriel on 5/24/04 at 14:55 (151128)

elyse, fotsavers are these half kind of hard rubber balls about 3 inches in diameter, you stand on them and do foot reflexology exercises. They seem to help for me. you can check them out at this site. http://www.bodylogic.com - they are kind of buried in the site. I use the regaulr ball for my back - it sure has helped.

I dont get the pain when I wake up - the pain is concentrated in my arches. What also helps is I have a small water bottle i keep frozen and massage and roll it back and forth with my foot.

laurie

Re: Curious, what comes first?

Dorothy on 5/24/04 at 16:41 (151133)

I'm butting into your conversation just to say that the Foot Trainers are both a stretching and strengthening tool which is good.

Re: Curious, what comes first?

Julie on 5/24/04 at 16:47 (151135)

Elyse

You are wise to have stopped running. PF is known as the 'runners' disease'. Running, like all high impact activity, shortens the calf muscles, and if you haven't been doing plenty of compensatory stretching it is highly likely to have been the cause of your tight calves and your PF.

Properly made orthotics will take care of biomechanical issues like excessive pronation (if that's what you do) but won't do much to address the muscular tightness. You need to stretch - but be very careful how you stretch. Aggressive calf stretching (such as the 'wall stretch' can do more harm than good. Non-weight bearing exercise is better. Dorothy recommended the Foot Trainer: it's a good product, and I think you would find it helpful. You could also look at the yoga foot exercises I've posted here (click on yoga). They are simple, safe, and effective.

Your orthotics, when you get them, will only be as good as the shoes you put them in, so always wear good, supportive shoes that are the right size. I don't know how old you are, but most people find their feet grow larger as they grow older, so get that checked out.

Most importantly, stay off your feet as much as possible to give them a chance to heal. That really does mean - in my opinion - no running until your PF is well and truly gone. And when you do resume running, work into it gradually, stop if you get setbacks - and don't forget your stretching.

Good luck.

.

Re: Curious, what comes first?

Dorothy on 5/24/04 at 16:56 (151136)

Yes, I would recommend the AIS Tape 1 and I would recommend the Foot Trainers. I also recommend a handheld massager with both massage and infrared head and using both or just the IR heat massage your calves frequently - along with doing other things like AIS, Foot Trainers and so on. As to Yoga, Kripalu is a pretty gentle form and one that I like. There is a style called Svaroopa that is also very nice but not so easy to find teachers. I would recommend Kripalu but use your own body as your guide for your limits and be gentle with yourself as you go along. Using the AIS or MRT Achilles and PF stretches, then do some self-massage using your hands, the Stick, the IR massager. You can also ask Mike Wilmot, designer/maker of the Foot Trainers questions about things to do w/the FTs for the kind of tightness you are experiencing. It will take time, persistence, diligence - and you may just need to put your mind to the fact that you will have to develop a good program for yourself and stick to it because the kind of 'tightness' you describe doesn't usually just go away and stay. I think Carlos has given you some great advice. You are also very lucky if you have someone who is really AIS trained/certified who could help you. By the way, about the handheld massager w/infrared that I mentioned: mine is a Homedics brand that I got at WalMart sometime in 2003 for under $10.00. I don't know about availability now, but surely there are things w/those features around. Good luck to you! (p.s. I don't have hives OR PF OR Achilles tendinitis OR back problems - I've got it all, but most of the stuff waxes and wanes. So far the hives are just waxing - and taxing.)

Re: Curious, what comes first?

Dorothy on 5/24/04 at 17:06 (151138)

Lauriel ~ Would you mind talking some more about the Body Logic ball and the whole process that you use for your back? Did you have any special instruction or prior use before you bought one? Did you just get one and try it? Is it a hard ball? Does it hurt?? How do you 'fit' yourself onto it?? Anyway - can you tell as much as possible about this whole process and your experience, etc.?? Is this the only resource for 'body rolling'? (is that what it is called?) Thanks.

