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my fourteen-year-old nephew has PF - opinions please

Posted by Kathy G on 8/05/04 at 15:56 (157009)

He developed PF in one foot and bi-lateral Achilles Tendonitis. The doctor told him to do the towel stretches, the wall stretches and to ice, take Motrin and rest the foot. He also suggested Birks, which of course, he would have no part of. He recommended running shoes as my nephew currently wears basketball shoes.

The doctor, a family practitioner, mentioned that since my nephew has just gone through a huge growth spurt, and I'm talking maybe two inches in the last six weeks, this might have contributed but he said he wasn't sure.

The pain started following basketball camp. My nephew is not very active and I personally think that the unusual activity might have contributed. He also has a 'knotted muscle' in one calf.

My questions:

I figure that if the majority of people who get PF get over it, the posters on this Board probably represent a very small percentage of the people with PF. Since those stupid wall exercises and towel stretches are so commonly recommended by physical therapists, do you think that for the majority of people, they are all right to do? I have to see, but I think the towel stretches are the ones that Julie recommends.

Secondly, my husband recently gave my nephew his old mountain bike. It's a good one, a Fujii, and has eighteen speeds. Riding the bike is one of the few physcial activities that my nephew seems to enjoy. Can he continue to ride?

Third, and I promise the last, should he get motion control running shoes? For me personally, with chronic PF and Achilles tendonitis, I found that the motion control shoes excacerbated the pain in my calf and my achilles tendonitis. I wear a neutral, cushioned running shoe, in my case, Asics Gel Cumulus. Are the New Balance that posters seem to like motion control?

Thanks for any input. I want him to get better but I don't want to discourage him from participating in any activity that's permissible. My sister knows that she may have to see a podiatrist but she has a lousy insurance policy and is hoping that she won't have to do that.

Re: my fourteen-year-old nephew has PF - opinions please

Julie on 8/05/04 at 16:18 (157014)

Hi Kathy

No, I don't recommend the towel stretches (pulling on a towel which is looped around the ball of the foot). Is that the one you mean, or the one where you try to pick up a towel with your toes? I don't recommend that one either, and Mike Wilmot of Foot Trainer fame doesn't either.

He shouldn't do the wall stretch. It's all right for fully fit people to do, but ff his Achilles tendons are inflamed, it's likely to make matters worse. Given that his problem is the result of injury, I really think he should rest until the tendons are less inflamed. At his age, and if the injury isn't that serious, it shouldn't take long. Then - non weight-bearing exercise until weight-bearing activity no longer hurts.

I would guess that riding his bike will hurt right now, but if it does he will find that out for himself and probably back off without being advised to. Does he swim? If he enjoys that, it's probably the best exercise for now.

Re: my fourteen-year-old nephew has PF - opinions please

Pete on 8/05/04 at 19:27 (157021)

I seem to recall reading somewhere that mid-teenagers were prone to heel problems due to the growth spurts you mention. When I was that age (long time ago) and used to play a lot of soccer I also had heel pain where it joins the achilles. It was painful but passed in a couple of months without any form of treatment other than playing a little less sport. It was also nothing compared to the pains my feet have given me these last 4 years !

Re: my fourteen-year-old nephew has PF - opinions please

Ed Davis, DPM on 8/05/04 at 22:54 (157035)

PF is not very common in 14 year olds. Be sure that the growth plate in the heel bone is checked to make sure it is not calcaneal apophysitis (inflammation of the heel's growth plate).
The growth plate is usually closed by age 13 although that can vary.
Calcaneal apophysitis can display symptoms similar to PF and achilles tendinitis.

Re: my fourteen-year-old nephew has PF - opinions please

Ed Davis, DPM on 8/05/04 at 22:56 (157036)

PS If an x-ray shows a growth plate that is still not closed, then calcaneal apophysitis is more likely.

Re: my fourteen-year-old nephew has PF - opinions please

Kathy G on 8/06/04 at 08:54 (157055)

Thanks, Ed, I think she will have to just bit the bullet and bring him to a Pod if this continues.

Julie, I stand corrected. As it is, I've told her not to let him do the wall exercises and I'm going over there today to show him your exercises.

I agree that he should ride his bike if it doesn't hurt. Since getting him to do anything physical is a challenge, if we say he can't do something, he'll just baby himself to death. He's just a sedentary person and unlike my children at that age. My sister does her best to keep him active and she was thrilled that he liked the bike. And yes, they have an above-ground pool which he seems to like.

Pete, I remember my achilles tendon hurting when I was a kid, too. For me, the most unathletic person in the world, it was always a result of running races. I had the distinction of being the fastest runner in my school until I was in sixth grade and Charlie Slack moved in with his six foot body, could outrun me! But I was always willing to accept his challenges and try to beat him. Never did, though.

Thanks for the advice, all!

Re: my fourteen-year-old nephew has PF - opinions please

Julie on 8/06/04 at 10:39 (157071)

Hi again Kathy

I dunno. My instincts tell me that with his inflamed tendons and a questionable PF diagnosis he should go easy on all exercise for the moment. Given Ed's reservations about the diagnosis, I think your instincts about going to a podiatrist are correct. Diagnosis first, then treatment.

The heel lift sounds a good idea. Good for Richard.

Re: my fourteen-year-old nephew has PF - opinions please

HelenEC on 8/06/04 at 15:43 (157085)

I'm not a doctor - this is solely from my own experience of me and those around me. When a lad puts on a growth spurt, he tends to get really awkward because his limbs do genuinely outgrow (temporarily) his ability to keep track of them. If he's been at a basketball camp, I'll bet he's been making all sorts of unexpected moves - any number of which could have resulted in damage to his feet.

Ask him if he recalls getting a terrible cramp, or series of cramps, in the leg with the knotted muscle and then a day or so later found the foot hurt at the heel when he walked on it. I don't know if the cramp is a cause of the damage, or a symptom of it, but it seems to mark the point where you do a 'sudden' injury resulting in heel pain.

If his basketball shoes are like my daughter's Chuck Taylor Converse Allstars, he could do with some Shock Doctors or some such in the heels, as they don't seem to have much padding in the soles, and they are very flat, which puts a strain on the arch of the foot, especially impacting on a hard floor like a basketball court.

He would also benefit (although I doubt you'll persuade him to it) when he has rested up a bit, in taking up a course of Hatha Yoga, as it stretches you gently from your neck to your toes, and all the tendons and ligaments are all interconnected, and benefit from being stretched together as well as individually. If he has a generally awkward gait - I know all teenagers do, but tall boys seem to be particular sufferers - training in the Alexander technique now could save a lot of grief later.