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To PF Veterans

Posted by Elyse B on 7/06/04 at 14:35 (154630)

Most of you know my short history of PF, 'diagnosed' at the end of March. 3 different podiatrists, physical therapists, doing Graston and TFM, 2 pairs of orthotics etc. So I decided to give it one more try with a podiatrist because this guy has helped many of my running friends in NYC, is young but experienced with running injuries especially PF. I hesitated about going to him at first because he was not covered under my insurance and he is expensive. In any case, I went to him and had x-rays and he saw me, of course for about 10 minutes, and put it into my head that he is not sure it is PF. He said the x-rays look 'too clear' and my feet 'just don't feel' like they have PF. So he wants me to have a diagnostic ultrasound with this new machine called a doppler ultrasound which supposedly definitely tells if you have PF. This machine estimates the soft tissue blood flow in pathological states of the musculoskeletal system and is a new form of ultrasonic blood flow detection method. I also asked him if I should be taping my feet as the chiro is taping my feet after doing graston and TFM and he said no because is compresses the fascia.

How do you guys deal with all these different diagnosis and different methodologies?

Thanks

Re: To PF Veterans

John from MN on 7/06/04 at 15:09 (154633)

Your doctor should be able to feel the bottom of your feet and tell you if you have PF or not. After my experince I could feel anyone's feet and tell them if they have PF and I am not a doctor.

Re: To PF Veterans

Place on 7/06/04 at 15:43 (154636)

Yea. I agree with John. I can tell a difference in the tightness and the amount of bumps on it! It might not be worth the money. You might want to ask DR. Z.

Re: To PF Veterans

Elyse B on 7/06/04 at 15:44 (154637)

I asked Dr. Z. but I cannot tell myself whether I have it. He felt the bottom of my feet and that is why he said I should have the ultrasound.

Re: To PF Veterans

Elyse B on 7/06/04 at 15:48 (154638)

well let's see how would I do that, I am feeling my fascia and the bottom of my foot is smooth. No bumps, yours feels bumpy and stuff? I cannot believe this, why would 3 previous podiatrists not pick this up?

Re: To PF Veterans

Pauline on 7/06/04 at 16:11 (154642)

Elyse,
You know me. I don't mince words. The guy has a new machine and need to pay for it.

Time to accept the P.F. diagnosis. If you've had the orthotics adjusted and still cannot use them put them aside for a while and begin taping on a daily basis.

It could be that you still have too much inflammation to wear the orthotics or like me you may never be able to wear them, but you can tape and it will help.

I would also advise you to use ALL the conservative treatments Scott mentions in his book.

1. The contrasts water baths. Massaging gently in the warm water not in the cold. Do it several times a day.

2. If you haven't tried taking Bromelain (found in health food stores) you might consider taking it. Ask them about it so you know that you are taking a Pineapple emzyme and you might want to check with your personal physician to make certain that it will not interact with any other medications you are currently taking. For the most part it is a safe anti-inflammatory. A natural product, but everyone should check for themselves prior to taking any supplement like this.

3. Every time you sit down play with your feet. Keep a jar of cream near your favorite chair and do gentle massage action in the sore areas. Always ending up by stroking your feet from toes to heal toward your heart. Ice afterward. Do not walk on your feet until they return to normal temperature. Never walk on cold feet.

4. Use a tennis ball and golf ball to stimulate the area followed by icing too.

5. Use night splints if you've invested in them. Use them nightly for as many hours as you can stand them.

6. Spend time doing Julies Yoga Exercises.

7. Be committed to resting your feet. I mean really resting them when ever possible.

I think one of the hardest things to accept about P.F. is the limiting factor that if has on your life. You've had it for about 3 months and it may take many more months to see improvement. Let patience become your friend. I was told once that the average case of P.F. lasts about 8 months. Boy was I disappointed when that 8 months came and went, but I held to a course of treatment.

You have the ability and strength to do the same. If you have the means you can always give ESWT a try. Above all keep the faith and keep posting. Heck we will all want to know when you've reached the top of the mountain and are on the way down.

You'll never know how close you are to the summit if you give up so keep on trying.

Re: To PF Veterans

Elyse B on 7/06/04 at 16:19 (154643)

Thanks Pauline as always for your words of wisdom. I totally accepted that I have PF and I always believed it but that darn doctor had to put it in my head that I did not have it. I am not concerned about the ultrasound since it is covered under my insurance.

FYI he said taping is not good because it compresses the fascia now why would he say that if he believed I had PF? That is what I mean, everyone has a different thing to say and it really bugs me.