Re: Curious, what comes first?

lauriel on 5/24/04 at 17:33 (151144)

Dorothy, go and check out the web site http://www.yamunabodyrolling.com- to see the balls. They are fairly soft and about 10 inches in diameter. They do have differents hardness of balls for the type of injury you may have, the softer balls are for people who may have chronic pain. I bought mine and took a few classes thru a local yoga instructor. They now have video tapes you can buy to guide you thru the process. It is kind of akward at first, but ohh the relief I get. when you roll on them they kind of stretch your spine

Laurie

Re: Curious, what comes first?

Ed Davis, DPM on 5/24/04 at 17:59 (151149)

Elyse:

Good question. Nobody knows the answer for sure BUT from a biomechanical point of view a tight heel cord will cause compensation in the foot that strains the plantar fascia so most will point to the heel cord (see my discussion on the gastrosoleus-achilles complex) answering your query on the ask the docs board. Another REALLY important consideration: the number one cause of orthotic intolerance is a tight heel cord. If the foot is overpronating (rolling in) in compensation for a tight heel cord and one attempts to take away that means of compensation with an orthotic, then the orthotic may hurt.

When a person has equinus (a tight heel cord) that fails to allow the foot to go back sufficiently on the leg an orthotic must be made with the foot casted/molded in a pronated postion or the orthotic will probably not be tolerated. Once the equinus has been rectified, then the orthotic can be modified to a less pronated or 'neutral' position.
Ed

Re: Curious, what comes first?

Robert J on 5/24/04 at 18:10 (151151)

Elyse--

At the risk of disappointing you, I don't think anyone has a firm picture of an effective treatment plan for the atypical variety of PF. A couple weeks ago we had a discussion about this on the 'Ask the Foot Doctor' Board and you might want to check it out. I started that discussion and I believe the heading was 'A question for Dr.Z about the Atypicals.' I'm not suggesting, by the way, that the recommendations made by the other posters here are not valuable. The big lesson of these boards is that everyone needs to keep stumbling towards a solution until they find something that does work. But I also believe that we atypicals need to recognize that we are a subset and that our solutions may turn out to be significantly different from those with classic PF. I'm also beginning to believe that there's more atypical PF out there than most of us realized. Maybe Scott should create a new board category for the atypicals.

Re: Curious, what comes first?

Ed Davis, DPM on 5/24/04 at 19:24 (151157)

Robert:
Do you beleive that Elyse has atypical PF? She really has not given us much reason to come to that conclusion. Most of what we are terming 'atypical' is defined as a lack of pain after arising in the morning. That may simply mean that the plantar fasciitis is not insertional plantar fasciitis. Keep in mind that the FDA only approved ESWT for 'insertional' PF. Insertional PF is more focal so when you are aiming ESWT you have a nice neat target. What we may have is simply a larger, more dispersed target that requires some technique modification if ESWT is to be used. Additionally, that which we call 'atypical' still may respond to other modalities. Elyse's major issue discussed today is equinus. Equinus, that is, the lack of adequate backward motion on the leg is a prime exaccerbating factor in PF, typical or atypical. It is a reason that some perform the gastrocnemius recession procedure (gastroc slide) -- something that Pauline has discussed (consider a 'search' on that).
Ed

Re: Curious, what comes first?

Robert J on 5/24/04 at 21:04 (151163)

Dr. Ed--

In most of the discussions on these boards, atypical PF has usually been described as having three basic characteristics: no first-step pain in the morning; pain that may be partially insertional but also extends under the arch; and pain that comes on gradually as a dull ache rather than as a stabbing or 'rock under the heel' pain.

That has been my experience, and I thought Elyse said it was her experience also. In the past I think both you and Dr.Z have stated that ESWT has not had a good record with such patients. In the discussion two weeks ago with Dr.Z, he referred to the difficulties of atypical treatment. But if your experience has shown that modifications of ESWT allow for effective treatment of such cases, I think that is great news and would love to hear more about it.

Re: Curious, what comes first?

Elyse B on 5/25/04 at 07:06 (151176)

well I guess I would have atypical because I do not have pain in the morning upon rising.

Re: Curious, what comes first?

