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My PF journey and lessons learned

Posted by JimB on 8/11/04 at 23:19 (157636)

As a fairly long term PF sufferer (11 months), I have read, watched, and posted on these boards over the past 1-2 months and gained considerable insight and knowledge from everyone here. I have read Scott's Book, read the various postings by Pauline, John h, John from MN, Julie, Elyse, Dorothy, Marty from SLC, Place, Goose, and many others, each with their unique PF symptoms and history and quest for relief and recovery.

For what it is worth, I thought I would share the approach I have found to work for me in MY pursuit to recover from PF.

I had been a fairly active individual and recreational runner when I initially became diagnosed with this condition. Like many other soft tissue injuries I have incurred over the years, I put the treatment of my PF into the hands of my sports medicine doctor and physical therapist. I really didn't pay much attention to PF or their treatment plan but simply went along with their approach. I went thru months of having various treatments done including rest, icing, Vioxx, ultrasound, stretching, walking boot, night splint, cortisone shot, deep tissue massage, motion control shoes, orthotics, electro stimulation, strengthening, and a few others I can't remember. However, none of these worked. And as with most of you, I went through the usual depression and near resignation to never getting back to my former activity level. Hell, I would have been happy just to walk at work without pain. However, it was this board that gave me the information I needed to find my way to recovery. It took me a while, but it became clear to me that PF is a result of a unique set of conditions for each individual. Something I think most of you know. And the treatment for it isn't like a sprained ankle where there is a very clear and defined treatment protocol. With that in hand, I knew that I had to first understand the specific causes of MY plantar fasciitis and the specific state of MY plantar fascia tissue before I could recover. In order to do that, I first had to become knowledgeable of the PF condition and so I read everything I could on this board, in medical journals, running magazines, books, and any other information source on the Internet and elsewhere I could find. Then I determined that in order to get better, I needed to take responsibility for my condition and not blame my lack of results on my doctors. I needed to become an active participant in my recovery and in evaluating whether any healthcare provider or treatment plan was going to help me get better.

Many people here on the board speak of how a certain treatment worked or didn't work for them some say that orthotics work, others not. Some swear by TFM, while others swear at ESWT. Everyone (not just on this board, but elsewhere including me) is searching for the one treatment that will cure them. The bad news is that they will never find it. The reason is simple and something we all know. And that is that each case of PF has its unique set of causes and unique condition of their PF tissue. Some people overpronate. Some are overweight. Some have no ankle flexibility or lack flexibility in thier hips, hamstrings, or calves. Some have excessive scar tissue. Some are older and heal slower. Some have flat feet and some have high arches. And the list could go on and on. The various modalities of rest, casts, proper shoes, massage, ice, anti-inflammatories, night splints, orthotics, cortisone shots, stretching, ESWT, etc., are not cures in and of themselves. BUT, it seemed to me that with the RIGHT assessment of a person's PF condition by a trained healthcare professional that is fully skilled in treating PF, a treatment plan could be developed using any or all of these treatments in the right order, with the right intensity, at the right time to cure PF.

I read on this board about the great success some individuals had working with Dr. Sandell and what impressed me was that Dr. Sandell discussed how he took an individualistic approach to treating PF, not a standard 'out-of-the-box treatment protocol. Unfortunately, I saw the discussion on Dr. Sandell's treatment turn into a holy war over whether TFM can cure PF or not. I found these discussions/arguments rather useless and ridiculous as I am sure Dr. Sandell did as well. What Dr. Sandell himself said, in his few postings here, was that he took a comprehensive approach to fully evaluating a person's PF and then developing a specific and individualistic plan to heal PF using multiple treatments, not simply TFM.

So, using this knowledge of how Dr. Sandell had success with the individualistic approach to treating PF, I tried to find someone in my area (Seattle) that had the right experience to take the comprehensive approach to evaluating and treating my PF. This was not easy. There is no place to go to find who is good and who is not. Sure, there are Chiropractor or Podiatrist referrals from professional associations but there is no way to determine if the doctor recommended has had REAL success treating PF and would reallly think through my unique PF situation. I ran into dead end after dead end. My sports medicine doctor was unable to do anything more that go thru what he believed to be an escalating set of treatments. My family practice doctor wanted rest and more rest but just wanted to wait until my PF got better. He even said, 'In eighteen months you'll get better with no treatment at all . So, it was clear that these doctors would not help.

As I said earlier, I was a runner. So, I finally turned to the running community. I thought, if there is any group that would get PF and know who was good in the area, I thought runners might. In each major city there are one or two running stores that serve the serious runners you know, the folks that run marathons, ultras, and compete well in the local road races. I knew that the Seattle Running Company here in Washington served a large community of ultra runners so I called them and they said, 'Oh yeah, we can help. There are really only two places in the Seattle area to treat this. So on their recommendation, I called and got an appointment with Neal Goldberg (www.footworkspt.com) . And what a difference from the other treatments I received!!! On my first visit, Neal took 2 HOURS to evaluate my PF. I was his only patient. He doesn't see more than one patient at a time. He did a *thorough* evaluation of my condition taking my history, evaluating my biomechanics, assessing my tissue, flexibility, and strength, and then he video taped me on a treadmill barefoot, with running shoes, and then shoes with orthotics. He reviewed all this with me on his computer. It was not clear to him at first what to do as my particular factors were an odd combination of overpronation coupled with lack of ankle flexibility and exceedingly tight calf muscles. But he finally was able to solve the puzzle and explained why my prior efforts had failed, what was causing my condition, what could be done, and answered all questions. When someone can explain and answer every question in a clear, rational way, I have great confidence in that person. And then by simply changing my shoes, stretching my calf muscles in a certain way, adding a heel lift under my orthotics, and having Neal do various manual soft tissue therapy on my feet and calves, AFTER 4 VISITS IN TWO WEEKS MY PF IS GONE IN ONE FOOT AND NEARLY GONE IN THE OTHER FOOT.

