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Do I have atypical PF and other questions.

Posted by Martin P on 7/05/04 at 09:09 (154521)

Hi Everyone,

I'm 27, living in London UK, generally fit and healthy, and previously a keen city walker and cyclist.

I 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 here in London 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. 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?

Many thanks in advance.


Re: Do I have atypical PF and other questions.

Pete R on 7/05/04 at 10:25 (154529)

Hi from a fellow Brit.

I've suffered with pf for some 3.5 years and like you have no first step pain. Pain is mainly in the arch and only sometimes in the heel. Standing is worse than walking. I've tried everthing promoted on this board inc 2 sessions of ESWT in London. If you decide to try this speak with me first since the 2 treatments I had were, in my humble opinion, carried out by people who didn't really know what they were doing. I've gone through about 8 pairs of orthotics, which help but don't cure the pain. Like you the knowledge in the country is very limited other than prescribing more orthotics. I'm not a doc but I'll attempt to answer your questions.

1. Atypical means NOT a typical pf sufferer. i.e illiciting different symptoms to the norm. Atypical with pf means not suffering from morning pain although you may still have pf. The doc's can comment as to whether there are any other differing symptoms.

2.I have the foottrainers which have never worked for me although maybe I should have used them for longer. Worth a try as they're relatively cheap.

3. I'll let the doc's comment on this one.

4. This has been suggested to me although judging from comments on this site, I'm doubtful. However, I'm having a nerve test done on Wednesday, only because my health provider is paying and NOT me! All other treatment which now runs into several thousands of £ has been at my expense. I believe the nerve test is often known to be inaccurate, but we'll see.

I wish you well. Let me know if I can help further.


Re: Do I have atypical PF and other questions.

Martin P on 7/05/04 at 12:17 (154533)


Good to hear from someone else in the UK, where I agree, knowledge does seem to be limited. Thanks very much for your advice.

Where did you go for the ESWT? I've spoke to a company called Chelsea Physiotherpists (?) about it they sounded a bit too certain that it would cure me which made me a little suspicious.

Can you recommend any good resources, doctors etc here in the UK?

Anyway, keep going, I'm sure you'll get there eventually.


Re: Do I have atypical PF and other questions.

AmyM on 7/05/04 at 15:12 (154542)


I'm in the UK too. Not had much luck with the NHS, although I got a pair of orthotics on the NHS last month (I've had foot pain for 15 or so years!) They have helped a bit, but not a lot. I haven't had ESWT, I did go to a clinic in Havant but wasn't too impressed with the set up there.

I have the footrainers too, I suppose they could work if I used them! I go through phases... I find heat helps. I have really tight hamstrings which doesn't help things, I won't even attempt weight bearing streches now.

Worth checking out the nerve issues, but I think you're even less likely to get help for tarsal tunnel or RSD than PF!

Re: To Martin

Pete R on 7/06/04 at 04:02 (154584)

Need to watch what I say, but the people you are suggesting for ESWT were probably the first ones I saw. From my experience they were poor and didn't really have any experience in treating pf. I became a bit worried when they kept refering to a book showing the anatomy of the foot. The success of this treatment seems related to the machine used, as well as the person using it, and the one they used wasn't the ones recommended by the american doc's on this site.

The second people I saw were Citysport in Epsom, who were much better but by their own admission didn't have a lot of experience of pf. However, they did at least hit the spot since my pain was worse for 14 days or so and they subsided back to its normal level. As you may know this is exactly what eswt is meant to do: cause a micro injury to the fascia which will promote greater healing of the whole problem.

I could never find anyone else in the UK who did eswt

It is my experience from reading these boards for the last 2 years that ESWT doesn't seem successful, although the doc's, who are more experienced than I'll ever be, will tell you different.

I've seen a number of pod's in the midlands area who mainly just give you orthotics. Two mri's have proved negative in terms of a swollen fascia ruling out surgery but not helping me with any diagnosis. The pod Julie recommended in London maybe a starting point since he did cure her. Good luck

Re: To Martin

Julie on 7/06/04 at 06:48 (154588)

Correction, Pete: I wouldn't say that Ron 'cured' me, but he certainly did help me. I had a straightforward case of classic PF which I took to him within a fortnight of onset. I followed his recommendations re taping, and he casted me for orthotics which have worked well. I do think that he is a good podiatrist, if Martin wants to consult him.