Night splints do not work for me as I do not have morning pain. Orthotics have never been my friend. I have continued to do Julie's yoga exercises plus I have the slant board. None of it has made much of a difference. I definitely ice a lot. I will continue with my program. I heard that a case of PF usually lasts about 2 months.

Pauline I will continue to post, I may have a nervous breakdown along the way with these crazy doctors. I am still doing the Graston and TFM and we shall see how that goes as well.

Re: To PF Veterans

Place on 7/06/04 at 16:20 (154644)

I used to feel my feet at the without pulling my toes back and they felt smooth. Try pulling your toes toward your knee caps and run your hand down the cord that sticks out with your thumb with some preassure. It should feel grizzely and rubbery.

Re: To PF Veterans

Pauline on 7/06/04 at 16:23 (154646)

Elyse,
Add a Vit. B12 tablet to your daily diet if your doctor approves. B12 is good for nerves and may help to break up the cycle of pain from your P.F.
It seems that once that tissues and nerves get irritated if you can break into that cycle you make progress. Baby steps in breaking this cycle can lead to giant gains toward pain relief.

Re: To PF Veterans

Dr. Z on 7/06/04 at 16:24 (154647)

Thanks Dr. Z. Was wondering why the three podiatrists I went to never did it. Can it tell if you have PF or whether it is a nerve issue. Do you do it in your office as one podiatrist I went to is sending me to a hospital to get it done.
The doctor SENDS out for the test !!!!!. Don't use a tennis ball !!!. Don't ice use heat ! All of my advice is based on 25 years of experience.

Re: To PF Veterans

Dr. Z on 7/06/04 at 16:29 (154648)

Elyse B,

Please get this ultrasound testing. It will confirm without a doubt that you do have pf. I have cases with pain at the area of the insertion and no pf due to normal ultrasound but due to a local nerve entrapment.
Pauline may mean well but isn't a doctor and is giving the wrong opinion about ultrasound testing. Its ashame but I am sure she has good intentions

Re: To PF Veterans

Pauline on 7/06/04 at 16:29 (154649)

I think he would say that because he wanted to sell you orthotics. Who really knows.

One last question? Do you know for certain that you are not diabetic???

As far as the nervous breakdown goes, I think we've all been on the brink, maybe some even went over, but we also all lived to tell about it:*

Re: To PF Veterans

lauriel on 7/06/04 at 17:54 (154655)

Dr Z, why use heat instead of ice?? and no tennis ball?? sinc ethey make those knobbles round things for PF.

thanks

laurie

Re: To PF Veterans

Marty in SLC on 7/06/04 at 18:06 (154660)

wonder how many cases of pf is really some sort of nerve entrapment? Nerve entrapment seems to me to be hard to narrow down and this is why so many suffer so long and who know maybe the nerve entrapment works itself out it time and we think we fixed it with all our night splints massages etc.

Hang in there with all the doctors you have to deal with, I know this is the hardest thing for me too.

Marty

Re: To PF Veterans

Dr. Z on 7/06/04 at 18:37 (154662)

Ice is used for an acute injury. The old saying is RICE. Rest, Ice , Compression, and elevation this for the first 24 hours to control excessive swelling. Heat is then used to promote blood flow and healing
Pressing a tennis ball against an already injuried ares can cause uncontrolled injury and pain. If you want ot use a tennis ball use it with very little weight bearing and distal to the insertion of the plantar fascia. I hope that is clear and makes sense to you.
Ice is used to make the pain go away by being an analgesic but constricts blood flow to an injury.

Re: To PF Veterans

elyse b on 7/06/04 at 20:05 (154674)

that is very funny that you say that Pauline. I was just diagnosed with central retinal occlusion to add to my PF. I have some clogging of the arteries or veins of my left eye which has left a film over it. It is necessary to find the systemic cause of the clogging and one of the tests is for diabetes. It would be interesting as I have had blood tests for years and years and never once was that mentioned. In any case, getting a bunch of heart scans, blood tests and hopefully something will turn up. Interesting to me that it happened around the same time I got PF. I hope to live to tell about this that is for sure. I will check with the doctor re: the B12

Re: To PF Veterans

elyse b on 7/06/04 at 20:07 (154675)

and how does one treat nerve entrapment? Will the ultrasound confirm nerve entrapment as opposed to PF?

Re: To PF Veterans

elyse b on 7/06/04 at 20:09 (154676)

I am not sure what you mean, the doctor sends out for the test. I am going to a hospital radiology department. I cannot believe you are advocating not using ice and tennis balls, yikes, I wish all you podiatrists sat down and would figure this out.