So, what happened here? A miracle cure? A silver bullet? Do shoes make the difference? Of course not. No more than TFM or EWST or orthotics are the answer. What is the difference is that Neal has lots of *successful* experience in treating PF. This is success as proven by referrals from people who had PF and were cured, not self proclaimed success. AND he spent the time to really figure out my specific situation and causes of my PF and then create a specific plan for my specific situation rather than throw a bunch of treatments at me following some general treatment protocol and hoping for the best as did the other doctors.

I hope this lengthy post will help someone who suffers with PF. Maybe they will find something in my journey or approach that will help them find their answer and cure.

And if you live in Seattle, I would highly recommend Neal Goldberg. And if not, try calling a store that serves your local running community (not a Foot Locker type) and see who they recommend. You might just find your own Neal.

BTW - I probably won't be posting or reading much on this board in the future. But if you want to reach me via email I will reply. My email is 'jab at beebehome dot com'

Re: My PF journey and lessons learned

Julie on 8/12/04 at 04:48 (157648)

Thanks for this excellent and most useful post, Jim,

'It seemed to me that with the RIGHT assessment of a person's PF condition by a trained healthcare professional that is fully skilled in treating PF, a treatment plan could be developed using any or all of these treatments in the right order, with the right intensity, at the right time to cure PF.'

This says it all. Skilled evaluation by a knowledgeable, experienced practitioner, accurate diagnosis of the cause, and a treatment plan targetted at the cause. Your advice as to finding such a practitioner is good - to ask around in the community that is particularly susceptible to PF. It might not work for everyone (older people, sedentary people, people whose PF has already become chronic) but it's a good start.

Your description of Neal Goldberg's approach to evaluation and diagnosis interested me: it was identical to my podiatrist's approach. He takes care of two football teams (that's soccer to you folks in the States). Podiatrists who deal regularly with sports enthusiasts are probably likely to have a better handle on the conditions that afflict them, and PF is certainly one of those. It has always surprised me that not all podiatrists evaluate their patients as carefully and systematically as yours and mine - but it seems they don't, judging by what so many have said here.

I'm very glad that your PF is gone and I'm sure others will take heart from your experience and perhaps be led towards their own healing thanks to your post. There's just one thing I would like to mention to you - and please forgive me if you've already thought of it. You're a runner, and you describe your ankles as inflexible and your calves as 'exceedingly tight'. Both are common in runners who don't stretch regularly/rigorously before and after running, which is, as I'm sure you know, the great muscle-shortener (all impact exercise shortens muscles). Now that your PF is gone, and you are probably ready or almost ready to start running again, please continue stretching to maintain good length in the muscles. Ankle flexibility can be maintained with simple flexing and rotation exercises (such as I described in my post on yoga foot exercises).

Also - when there is a biomechanical reason for PF (as in your case - and mine - overpronation) it's important to continue with the treatments that have helped. My PF resolved in five months, four years ago. I have had no trouble since, and I put that down not to having been 'cured' but to continuing to do what helped, including wearing the right shoes, and orthotics.

I had to laugh at your doctor's comment about getting better without treatment in 18 months. I had an orthopedic consultant say exactly that to me. I think they lump all tendon conditions into the same bag, and in fact some of them do resolve in 18-24 months without treatment (tennis elbow, for example). What they forget is that we don't walk on our elbows or our shoulders, so we don't keep re-injuring them.

Thanks again for your good post.

Re: Consultation with Marathon doc

Cyndi T. on 8/16/04 at 11:57 (158091)

Jim, that is great news that your PF is almost healed! I think that this is a good place to share my story. After three podiatrists, an acupuncturist, an orthopedist, and two chiropractors, I finally came up with the idea to consult an expert in running. This doctor is the medical director of the Houston Marathon! What a difference it was to visit with him. He also gave a thorough (2 hr.) evaluation which was just as you described, and I now have a better understanding of the biomechanical causes of my PF and what treatment plan to follow. In my case, I learned that the inverter muscles in my feet are weak, in addition to hip flexor and piriformis muscles. I have recently begun a physical therapy program that is addressing the whole body, not just the feet. It was explained to me that I can't fix the feet without fixing the weakness in the hip and vice versa. It has only been two weeks and I am already seeing improvement. For those of you who have not had any luck with doctors so far and are thinking of seeing someone else, my suggestion is that you contact the closest city that has a marathon and ask who their medical director is. If you are not close to a large city with a marathon, then take Jim's advice and ask for referrals at a serious running store.