He is (or was) possibly a bit too keen on surgery - something to take with a grain of salt.

Re: Do I have atypical PF and other questions.

Dave S on 7/06/04 at 10:52 (154604)

Hi Pete,
I'm another PF sufferer in the UK. I don't have any advice to give but ,for me , it's a kind of relief to find a name for the symptoms I've had for the last 5 or 6 years. I find that the pain , which although is seated around the heels radiates up around the front of my ankles, tends to increase as summer approaches (with associated swelling) but occasionally subsides to a more tolerable level for no apparent reason.
My doctor has prescribed various painkillers but the only ones that have had some real effect are Ibuprofen Retard 1000mg and . more recently, Co-Dydromyl (which is 500mg paracetamol & 10mg codeine). They can take the edge off it after a few days continued usage. I had an MRI scan and some blood tests which came up negative.
I'm due to see a rheumatologist in August so we'll see how that goes.
Does anyone find that they are exhausted all the time? I'm finding it really difficult to concentrate on my work by midday!

Re: To Julie

Martin P on 7/07/04 at 07:08 (154710)


Thanks very much for this suggestion. I'm booked in to see him on 20th July.

I don't think my case is as straight-forward as yours. I had orthotics which worked fine for five years, then all the pain suddenly came back, and the stretching I did only made things worse i.e. more arch damage and achilles tendonitis. I'm pretty much house bound at present with the pain.

I'll keep you posted as to what happens.


Re: Do I have PF.

Ami M on 7/07/04 at 09:38 (154723)

It's been about 6 months of heel pain when I would get out of bed in the mornings. Shortly after it would leave. I increased my walking and one morning woke up with what I thought was a chin splint. The pain increased in the next few days, so much so I could barely walk. I went to an orthopedic, he did an MRI of the tibula. He found nothing and said it was a stress facture. My leg has been in a boot for 4 weeks with no improvement. I went to another Dr. which said it was PF. The pain goes half way up my leg but the pain is not there during rest. If I pick up my leg ie. to step on the break of the car it's painful in the front of my leg. Please tell me what to do.

Re: To Julie

Julie on 7/07/04 at 11:25 (154741)


What I liked very much about Ron is that he takes a good deal of trouble to investigate the cause of one's problems. He does a full lower body examination and evaluation to assess the state of all your leg muscles as well as your feet, and has you walk on a treadmill, videoing you as you walk. Then you both watch the video so that you, as well as he, can see what's going on with your gait. This identifies any biomechanical problems, such as overpronation, and makes possible a targeted treatment plan. As the experience with him is my only experience of podiatry, I've been astonished to read of the experiences of others, whose podiatrists have been a lot less diligent.

Ron also introduced me to taping, which I've always credited as one of the most helpful aspects of my recovery. I taped regularly according to the instructions in the heel pain book, which you may have looked at - if not, I suggest you do. And as I've said, he casted me for orthotics. He didn't push that - we waited a couple of months, and then, as my PF was 'lingering', as he put it, we went for the orthotics, which have been very successful, and I still wear them, though it's almost four years since I've had any trouble.

What I liked less about his approach was his attitude to surgery - he may not be as keen now as he was four years ago (at which time he had recently qualified as a surgeon). Also at that time (perhaps this has changed) he was recommending the classic wall stretch, which I (like yourself) found less than helpful. I won't go into my views on exercise, but you can search the archives for my many posts on this subject. To encapsulate: stay away from weight bearing exercise. Did you try the yoga foot exercises? I know you've said that you 'can't do yoga', but these are non-weightbearing and different, and you might find them helpful.

Let me know how you get on. I hope the visit with Ron will be fruitful. Please give him my best. I have to get in touch with him myself soon, as my orthotics are beginning to come to bits - four years of hill-walking on rough ground.

Re: To Julie

Martin P on 7/09/04 at 06:55 (154904)


That's really helpful. Your description of Ron's diagnosis technique does sound far more diligent than anyone else I've seen who seem to work more on possibilities and guesswork. I'll ask him about the yoga exercises to get his advice, and I will send him your regards.

I'm very glad to hear that your orthotics have been worn out with four years of hill walking, encouraging stuff!

All the best.