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Oh Scott and the Wise PF'ites... I need your advise please!

Posted by Martin P on 7/05/04 at 09:03 (154520)

Hi Everyone,

Perhaps I should introduce myself as a newcomer to this little community. I'm 27, living in London UK, generally fit and healthy, and previously a keen city walker and cyclist.

Had severe bi-lateral PF five years ago (due to overpronating) which was cleared up by orhtotics, then in March this year it came back in my heel/arch point with a vengeance, meaning I now leave the house rarely unless I have to. Apparently my fasica and gastro/soleus is tight so I was prescribed 'weight bearing' fascia and calf stretching exercises which caused loads more damage - I seemed to tear my right arch across the middle (meaning I now can't pull my toes back without it re-tearing); I re-injured the heels; and caused acute achilles tendonitis (I got this one week ago). Needless to say I'm now doing NO stretches and hardly any walking.

I've seen a fair few medical people and am finding that they often know a lot less than the stuff I've learnt from Scott's book and your advice and messages. So in one sense I'm realy grateful to Scott and all of you, but another sense it makes me feel very isolated when my condition seems beyond the doctor's knowledge. I wonder if I could ask you a few questions?

1. I do NOT have the typical morning pain, if anything the pain is better in the morning after a night's sleep. Is this 'atypical PF'? What does this mean? How should this be treated differently?

2. I'm on the verge of buying 'foot trainers' (after Dorothy's advice, thanks!). Will these still help even though I don't have morning pain? Should I use them while my acute achilles tendonitis is still inflamed?

3. As I can't stretch or do yoga at all at all at present, I'm vigorously massaging my gasto/soleus muscles. Is there a particular way I should do this?

4. One 'expert' I've seen thinks my pain may be nerve related, as I've had so much rest with little improvement. He suggests acupuncture to 'calm the syndrome down'. Any thoughts?

I finding this whole experience very difficult, as I know you all do, so my sympathies are with you. I really want to sort this out before it gets too chronic, but am totally confused by the conflicting advice I've been getting, which has only made things worse up till now.

Any thoughts will be much appreciated. Many thanks to all of you, and especially to Scott for creating this great resource.

Martin

Re: Oh Scott and the Wise PF'ites... I need your advise please!

john h on 7/05/04 at 09:33 (154522)

Martin I am not a Physician so the Doctors will give you medical advice. I have had bilateral PF for 9 years.

1, Many of us do not or have ever had 1st step pain in the morning and that includes me. I am not sure anyone knows why some have 1st step pain and some do not.

2. The foot trainers help some and do not help others. The fact that they are non weight bearing is a big plus. If it hurts to bend your toes back then it many not be the time for the foot trainer as that is one of the ways you use it.

3. Stretching is one of the main ways to treat achilles tendonitits. Ice in the early stage and then heat,massage and stretching of the calf and ham strings. In the very acute stage I found a physical therapist was very beneficial and the one who ultimately cured me.

4.How do you know you have torn the fascia? If it is torn I would think the Doctor would prescribe a lot of rest if not crutches and or a cast?

5. They symptomps you describe sure do not sound like nerve pain. You may need a Nerve Conduction Test to review this but when you talk about a torn fascia and a lot of pain when pulling up on the toes that sounds very much like a fascia problem.

6. Achilles problems and fascia problems often go hand in hand. Many of us like you who apparently were very active are more suspectable to PF and achilles problems to start with.

7. Of course follow your Doctors advice but make sure you have the right Doctor and one who specializes in foot problems. Since this only occured in March you probably need to rest those feet as much as possible until everything calms down and use ice when you do any activity. By no means over do or rush things.

8. Good sailing and remember 90% of all PF cases are resolved in less than one year. (unless you run through the pain)_____

Re: Oh Scott and the Wise PF'ites... I need your advise please!

LARA on 7/05/04 at 19:15 (154552)

Most people diagnosed with PF have PF. HOwever, many (good) doctors are not famililar with TTS and TTS is not infrequently misdiagnozed as PF (I was for three years until I got to a doctor that knew TTS - took him 5 mintues to determine my diagnosis, which he confirmed with a test). The symptoms can sound similar.

I was given orthotics which I thought helped, but I realized (much) later that they helped because I had been given a treatment that caused me to rest so by the time I had the orthotics I wasn't as bad as I used to be, and then the orthotics slowed the progression of symptoms. Once I discovered compression socks, I decided the orthotics weren't doing much for me anymore.

Not everyone PF has morning pain, but very few people with TTS have morning pain - since rest helps TTS, while rest/sleep can result in contracting muscles and aggravate PF.

Accupuncture might be worth of try. People on the TTS board don't talk much about accupuncture but I'm not sure there bad side effects. Only down side is your time and money as best I can tell. I'd also suggest trying compression socks. They worked magic for me. They're relatively inexpensive. Cheaper than getting the test to determine if you really do have TTS. Compression socks don't help everyone with TTS, but they help a signifcant (although not a majority) of number of people (according to my podiatrist)

An NCV test can confirm the diagnosis of TTS, but a negative test doesn't necessarily mean you don't have TTS (it has few false positives, but false negatives are significant)

The fact that your doctor seems to think it looks like nerve pain, and you don't have morning pain, I think I would want to rule out TTS. I assume you have tests to rule out systemic problems. That's what most doctors do first so I assume that was done.

Re: Oh Scott and the Wise PF'ites... I need your advise please!

Marty from SLC on 7/06/04 at 13:04 (154616)

Martin,

Make sure you have pf, get a nerve conduction test to start out with. Like john I have both tts and pf and one can feel like the other sometimes. Good luck. Keep us posted with your quest to good feet again.

Re: Oh Scott and the Wise PF'ites... I need your advise please!

Martin P on 7/07/04 at 06:57 (154709)

Thanks for all your advice. I'm seeing a specialist on 20th July and will raise all these points with him and keep you posted.

Martin

Re: Oh Scott and the Wise PF'ites... I need your advise please!

Ed Davis, DPM on 7/07/04 at 10:02 (154727)

Martin:
Be sure to read Scott's Heel Pain Book because it will give you a more thorough understanding of the process.
Ed