Re: To PF Veterans

john h on 7/06/04 at 21:04 (154685)

A very prominent foot and ankle surgeon (fellow) told me that the bottom line on nerve entrapment is you will only know for sure is through surgery. He did have me have a nerve conduction study which was positive for nerve entrapment but he said that there are many false positives on this test. He said it was clearly my choice to have TTS surgery or not but most foot pain similiar to PF is not entrapped nerves. In fact very little is. Statistically speaking very few of us will have TTS.

Re: To PF Veterans

Dr. Z on 7/06/04 at 21:11 (154687)

Why would you not believe this. Read the common sense

Re: To PF Veterans

Dr. Z on 7/06/04 at 21:44 (154691)

Local steriod injections, cryotherapy, RFL, and or surgery. This all depends on the location and degree of nerve problem

Re: To PF Veterans

lauriel on 7/07/04 at 11:52 (154750)

Dr Z thank you for clarifying this, I have these things called footsavers, they are half round kind of rubbery, about 3 inches in diameter to do trigger point excercises, I dont want to hurt myself so what does it mean 'distal to the insertion of the Plantar fascia?

thanks

laurie

Re: To PF Veterans

Janice N on 7/07/04 at 11:52 (154751)

The first time I saw my podiatrist he said to use heat and not ice. I had been suffering with this for over a yr at the time. He said that heat is better like Dr Z said when it is chronic and not to use ice. Just like a sprained ankle. Ice the first 24 hrs then go to using heat. I never got much relief from icing. Now if you are out on you feet for hrs at a time and the pain is really flaired or reinjure them and it becomes a situation where it is acute again then I would use ice myself for a while. Then go back to heat. But then that is me. I get two different stories from my internist sometimes. If I don't agree with something she tells me I just ask her again the next time and see what she is saying then. Not so lol Next dr might tell you to alternate ice and heat. You just never know.

Re: To PF Veterans

Pauline on 7/07/04 at 12:00 (154753)

Elyse,
My brother also has experienced central retinal occlusion so I am somewhat familiar with this condition. I'm certain you're taking the necessary steps to prevent farther damage.

My brother's was not caused by diabetes, but as you say thats on the list of tests and I think one always good to check out, but please remember I'm no doctor.

CRO is no fun and as you know needs close follow up. Its certainly one more thing that you didn't need. You'll be in my prayers.

Re: To PF Veterans

Elyse B on 7/07/04 at 13:53 (154767)

thanks Pauline, how in the world I got this I have no idea. You can trust that I am on top of it. Of course all tests showed up negative so onto the next battery of tests. Seeing a hemotolgist next week to see what we can find and having a carotid artery ultrasound next week as well. Tell me what your brother did. I know that there is not treatment for this or at least that is what I read on the internet. The most important thing is finding the cause, did they ever find the cause for your brother's CRO? Biggest fear, getting on plane 7/17 not sure if that is okay, waiting to hear from opthalmologist on Monday. Want to e-mail me offline, would love to know more about it, never heard of this before? (email removed)

Re: To PF Veterans

Pauline on 7/07/04 at 15:15 (154779)

Elyse,
Don't take this personal, but I don't backboard with anyone on this site.
My controversial status here tells me it's safer. One never knows what I will be accused of next.

I will tell you that my brother was referred to a Retina Specialist for his condition and has continued his follow up with him on a regular basis. In his case, the blockage which they feel is do to hardening of one of the tiny arteries caused the blockage. Unfortunately the CRO occurred in the macular area causing it to pucker and fluid leakage under the macular. The result has been some loss of vision. Eventually he was treated by a relatively new treatment by injection into the eye to try and stop the fluid leakage and it's resulting damage to the macular area.

The injection itself is not without risk one being permanent increased IOP causing Glaucoma. Thankfully this has not happened. The leakage has stopped, however because of the macular pucker his vision has not improved. Additionally he was put on blood thining medication, but must be monitered closely because this medication in his case can cause additional bleeding into the posterior eye chamber. It become a delicate balance of thining the blood but not causing the delicate arteries in the eye to bleed because of it, thus the Retina Specialist.

Depending on where yours occurred you too may eventually be referred to one if your doctor feels it necessary.

My medical disclaimer:
Remember I am not a doctor and this post is from personal experience and has no medical reference other than that or personal bearing on your particular eye condition or that of anyone else reading this post. Anyone having any eye problems, condition, or difficulty should seek the care of a qualified medical doctor.

Re: To PF Veterans

Elyse B on 7/07/04 at 16:02 (154784)

no problem I understand. thanks for your input. I am seeing a retina specialist and having him monitor this.

