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how is everyone, post eswt?

Posted by Lori S. on 11/22/04 at 00:39 (164524)

I am 7 1/2 weeks now, and set backs. My right foot is still bad, sometimes really bad. I have an appt this week, maybe theres something else wrong, stress fracture, something I dont know. It was nice to be able to walk without a limp, but..the limp has returned. It was nice to shop, and I did walk alot one day, but now im afraid to.

How long before you felt very little pain? I still stretch, and use heat, my doc says 12 weeks for anti-inflamatories, ice. I still have that pain in my ankle- just the right one now tho, its pain like having shin splints but in my ankle.

Tina, how are you doing? Did anyone ever have pain in their ankles? Do you still have swelling? lol...... guess im trying to see if im normal, tho I realize this is all about individual people, it doesnt hurt to compare notes. Anyways, I am hoping for a better tomorrow,,,, for everyone ....
best wishes,

Re: how is everyone, post eswt?

Tina H on 11/22/04 at 08:19 (164533)

Hi Lori- I was doing pretty well however the past few days I've started having morning pain again, not sure why. My load bearing activity level has actually decreased as my field hockey coaching season is over. The only thing that I can think of is that I've stopped taking anti-inflammatories. I was taking Bextra for three years and decided it was enough with all the hoopla. Maybe I'll have to go back to alleve because the Bextra may have been keeping the moring pain in check.
As far as the swelling, that seems to be almost gone, unless I'm on my feet all day. My ankle still seems stiff. I'm too scared to have another treatment of ESWT at this point. It will be intresting to see if the autologous platelet injections work in larger scale trials. I think I will wait for that. Hope you will be doing better soon. So far for me the most improvement occurred between week 12 - 16. Tina

Re: how is everyone, post eswt?

Dr. Z on 11/22/04 at 09:26 (164535)

Try using the plantar fascia stretch that we have been talking about. It really helps but you need to keep with it for at least six weeks. Good for morning pain

Re: how is everyone, post eswt?

Tiger1 on 11/22/04 at 13:42 (164546)

I'm three weeks post ESWT and I feel worse. My ankles are swollen and the muscles in my legs and in particular around my ankles are killing me. They are so sore, i find it difficult to rub any creams into them. My right foot wasnt too bad before ESWT but now its catching up on my left. I am in pain every moment my feet are on the ground. No type of anti-inflammatories work for me, neither do any painkillers. Can anyone offer any help PLEASE. Depression is setting fast. Thank You.

Re: how is everyone, post eswt?

vince on 11/22/04 at 19:22 (164561)

Would you tell us whether you were treated with the Ossatron or the Dornier?

Re: how is everyone, post eswt?

Tina H on 11/22/04 at 20:20 (164567)

Tiger- Hang in there. This is exactly what I was feeling like around 3 weeks. Just try not to over do it. Rest, drink lots of H2O, take your vitamens and keep up with the normal pf routine, night splint, non load bearing stretching, etc. Most doctors advise against taking anti-inflammatories at this point. Unfortunately, what got me through this stage was just staying off of my feet. Swimming at this stage seemed to help a great deal. Good Luck, Tina

Re: how is everyone, post eswt?

Tina H on 11/22/04 at 20:23 (164568)

Thanks, As soon as Julie gets this posted under Yoga, I will try it. I did try it from your recent instructions, but I didn't feel like anything was happening. Can I use my knuckles instead of my palm to rub the foot?
I have carpel tunnel in that hand and I don't like to overextend my wrist more than I have to. Thank you, Tina

Re: how is everyone, post eswt?

Dr. Z on 11/22/04 at 20:35 (164569)

knuckles will work

Re: how is everyone, post eswt?

Lori S. on 11/22/04 at 23:49 (164584)


Around the 4 to 5 week period I was in alot more pain. My doctor told me there could be a calm before the storm, and there was. Heres what I did,
1. Stayed off my feet as much as possible, including keeping my feet up on the couch level, not on the floor when I was sitting.
2. heat, hot soaks, heating pad, which ever felt better, seems moist heat worked better for me , but it just depended on the day.
3. I was taking pain meds - loritab 7.5/500, no anti-inflamatories or ice per my doc for 12 weeks
4. I found that sleeping with a pillow under my feet helped a great deal at night
5. massage, massaging my feet helped a lot too, I massage my feet several times a day
6.I use the fascia stretch Dr.Z posted awhile ago, it really did realieve alot of pain during that period, do other stretches per your docs orders, but dont overdo them, when my feet were really bad at that point, I took my stretching very easy.

I have had some sort of setback, but today is a better day. I think you may be experiencing the storm part of post eswt. Mine lasted about 2 weeks, then I felt alot better, I am still improved over what I was like before eswt, and theres still time to get better, keep your chin up and take care of your feet, baby them.
Hope something here helps,

Re: how is everyone, post eswt?

Lori S. on 11/22/04 at 23:54 (164585)


I saw my doc today, alot of my current pain is due to another tendon, we are dealing with that now. I was told no anti-inflamatories for 12 weeks after eswt. I still feel I have improved greatly since eswt, and would do it again. I couldnt walk before, I was to the point of considering a wheelchair. I guess we just keep hoping for more improvement. I do hope you start feeling better. Like Dr.Z said, try the stretch, it really seems to help me alot, I just read and reread how it was explained and tried it until I felt I was doing what helped me feel better.