Elyse B on 5/25/04 at 07:16 (151177)

thank you so much Dorothy for all your helpful info. I will order the foot trainers today. I have a handheld massager but it does not haev an infrared head but will try that but I have a heating pad. I guess I will get the Stick as well, do you think that is too much. So many things to do, it is hard to figure out a program with so much advice. A plan is definitely needed. Hope the hives are better today. Elyse

Re: Curious, what comes first?

Elyse B on 5/25/04 at 07:18 (151178)

thanks Julie, I am finding out more and more that this is 'runner's disease.' I have not been doing enough compensatory stretching and will try and be more diligent. Not sure if I have excessive pronation. I will order the Foot Trainer and see how that goes. I will also look at the yoga foot exercises. Shoes, well I have 14 pairs of sneakers all recommended by different 'experts.' Who knows which are better. I am trying to stay off as much as I can and I am committed to no running until I am as good as I can get.

Re: Curious, what comes first?

lauriel on 5/25/04 at 10:50 (151186)

Dr. Ed

my orthodics are making my calf muscles so tight, it is making things worse, you say the foot must be cast in a pronated position. How is that done? Mine were formed by me laying down on my stomach with my feet hanging over the edge of the table. (I am a big overpronator)

Laurie

Re: Curious, what comes first?

Elyse B on 5/25/04 at 10:54 (151187)

Lauriel, wow we are having the same issues. I cannot believe how tight my calf muscles are. My orthotics were also cast while I was lying down on my stomach with my feet hanging over the edge. I agree, what does that mean the feet have to be cast in a pronated position? Hmm, maybe Dr. Ed can answer this one? I am not even wearing orthotics yet and my calf muscles are tight. I am figuring out a way to get them looser. I am going to order the foot trainer and believe it or not, I am hiring my friend who is accredited in AIS to help me stretch twice a week. More money!!!

Re: Curious, what comes first?

lauriel on 5/25/04 at 12:17 (151201)

because of the orthodics, I have been waking up at night with my calfs cramping. I am going to start massage too. but waiting to get a presciption to see if my insurance will cover it. Cant wait to see what Dr Ed says

Laurie

Re: Curious, what comes first?

Elyse B on 5/25/04 at 13:14 (151206)

well my insurance pays for nothing unless I have a presciption and I need to see a doctor to get one. I guess I am going to have to formulate a plan to somehow get my calf muscles loosened. I am going to try heat as well tonight. A friend recommended Biofreeze and put that on my calf muscles. Yes it will be interesting to see what Dr. Ed says but I think he might have addressed this already. It is again the horse before the cart, I think, tight calf muscles equals PF on one hand, and an orthotic will help but nothing works until we get our calf muscles loosened up and that is the big question. Someone also suggested taking shorter strides. Sounds good to me!!!

Have you had your orthotics adjusted? Why don't you read up on http://www.drkiper.com

Re: Curious, what comes first?

Ed Davis, DPM on 5/25/04 at 13:21 (151207)

Robert:
I find that 'atypical' PF is often cured by the more conventional PF treatments and does not get to the ESWT stage. Now, here is the kicker: with ESWT. Dr. Z is a Dornier fan, I a Sonorex fan, although I have long maintained that I feel that the differences in effectiveness between machines are not that significant. I feel that for atypical PF, the Ossatron is the winner. I don't have a lot of numbers to back that up but my reasoning is as follows: the Ossatron is the only machine in which the 'target' is very broad and that the shocks are dispersed over a large area. This approach, seemingly a less sophisticated one, seems disadvantageous when we are going after a small target. But with atypcial PF we need broad dispersion of shocks over the PF as opposed to the more accurate targeting with Dornier or Ossatron. Again, just my assessment of the technology.
Ed

Re: Curious, what comes first?

Ed Davis, DPM on 5/25/04 at 13:21 (151208)

Yes. How 'focal' is the pain, that is, how large of an area does it cover?
Ed

Re: tight calf muscles

wendyn on 5/25/04 at 13:52 (151210)

elyse, I also have very tight calf muscles. They are much better than they used to be (years of yoga and stretching). Your flexibility really can improve, but it will likely take time.