Re: To PF Veterans

john h on 7/08/04 at 10:51 (154849)

It has probably been 15 years since my eye problem. It began with some flashing lights I would see off to the side and then I began to see big floaters. This is symptomatic of a detached retina and can lead to blindness in the eye if not treated very promptly. I called a retina specialist and was advised it would be several weeks before they could see me. I explained my symptoms and they said to come to the office immediately. I did not have a detached retina and have forgot the exact diagnosis but as we age a viscous material begins to detach from the retina and can cause these scary symptoms. The Doctor said it might take a month or more for it to complete the process but generally the process would pass and all would be well and so it did I continued to have the flashing lights and floaters and did get another opinion which was the same. In some cases this can cause a detachment but not often. My cousin in his early 50's a few years ago experienced flashing lights and had a wedding to attend that weekend so he postponed seeing the Doctor for over a week. His retina was detaching and he lost his eyesight in that eye

Re: To PF Veterans

Elyse B on 7/08/04 at 12:31 (154855)

I have been diagnosed with CRVO. Saw 1 retinal specialist on July 1 and am getting a second opinion tomorrow. Of course I am going on vacation and flying so I would like to know if I can or if that would cause any issues. Naturally my original doctor is on vacation so I am seeing another retinal specialist tomorrow. Not sure if it is stress, but it seems like vision is getting a tiny bit worse. From everything I have read there is treatment for this. This is fantastic to have coupled with PF. I really don't have time to get a job as getting well is a full time job. By the way those new HIPA laws regarding privacy work REALLY well. I asked to get my records from Dr. No. 1 and they said he was on vacation and he needed to authorize it, then they said he took my records home. In the meantime, I get no records.

Re: To PF Veterans

Pauline on 7/08/04 at 13:18 (154858)

John,
You may have experienced what is called a posterior vitreous detachment. This happens in older people due to the fact that the vitreous is becoming more liquid and as such its weight pulls against the retina and the fiberous material that makes up the vitreous. While it is somewhat common in older people the same condition also can exist in younger ones too.

I've interview some as young as 12. The condition can be related to an eye injury, extreme myopia or for unknown reasons.

While some people have no problems with PVD's others have tremendous problems one being retina tears, macular holes or many who are extremely myopic can be left with many dark or solid white densities known as vitreouos opacities more commonly called 'floaters'.

A highly myopic person will have many more of these and for some they are more than annoying they actually interfere with their daily living. A pilot for instance or someone looking at a computer screen or drawing paper all day or in a microscope would have a lot of difficulty. These vitreous opacities can and often do block a persons vision stuck in various parts of the remaining solid vitreous or they can also be moving jetting from side to side, up and down constantly bumping into one another on a regular basis with every eye movement.

One of the worst to be left behind following a PVD is called the Weiss Ring. This 'floater', vitreous opacity, is one of the largest and most dense because it is the vitreous that encircles the optic nerve. That is where the vitreous material is the thickest. The entire thing comes off clean at times and when Opthologmist see a Weiss Ring they know immediately a PVD has occurred. The patient sees this floater as a large dense black moving spot hanging on what appears like a bungee cord, but is actually one or many of the fibers that make up the vitreous. It is almost always in constant motion swinging back and forth in a person's direct line of vision from its attached location somewhere at the rim of the back capsule.

I've spoken to many people that suffer with various eye problems having written stories for local media for the purpose of raising awareness and of course for raising money for research.

One gentleman I interviewd said he has so many floaters it's like looking through shaken snow globes. His condition and that of many others makes his day a living hell.

From my research and interviews, I've found out that many people simply brush 'floaters' aside as a normal happening not realizing the difficulty many people round the world have because of this condition.

The highly myopic are usually the ones that suffer the most, however, since the development of Lasik surgery many post surgery patients now find themselves with major problematic vitreous opacities as do some cataract patients after lens removal.

Currently no simple or really safe treatment for this condition is available. In the most serious cases occassionally one will find a sympathic Retina Surgeon willing to perform a vitrectomy to remove the contaminated vitreous. This surgery carries with it high risks, one being blindness, thus the benefit of the surgery is heavily weighed against the risks. You will find most Retina Surgeons try to avoid doing FOV's (Floater Only Vitrectomies).

In addition to risks involved with the surgery itself, comes the probability of cataract formation within a year's time. That then leads to an additional surgery on the same eye, an artificial lens implant. Because not all of the vitreous can be totally removed any remaining pieces can and do break off following cataract surgery and the patient is back to square one again only this time there is no vitreous to support the dense opacities only thin aqueous fluid. The new floaters appear larger, darker and move faster.

