Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

Visit to Physical Therapist

Posted by john h on 6/10/04 at 11:06 (152641)

Yesterday I had my first visit to a Physical Therapist to begin a treatment program for PF. I had made sure he was trained in Transverse Frictional Massage. We spent most of the hour with him watching me walk, examining my foot and trying to get a handle on the mechanics of my walking. He looked at the wear pattern on my shoes and orthotics. He noted that because I had Hallux Limitus it did cause me to walk a bit different as I unknowningly compensated for the less than flexable great toe. He asked a lot of questions about the history of my PF. My orthotics are now about 4 years old and being semi rigid are weak. His thought seemed to be if you do not correct what is causing the PF and only treating symptoms you are fighting a losing battle. I had alread decided I needed new orthotics due to age and the fact that several Docs did not like mine as they have virtually no heel cup. He said the same thing and pointed out that with my hallux limitus he would have some constructed with some sort of support in the area below the toes to try and stop my foot from over compensating because of Hallux Limitus. He made a hard cast of both feet and then inked in the cast where he wanted the manufacturer to do what ever he wanted. He uses Biomechanical orthotics (www.biomechanical.com). I fully expected to be looking at another pair of $300 orthotics but low and behold he said he only charged his cost which is $87. He said he was paid my Medicare for the casting process and that these would normally sell for $300. He formerly worked with a large orthopedic group in their rehab clinic and did all their foot castings so he knew what he was doing. We discussed Transverse Friction massage and will start on that Friday. I will go for 3-4 weeks 3 times a week. I was supprised at how much he knew about feet and orthotics. I am lousy about doing daily stretches but I began yesterday and will try and do some of the first ones he started me with 3 times a day. We are starting with the calves and achilles using gentle stretches holding them for 30 seconds in sets of 5. One thing I learned is when you stretch your calf with a straight knee you are stretching a different muscle group than when you stretch with a bent knee. You would think I would have known that.Have a look at the http://www.biomechanical.com website. They manufacture rigid,semi-rigid and soft orthotics. $87 for hand casted custom orthotics seems more than reasonable.Will keep you informed as this progresses.

Re: Visit to Physical Therapist

john h on 6/10/04 at 11:13 (152642)

Forgot to mention that when I looked at the website the orthotic manufacturer can take a pair of your favorite sandals which you send to them along with the Doctors foot cast and they somehow place the custom bed from your cast into the sandal. the sandal must have a cork bed. They have info on the webpage about the process.

Re: Visit to Physical Therapist

JudyS on 6/10/04 at 11:15 (152643)

John it sounds as though your new PT knows what he's about - it must feel good to have a sense of confidence in him.
Yes - I'm surprised you didn't remember that we've often talked here about straight leg/bent knee stretches as they relate to different muscles in the calf area.
And now.....you're going to be a good boy and do those stretches every day? :)

Re: Visit to Physical Therapist

Place on 6/10/04 at 11:28 (152646)

Please keep us posted on your progress. I have been looking for someone in my area who does TFM. but have not had any luck. I know how tough it can be to get in the streaching, I put my self on a rewards program if I streached, sounds silly and childish but it motivates me to streach!

Re: Visit to Physical Therapist

john h on 6/10/04 at 12:41 (152651)

What I did was start calling all the Physical Therapist in the phone book and questioning them until I found someone who knew what they were talking about. Not hard to figure out.

Re: Visit to Physical Therapist

john h on 6/10/04 at 12:45 (152653)

Now if my Physical Therapist was not a he and looked like you I could follow directions much better. Seems like I alwasy did the straight leg knee bends when I was really into it and running. The bent leg knee bend stretch could not be felt as much so I figured I did not need it. I did the stretchs yesterday and started out with them this morning and hopefully will do at lunch.

Re: Visit to Physical Therapist

John from MN on 6/10/04 at 13:23 (152658)

You should be well on your way to a an active lifestyle soon. I would add there is a lot of benifits combining chiropractic care with your treatment. Good Luck John h, please keep the group updated with your progess.

Re: Visit to Physical Therapist

Dorothy on 6/10/04 at 14:16 (152666)

I am very excited about this opportunity you found and are taking. I am putting out every good vibe I can muster for this to be a really good experience for you - and, selfishly but gratefully, I know you will share good information with us here and we can learn from your work!! May I say that I love your attitude, John H.!! Good luck!! We go with you in spirit.

Do you know if they are using/recommending the AIS type of stretches?? The 30-second timing made me wonder.... (AIS=Active Isolated Stretching - like that developed by Aaron Mattes, used by the Whartons, I think, and Michael Young)

Re: Visit to Physical Therapist

Elyse B on 6/10/04 at 14:39 (152672)

John, how much experience did he have with Tranverse Friction Massage? Did he feel that it would be beneficial to you? John from MN says he thinks 100 hours of clinical experience with TFM is right. Now I will call all the PT in NYC but there a million, what kinds of questions did you ask?