Re: tight calf muscles

Elyse B on 5/25/04 at 13:58 (151211)

Wendyn, well yoga and I do not get along. Nothing worse than seeing a 51 year old inflexible woman try and do a downard dog!!! I am going to try, I have to. Instant gratification is not fast enough

Re: Curious, what comes first?

Ed Davis, DPM on 5/25/04 at 14:04 (151213)

Lauriel:
Orhtotics should not make your calf muscles feel tight. They can do so if they are already tight and the orthotics elimnate a means for compensation, that is, they eliminate the means by which the tightness expresses itself in foot function change. When you are being casted, the person doing the casting is determining the best postion to hold your foot. Most of the time, your foot is being held in subtalar neutral position but that can be changed by changing the position to one of mild pronation at the time of casting.
Ed

Re: Curious, what comes first?

Ed Davis, DPM on 5/25/04 at 14:05 (151214)

Elyse:
It is simply the position the foot is held in when one is taking the cast of your foot.
Ed

Re: tight calf muscles -- calling Julie

Ed Davis, DPM on 5/25/04 at 14:07 (151215)

Elyse:
Julie can probably explain what has occurred during your attempts at Yoga. My impression, although I have little expertise with Yoga is that it is something that most should be able to do with the proper instruction. I will await Julie's repsonse on this.]
Ed

Re: Curious, what comes first?

lauriel on 5/25/04 at 15:23 (151222)

Dr Ed, my left calf is the worse, when Iwoear the orthotics my left arch seems to be held up more, because I can really feel the support vs the right foot. I hardly notice I am wearing them. i think because of this it tightens up my calf real bad. my right tightens up but nothing like the left. I made the perthodist take some of it down because they are not wearable. I think H eshould still take it down more. I am confused on your statement 'They can do so if they are already tight and the orthotics elimnate a means for compensation, that is, they eliminate the means by which the tightness expresses itself in foot function change.' can yo please explain more what this means?

thanks
Laurie

Re: tight calf muscles -- calling Julie

Elyse B on 5/25/04 at 15:43 (151226)

ha, you think so? It is the hardest thing I have ever done and especially hard for someone so inflexible. I think, as with everything, one needs to practice and do it a long time to get pretty good at it.

Re: tight calf muscles

Dorothy on 5/25/04 at 16:29 (151242)

Be VERY VERY careful about downward dog. I believe that doing it contributed to my first 'getting' PF - not the only factor, but maybe the tipping point factor. There are lots of excellent ways to increase flexibility of which yoga is a significant one, but not the only one. YOu may find yoga to be a later, down-the-road approach after your AIS and massage experiences. Whatever, be cautious with downward dog- it should come later, not sooner.

Re: tight calf muscles -- calling Julie

Kathy G on 5/25/04 at 16:32 (151244)

I developed extreme pain in one of my calves when I first had PF. It still flares up now and then. Julie's Yoga Stretches, which really don't seem like traditional Yoga like you may have tried in the past, really help me a great deal. So does standing on a slant board that my husband made for me. And my husband massages that calf to loosen the muscle up for me which is great.

I just remembered. When I wore motion-control shoes, my calf pain was far worse. I believe they recommend motion-control shoes for people with PF but when my doctor suggested I try another type that didn't have that control, it helped to alleviate the calf pain.

Good luck!

Re: tight calf muscles -- calling Julie

Julie on 5/25/04 at 16:56 (151245)

Elyse

Dr Ed has summoned my expertise as a yoga teacher and trainer of many years. In the few minutes since I saw his post and yours, Dorothy, who is also a yoga practitioner, has given her thoughts, and the first thing to say is that she is absolutely right about downward facing dog. The last thing you need right now is a stretch strong enough to exacerbate the inflammation of your injured plantar fascia.

