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What the heck does he mean??

Posted by lisa71 on 8/25/04 at 17:13 (158692)

My doc told me to stay off my feet. At school I walk to my diff. classes and don't stand during school. At work I walk the least amount neccesary, walking on the grass if possible which helps a litte. I probably spend two hours a day on my feet. Is that too much? My feet just keep getting worse daily and it is scary cuz I don't know how bad it will be in a week or two. I don't really know what else I can do. I don't even stand in the shower any more.

Re: What the heck does he mean??

Place on 8/25/04 at 17:55 (158695)

I am not sure what he means but I have been told to stay off my feet to a point where I feel no pain throughout the day. At this point I got a wheelchair. Every doc I have seen has told me that if I am on my feet and I start to feel pain, I needed to get off of them and stay off of them for the rest of the day. I have found Icing really help prolong my time on my feet.

Re: What the heck does he mean??

Julie on 8/26/04 at 02:03 (158714)

Lisa, you haven't (as far as I can remember) said anything about your shoes. What sort of shoes are you wearing?

Whatever amount of time you spend on your feet (and we all have to be on our feet some of the time, however hard we try to 'rest' them) you need to wear good shoes with plenty of support and cushioning. No high heels. No cheap rubbish. No worn-out shoes. And they must be the right size (you'd be surprised how many people don't wear shoes the right size.) Shoes should bend only at the metatarsal (where the toes meet the ball of the foot) not in the middle. A good walking shoe or running shoe - not a flat sneaker - is usually best, but there are so many kinds, for so many different types of feet, that you need to do a lot of hunting.

If you have any doubts at all about your footgear, it would be a good idea to go to a good store where the sales people know their stuff and can understand your problem and fit you properly.

I also suggest that you investigate taping, which provides support and pain relief. There are instructions in part 2 of the heel pain book.
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Re: What the heck does he mean??

Richard, C.Ped on 8/27/04 at 07:56 (158784)

Lisa,
Do you have orthotics? If so, I hope they are not the hard plastic type. We see so many teachers with PF. The majority of them stay seated as much as possible while teaching. When we have patients that have to stand or walk alot during work, we stick with a softer orthosis. Softer does not mean less support, but more cushion.

Re: What the heck does he mean??

lisa71 on 8/28/04 at 00:18 (158844)

Julie

Thank you for your input. It has helped me alot. I just started taping today. It helped but I think it will take a little while to figure out how to do it correctly.

I saw an orthopedic surgeon who fitted me for orthotics but did not offer any more ideas for a treatment plan so after the pain came back I went to a new doc who gave me stretching exercises (wall, towel, hang off step). He told me I would be better in three weeks. Yah right I am probably twice as worse off now as I was before. I'm thinking the calf stretching did it because every time I try those now I get a sting of pain in my 'Problem areas'. I don't know if I will stay with this new guy but he seems to be a lot more knowledgeable about PF than the other one so I'll see at the follow up appointment if I'll stay with him.

Well, at least I've leaned a lesson about not overdoing it. My shoes are all flats and 'orthopedic' shoes. I don't think I could survive in heels. I'm not sure of the brand at the moment. Looked at footrainer so all those weight bearing exercises are gone.

I would stop the calf stretching all together but my doc said the reason for my pf is inflexibility which I totally agree with so I will just cut way back and add on gradually.

I guess for now I'll have to just continue with the Yoga and rolling pin and very slight calf stretch and rest and taping.

I was freaking out a bit at first but now understand the hows and whys alot more mostly because of your informative posts. So now just must be patient and try not to get too depressed. Anyways just wanted to thank you for replying with such detailed info. Thanks again.

Re: Lisa

Julie on 8/28/04 at 02:11 (158846)

I'm very glad to have been able to help.

Yes, stretching is an interesting area, to say the least. If the cause of your PF is tight calf muscles, then you do need to lengthen them, but any aggressive stretching, especially weight-bearing stretching, is likely to further injure the PF. Stick with the yoga foot movements, which seem to help most people, and do investigate the Foot Trainer. And yes: be patient. Understanding is the key: actively pursuing a treatment plan and working towards your healing, as you now are, will help you avoid getting depressed. Just remember you have everything going for you - especially your age.

Another important factor is the length of time spent applying gentle stretch. So I would suggest you investigate buying a night splint, which maintains lengthen in the calf muscles and achilles tendon over a period of several hours. The one Scott advertises on this site, the N'ice n'stretch, is supposed to be the most comfortable. You can also wear it during the day, while watching television, studying, etc - whenever you're sitting for a long time.

Taping was a life-saver for me, so I do think it's worth your persevering with. If you have any problems with it, please ask: I may be able to help.

Take care.
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Re: Lisa and question for julie or docs

Linda V. on 8/28/04 at 08:31 (158855)

hi,
i am (or was) a belly sleeper....it has been suggested to me that this position may have been at least partially responsible for my PF as my feet were in extension 8 hours a nite. any thoughts?