Re: Visit to Physical Therapist

john h on 6/11/04 at 10:37 (152729)

Elyse I did not ask him how many hours he had doing this. Should have. Asked him about his training and experience. Talked to him about 30 minutes before making an appointment. This will be more than Transvere Friction and will include some stretching. I also think understanding the biomechanics of my foot to be very important and to offer something to perhaps correct this problem to be equally important. If I am walking wrong and placing stress on my foot where it should not be then no treatment will be successful until I correct that problem. I do not think it is an accident that I developed PF about the same time as I developed Hallux Limitus..Seems one of the professionals on the board was making a study of the correlation between Hallux Limitus and PF a few years ago. All I can say today is two days of mild stretching of the calf muscles and achilles has made the PF just a little worse. I did walk 2 miles two days in a row which may also have contributed. Today we do a little Transverse Friction.scheduled. Having had my foot massaged in many ways I still wonder just how many ways you can massage a foot that would produce a lasting result or cure. I am a skeptic who still will try anything.

Re: Visit to Physical Therapist

Elyse B on 6/11/04 at 10:47 (152731)

John what is hallux limitus? Well I looked in my HMO medical book and there are billions of Physical Therapists. I would not know where to start. I did call one and asked one about TFM and he said they are all 'trained in it.' No special certification needed. I bought a slant board and I have used it 3 days in a row. Yesterday I decided to go 'naked.' No sneakers, no orthotics and I felt great Today back in the orthotics and my feet are achy. I gave up all walking because the people on this board said it was a no no walk with PF. Why are you walking?

I have had ART and have been in PT so I am skeptical as well as the different ways one can massage a foot.

Re: Visit to Physical Therapist

john h on 6/11/04 at 10:52 (152733)

Dorothy: Good question about AIS stretches of which I know little. Since we spent most of the time yesterday looking and talking about my foot mechanics I only worked on the two sets of muscles in my calves and of course what they attach to the achilles and plantar. We did isolate the two sets of muscles in the calves by doing straight leg and bent leg stretches. Today we do some actual Cross Friction stuff. Stretching those calf muscles and achilles did make my pf just a little worse which would sort of indicated that perhaps those tight muscles do need stretching out and I must deal with that even if it causes a little discomfort. He did say 'gentle' stretches but 'gentle' is usually not part of my vocabulary when it comes to athletic or endeavors. I am trying to control myself however.I still have a marathoners heart but feet like a camel.

Re: Visit to Physical Therapist

Elyse B on 6/11/04 at 11:10 (152743)

John, again ARE YOU RUNNING? It is killing me now that I am on week three but after reading this board I am terrified to run.

Re: Visit to Physical Therapist

Elyse B on 6/11/04 at 15:44 (152772)

John h let us know how it goes today with the first session of TFM.

Re: Visit to Physical Therapist

john h on 6/11/04 at 19:10 (152785)

Elyse: My first session of PT was this PM. We did some of the massage but not a lot. I had various foot exercises using very simple little tools for about 20 minutes. I had 15 minutes of electrical stimulation on the plantar with a device much like the TENS unit only stronger. One lead placed on the achilles tendon and one on the fascia where the pain is. Also had some deep heat type therapy and some ice. I now have two foot exercises and two stretches to add to my daily routine. My foot actually felt better after I left than when I went in but this is only session two so much to early to report anything. I really expected more of the massage cross section but he is doing his thing so I will go with the flow as my foot is better today than it was yesterday. I would think anyone who starts a new stretching routine is initially going to have more pain after the first few days and then if if it is going to work the graduall begining of some improvement. Probably be two more weeks before the orthotics. I know he is not making a profit on the orthotics as he said he will just give me their invoice and i can pay them directly. I was walking all around his place barefoot and he did not thing that was any big deal and it does not bother me when I do. He seems to not only be addressing the fascia but all the muscles in the feet and attempting to loosen or make the entire foot and ankle more flexable. See him again Monday.

Re: Visit to Physical Therapist

elyse b on 6/12/04 at 06:44 (152806)

I am printing all of these out and bring them to my visit Monday evening with the chiropractor. I think it is different if you see a chiropractor than a PT. I am going to try and get a referral to a Physical therapist as well because I think they spend more time actually working on you than a chiro does. As I mentioned this guy will only spend about 20 minutes with me but I know he does TFM and grafton technique. I am going to interview him and see what he has to say before I continue with this. At $150 a shot that might be too much for too little. John please continue with the reports because they will be very helpful to me and others. I actually started on a slant board and my calf muscles are really, really achy. In my previous visits to PT I had ultrasound and electronic stim and did not find them particularly helpful. I think PT does a combo of the heat, ice, ultrasound, stim and massage not spending too much time on each. I agree with you that it is not only the fascia that is the issue, from my little experience, the PT and doctors said the achilles is extremely important to loosen up. Thanks again John.

Elyse

Re: Visit to Physical Therapist

Rose on 6/12/04 at 18:08 (152837)

My therapist works with a choropractor and is wonderful and will deep tissue massage me as hard as I can stand. Tried the TFM some on Friday....very painful, but I can see how it will work a litle at a time. Was told to soak feet in epson salts for 30 minutes after treatment, drink all the water I could all day and to soak my feet and ice daily between treatments. I am very impressed. ALso encouraqged to eat right...no sugar, no processed foods, etc.

Re: Visit to Physical Therapist

Rose on 6/12/04 at 18:10 (152838)

Make sure you are very warm when you stretch. I was told to do it after a very warm bath or a soak in the hot tub and to fhold the stretches from 30 seconds up to 4 minutes. It seems to be working.

Re: Visit to Physical Therapist

Rose on 6/12/04 at 18:11 (152839)

I would not even consider runnng, ever after the PF I have had. Be sure to completely warm up and stretch before any running at all. I used to teach high impact aerobics and other group exercises and it is imperative to be very warm to prevent injury.