There are many different 'styles' of yoga. As 'a 51-year-old inflexible woman' you should be looking - assuming you did want to investigate yoga - for the gentlest of beginners' classes. Satyananda Yoga (the tradition in which I work) and Kripalu Yoga are two that you could explore. Avoid Iyengar Yoga (a perfectly reputable school, but it focuses largely on strong standing poses and is therefore quite unsuitable for you) and Ashtanga (aka 'Power') Yoga, another demanding and dynamic style.

I always err on the side of caution when advising people about yoga, especially people with PF. I don't think it the best time to start a yoga practice unless you are absolutely sure you have found a teacher who not only teaches in a way that is going to help you rather than make you worse, but who understands PF. Most would not, and some would insist that you work barefoot. If you were in my class, I would insist that you wear your shoes.

However, the fact remains that your short, tight calf muscles are probably one of the main contributory causes of your PF, and you need to loosen and lengthen them. And you need to do so without making your PF worse. It will take a long time: you will have to be patient, establish a routine, and stick to it. Stay clear of weight-bearing exercise, which will almost certainly make matters worse. The yoga foot exercises I told you about earlier will probably help, but only if you use them regularly over a period of time. The foot trainer will probably help, but only if you use it regularly over a period of time. The night splint, as suggested by Dr Ed, will probably help, but only if you use it regularly over a period of time.

Orthotics should help sort out any biomechanical problems if properly casted and made, but they won't do much for your calf muscles. You are looking at undoing years of shortening and tightening those muscles through running but not stretching, so you need to make up your mind that it won't be a quick fix.

Finally, if you do take up yoga, you should understand that it isn't something you need to 'be good at'. It is, or should be, totally non-competitive. You begin where you are, and proceed from there. It's not about flexibility (I've taught people in their 80s and 90s in wheelchairs who were a lot less flexible than you). It's not even primarily about the body. It's about learning to know yourself better, it's about integrating body, mind, emotions and spirit. And it's not a quick fix.

I wish you all the best.
.

Re: Curious, what comes first?

HilaryG on 5/25/04 at 18:34 (151248)

Dr.Ed, Do you remember Mohez? Mohez had Atypical PF and if I remember correctly he had ESWT with several different machines and said that the Ossatron was by far the most helpful in his case. Your explanation makes his results understandable. I never understood it before. Thank you. I also feel like there is another option available to me if I should need it-- and God knows I might. Hilary

Re: Curious, what comes first?

Dr. Z on 5/25/04 at 18:51 (151250)

Here is a comment to add to Dr. Ed.explanation as to why he feels the ossatron works better with Atypical. Both the Dornier and the ossatron cover the fascia with the same amount of energy. Both devices cover the same ares . The ossatron by rotating the machine with wide sweeps. The dornier with small movements under ultrasound guildance. Most of the ossatron energy is distributed not in the plantar fascia but into the surrounding tissue and the bone with the plantar approach and the depth of pentration of the shockwave. Ok so just maybe the atypical pf isn't a problem with the pf but a problem with surrounding tissue and the cover of the bone called the periosteum. Just a though to throw out there.

Re: tight calf muscles -- calling Julie

wendyn on 5/25/04 at 20:12 (151253)

elyse, I see you've already had some great responses from 'the' yoga experts on the board....all I can add is to reiterate what Julie said. Yoga isn't competitive. My yoga class if full of non-yoga people. We laugh a lot. If you go somewhere like a communicty centre, you may find something a little more informal and more to your liking.

Regardless of which mode of stretching you pick, I hope you find some relief with it.

Re: tight calf muscles -- calling Julie

Julie on 5/26/04 at 01:48 (151260)

Kathy, the foot exercises *are* traditional yoga: it's just that they're not as widely known as the more challenging postures you would find in most classes. They're the lower limb section of a comprehensive series for all of the joints of the body. The series is called Pawanmuktasana, which means 'exercises that release blocked energy'. They do this through improving circulation and removing blockages along the energy pathways. They are simple but powerful, safe and effective, which is why I value them so highly and teach them to all my students - young and fit, old and arthritic, healthy and strong, ill and frail. Being non-weight bearing - unless you do them in a standing position, which you can, apart from rotating both ankles :) - they're particularly suitable for people with PF.