Re: Lisa and question for julie or docs

Julie on 8/28/04 at 11:14 (158864)

Linda

Yes, I think this is possible. Tightening/shortening of the calf muscles and achilles tendons are certainly an effect of the feet being in a plantar flexed position all night.

But it's hard to change one's sleeping habits!
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Re: Lisa and question for julie or docs

Linda V. on 8/28/04 at 17:50 (158888)

Julie,
Long before someone asked me about my sleep position...my body instinctively slid down to the bottom of the bed and i hung my feet freely over the bottom. My poor husband couldn't figure out WHAT i was up to...now trying to stay on my side or back..but its tough. I also bought some real good therlos cushioned sox..in a few sizes too small. they almost act like taping as they are clingy and provide a nice, soft support to the bottom of my feet. weird, huh?

Re: Lisa and question for julie or docs

Julie on 8/29/04 at 03:04 (158896)

Linda

That changes the picture. If your feet hang over the bottom end of the bed, they're actually in neutral, more or less, not plantar flexed, as they are when the tops of the feet press into the bed itself. (I've just tried both out on my bed to make sure.) So maybe your sleeping position isn't such a problem after all.

If you are doing the yoga foot exercises, do them when you wake up in the morning while you're still in bed. They will help undo the effect of overnight shortening, which happens to everyone.

Thorlos are terrific socks: I wear them for hillwalking. When I first found them (thanks to a recommendation on this website several years ago) I was amazed that there was a sock that actually helped support the foot - but they do. It sounds as though your too-small Thorlos are acting as a kind of compression sock.
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Re: Lisa and question for julie or docs

Linda V. on 8/29/04 at 16:05 (158928)

julie,
i was a belly sleeper for years and years..THEN developed the PF in feb..long about june, my body told me to hang my feet over in the neutral position; it just seemed like a natural thing to do for comfort. last week, my massage therapist suggested my PF might have been caused by years of sleeping on my stomache. i love the therlos sox..and actually found some little boys (i have small feet) basketball sox with a nice support too. i am trying the yoga, along with the in bed stretching suggested by that study. no more against the wall or on a step for me. that was way too rough for me.

Re: Lisa and question for julie or docs

Julie on 8/29/04 at 16:27 (158930)

That changes the picture back again! It makes sense that belly-sleeping with your feet on the bed could have contributed to your PF, and it makes sense that hanging your feet off the bed gave some relief.

It sounds as though your body knows what it needs to do, and that's good!
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Re: Lisa and question for julie or docs

john h on 8/30/04 at 09:10 (158956)

I tend to hang my feet off the bed when sleeping as it seems to help PF. I have done this for some years. I dobut sleeping with your feet on the bed would cause PF because that is the way most of the world sleeps.

Re: Lisa and question for julie or docs

john h on 8/30/04 at 09:19 (158958)

Linda: I have adjustable beds. At the end of the bed is an iror bar to hold the mattress in place when the bed is in the up position. Like you I tended to slide down and let my feet hang over. Unfortunately that bar caught the top of my foot. Over time I developed a very sore foot on top and did not know what the reason was. My Doctor was confounded. One night I awoke myself when I jerked my foot and really slammed it on the bar. After that I let my feet hang off the side and the pain on top of my foot went away. I have for most of my life slept on my stomach or in the fetal position. Maybe this all develops when we develop in our mothers womb as to how we sleep. How is that for some Psychiatric smarts? Pauline probably sleeps on her head right Pauline.?

Re: Lisa and question for julie or docs

Julie on 8/30/04 at 10:06 (158963)

But John, most people don't sleep on their fronts with the tops of their feet *on the best*. That brings the feet into extreme plantar flexion, which could be a contributory factor. That is what Linda says she was doing.
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Re: Correction: "on the BED"

Julie on 8/30/04 at 10:56 (158967)

nm

Re: Lisa and question for julie or docs

john h on 8/30/04 at 18:27 (159007)

How do we know how most people sleep. I have no clue?

Re: Plantar flexion in bed

Julie on 8/31/04 at 01:23 (159016)

John, given that there are four basic sleeping positions (front, back, right side, left side) and even assuming that the numbers of people who adopt each of those positions is not exactly equal, I think it would be safe to say that 'most people' don't sleep on their fronts. Of course the issue is far more complex: 'most people' move around in their sleep, alternating amongst the various positioning possibilities.

What I said was that when a person sleeps on his or her front, with the tops of his or her feet ON THE BED, the feet are being held in an extreme plantar flexed position. (This does not apply to people who sleep on their backs, or their right or left sides: their heels, or the sides of their feet, are in contact with the bed and are not severely plantar flexed). This has an effect on the calf muscles and achilles tendons. It increases the overnight shortening and tightening effect - which, as we know, contributes to PF, and to the first step pain that many people with PF experience. Linda, who has habitually slept in this way, asked if anyone could throw light on her massage therapist's idea that it could have contributed to her PF. I think it could have.

Linda then explained that after she got PF, and her feet started to hurt, she started hanging her feet over the bed end. This puts the feet in neutral: they are no longer in an extremity of plantar flexion. This gives relief. As you have discovered - thankfully.
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