So to end this post, I'll simply say that anyone who thinks people who complain about floaters are alike are mistaken. Many people suffer terribly on a daily basis, so much so that they have lost their jobs because of them. They also suffer a great deal of depression and anxiety because of the constant movement that they cannot turn off. If you have a family member or friend with this condition please try to understand there are 'floaters' and then there are 'FLOATERS'. A hug and understanding goes a long way.

Currently in England research is under way to try and stop myopia from developing in the unborn fetus, while here in the states research is underway to try and keep the vitreous solid for life. Both these research projects are aimed at stopping eye problems before they begin.

I don't know how many of you know that myopia is the third higest cause of blindness in the world. If they are successful at stopping the elongation
of the eye they not only cure myopia, but a lot of other conditions as well.

My Medical Disclaimer:
I am not a Doctor. The above post is taken from over 2 years of my personal research on eye conditions for use in public media to raise awareness and support for eye rearch. It's purpose is intended to raise public awareness and anyone who experiences any condition similar to anything mentioned in this post should seek the advice of a medical doctor. Eye conditions of any kind should not be self diagnosed or self treated.

Re: To PF Veterans

Dr. Z on 7/08/04 at 16:41 (154875)

Pauline,

Very eye opening ( no pun intended). This is something that no one can really understand what it must be like unless you go thru it yourself. We should all count our blessings.
You remind me of a very close friend who is a writer that I have known for the past fifteen years. I don't kmow why but this post made me think it was her writing this .
Good post !!

Re: To PF Veterans

john h on 7/09/04 at 10:00 (154924)

once again you are correct Pauline. It was a vitreous detachment. very easy to diagnose as they look right through the eyeball. yes it was scarry with flashing lights and large floaters. Everything cleared up in a couple of months and I have never had a problem since with floaters or flashing lights. I had never heard that an injury might cause this problem. when I was shot down in Vietnam I sustained an eye injury and had some surgery on my eye near Bankok, Thailand. My doctor was named Dr. Ball and affectionately known as Dr. Eye Ball. My surgery was performed under a local as I was required to move my eye around on command. I was operated on in a theatre type surgical room with 30-40 medical personnel sitting in the balcony above observing and of course laying on my back and awake I was observing them. This could very well have participated my viterous detachment. I prefer this scenerio than your one about 'old' people. I was back to flying combat in three weeks and could see like a hawk. You seem to know a lot about the eye. What is this all about?

Re: To PF Veterans re PVDs & Floaters

BenM on 5/11/05 at 14:06 (174723)

Pauline - I'm a year late, but need to point out that you're not correct when you say 'no simple or really safe treatment for this condition is available.' You meant to say that you personally KNOW of no treatment. In 2002 I had a simple, painless and effective laser 'zapping' of the Weiss rings and other big stuff in both eyes that resulted from PVDs. This procedure, which took literally five minutes in his office (I drove to lunch afterward), got rid of all the dense blockages and virtually restored my vision to 100%. There is some vaguely visible liquified vitreous still visible if I look into a bright sky or too white of a computer screen, but it does not interfere with my vision per se.

The opthalmologist who did the procedure is in Falls Church, VA (Washington, DC suburb), and his name is John Karickhoff. He invented the lenses for the process, and is only one of two doctors who do this, so far as he knows. He's publishing a book on the subject this year, funded by a research grant from NIH, I think.

Look him up, with my hearty recommendation.

Re: To PF Veterans re PVDs & Floaters

John H on 5/12/05 at 09:34 (174815)

About 10 years ago I developed some big floaters and flashing lights. This of course can be very scary because it is symptomatic of a detched retina. I immediately headed to the opthalmologist and was diagnosed with a vitreous detachment. It seems the vitreous gel gets more dense as we age and pulls away from the retina. The Doctor said it should clear up on its own. The floaters and flashing went on for a couple of more months and then everything cleared up as he said it would and my vision is 20/20 with glasses. I do not know what percentage of people develop this but it is not uncommon and usually develops after age 50. The only problem can come if the stringy vitreous pulls on the retina so much it detaches it. This is big time serious so one needs to be aware of this while waiting for the vitreous detachment to run it course.

My wife has now had three cold laser treatments for macular degeneration in one of her eyes. The one that has developed a leakage (wet type macular) and the cold laser treatment is designed to stop the leakage. It works in about 40% of the cases. This does not cure or improve your vision it just keeps it from getting worse. She still has some leakage but it has improved some. She will probably have three more unless the leakage stops. A new alternative treatment requires shots directly into the eyeball every few weeks for two years. She is not going that route.