Although the foot exercises specifically target the joints, you can feel, as you do the one for the toes, how it works to strengthen the whole musculature of the feet. And you can feel, as you do the two ankle exercises, how they work on the entire gastrosoleusachilles complex. I'm glad they've helped you, and I think they would help Elyse and anyone else with shortened calf muscles.
.

Re: tight calf muscles -- calling Julie

Elyse B on 5/26/04 at 07:20 (151266)

I know yoga is not competitive and I am not a competitive person. I just think it is pretty funny that all this 'young' things are wrapped around like pretzels and poor me cannot even touch my toes!!! I printed out Julie's yoga exercises and will try to do them faithfully. I did go home last night and used the heating pad and massager which helped a little bit.

Re: tight calf muscles -- calling Julie

Richard, C.Ped on 5/26/04 at 07:59 (151270)

mmmm I like black cherry yoga...no wait, I mean yogurt. LOL

sorry....really good mood this morning.

Re: tight calf muscles -- calling Julie

Vern S. on 5/26/04 at 10:01 (151281)

Julie- Would you discourage Downward Dog for most everyone with foot pain? It does not seem to hurt when I do that pose.

Re: tight calf muscles -- calling Julie

Julie on 5/26/04 at 11:40 (151296)

Hi Richard

Black cherry is the best kind. Definitely.
.

Re: tight calf muscles -- calling Julie

Julie on 5/26/04 at 11:57 (151297)

Vern, no, I wouldn't discourage everyone. It has always been one of my favourite postures, and I practised it - carefully - all through my PF. But when you advise a group of people on an internet forum, people whom you don't know, with PF of varying degrees of severity, and with different tolerance for (and attitudes towards) exercise, it makes sense to be cautious, so I am.

It's a great posture, a wonderful stretch-and-release for the entire back of the body, and specifically a very effective lengthening stretch for the calf muscles and achilles tendons. It is controllable, and can therefore be safe, but you do have to control it. You need to (a) know your body and your capacity (b) be properly instructed and (c) be gentle with yourself. It's an easy pose to 'endgain' with - i.e. to think 'I must get my heels to the floor', and to try too hard to achieve that. That's an attitude that encourages aggression. So you can hurt yourself. Since I know that many people do have that attitude towards the pose, and since I don't know the mindset of the person I am 'talking' to here, I prefer, when talking about it here, to err on the side of caution. When I am teaching real students my approach is rather different. It is based on the students: I know them, I can see them before me, I know their problems, so I can advise them accordingly and help them individually.

If the posture isn't making your PF worse, by all means continue with it. But be careful with it and don't try to push your heels to the floor: instead, just let the backs of your legs soften and relax. The stretch will be more effective. And don't hold the pose for too long - just a few breaths. And although it doesn't hurt while you're doing it, be aware of how you feel the next day.

Sorry for such a long answer to such a simple question.
.

Re: Follow-up to Dr. Ed and Dr. Z

Robert J on 5/26/04 at 13:44 (151318)

Dr Ed and Dr Z--
That's very good news about the possibilities of ESWT for patients with under-arch pain. But I have a question: can either of you give us some sense of the prospects of success using ESWT modified for under-arch pain? Even if the evidence is anecdotal, I would love to hear about it. Thanks.

Re: Curious, what comes first?

Ed Davis, DPM on 5/26/04 at 13:56 (151321)

The inward rolling of the foot, parituclarly the back of the foot, AKA 'pronation' carries the arch downward. A tight achilles causes one or more alterations in gait, a common gait alteration is increased pronation. So the foot rolls in more, the arch is pushed further down so there is increased arch contact/pressure.
Ed

Re: Follow-up to Dr. Ed and Dr. Z

Dr. Z on 5/26/04 at 19:25 (151340)

Robert
I hate to treat atypical pf. It is very difficult to treat. While there is some success with ESWT I find it not that effective for pf that is mid arch and or distal. I do find a slipper cast very helpful in the early stage as well as physical therapy. Must catch this atypical early