I actually have had a couple pain-free days about 10 days ago, it was wonderful. Hope you keep improving, and keep in touch!

Re: PF stretch update for Tina and scottr

Julie on 11/23/04 at 03:00 (164588)


I've written the exercise up and Dr Z has approved it. Scott has it and I'm sure he will post it soon. Meanwhile, I'll copy the instructions below.

If you have to use your knuckles, don't dig in. Be gentle! You won't 'feel anything happening' - it's not that kind of exercise. It will work (if it works) with consistent daily practice over a period of time. The people in the trial were asked to practise it ten times, for ten seconds each, three times a day for eight weeks. The results were encouraging: over 50% reported significant improvement. 'After eight weeks of treatment the group managed with plantar fascia stretching exercises exhibited enhanced outcomes with regard to pain, function, and overall satisfaction compared with those of the group managed with standard Achilles tendon-stretching exercises.'

Here are the instructions:


Here is another exercise that you may find helpful. It has been described several times on the board by Dr Z, and has been found in a randomized trial to be an effective non-weight-bearing exercise for plantar fasciitis. We are including it here so that it has a permanent place on the website.

The exercise should be done first thing in the morning, before taking the first step, in order to reduce first step pain. It should also be done two more times during the day.

I will describe the exercise for the right foot. If it's your left foot that is painful, just reverse the instructions.

Sit upright on the edge of your bed (but see Note below *)

Cross your right foot over your left leg, and rest the ankle on the left thigh just above the knee.

Using your right hand, place your fingers across the base of your toes, and gently pull them towards your shin until you feel a stretch through the arch. If you find this painful, do it more gently.

Hold the stretch for ten seconds, and repeat it ten times, three times a day.

While holding the stretch, use the heel of your left hand to gently massage the sole of the foot from the middle of the arch towards the ball of the foot. (This massaging action is Dr Z's addition to the exercise described in the research article. We both feel it enhances the stretch. If you find it at all painful, do it more gently.)

* Note: sitting on the edge of the bed can be a strain on the lower back, especially if the bed is low and/or soft. It is really better to sit on a straight-backed chair. If your hips sink below the level of your knees when you sit on the bed, it will almost certainly be bad for your back - so sit on a chair. Place the chair close to your bed to that you can do the exercise before you take your first steps.

Re: PF stretch update for Tina and scottr

Tina H on 11/23/04 at 06:38 (164591)

Thanks Julie- This seems to be what I was doing. Now I am more confident that I was doing it properly. I've decided to do it in the morning before getting out of bed and everytime I sit at the computer and before going to bed, that should do it! Thank you, Tina

Re: PF stretch update for Tina and scottr

Julie on 11/23/04 at 06:58 (164593)


I think it sounds like a useful stretching exercise, and I hope it will help you. But don't forget the importance of strengthening the entire foot musculature. The yoga foot exercises contribute to that overall strengthening, as of course do the foot trainer exercises.

I'm glad that the study from which the exercise comes has confirmed that there is a better way of stretching than the weight-bearing calf-and
-achilles stretching exercise against a wall that has been prescribed for pf for so long. (This is my particular bee-in-the-bonnet, as I have always believed that this exercise makes many if not most people with PF worse, and have been de-recommending it ever since I came to heelspurs.) But I do think that stretching, though important, can be over-emphasised. Strengthening is equally important.

Re: PF stretch update for Tina and scottr

Tina H on 11/23/04 at 08:59 (164595)

I totally agree with you! The worst stretch that I tried and deeply regretted after, was the foot hanging over the step stretch ouch! Thanks again, Tina

Re: PF stretch update for Tina and scottr

Buck T. on 11/23/04 at 15:54 (164612)

Hi Julie: I was instructed in physical therapy to do weight bearing stretches that caused horrific pain. I told PT it was killing me. She wrote note to doctor saying I had low pain threshold and was a whinner. Since then, he's changed mind about weight bearing stretches. I switched to the yoga and swimming with better results. I wonder how many are still going down that wrong avenue.

Sincerely, Buck T.

Re: PF stretch update for Tina and scottr

Julie on 11/23/04 at 16:19 (164618)

Hi Buck

Lots, I should think. The article that Dr Rompe told us about the other day is the first sign I have seen that podiatrists are beginning to realise that weight-bearing stretching is not helpful. I think the message will take a long, long time to filter down to the troops. But eventually, perhaps, it will.

Meanwhile, I have been pursuing my one-person campaign against the wall stretch and the hanging-off-the-stair stretch that caused Tina (and many others) so much grief. When I finally hang up my Birkenstocks one of the things I will be pleased about is that I succeeded here at heelspurs in steering people away from them. :)

I'm glad you are doing well, Buck. Take care,

Re: PF stretch update for Tina and scottr

Tina H on 11/23/04 at 17:57 (164625)

Yes it might be catching up with the podiatrists, because my new one told me only to do the straight leg (sitting) towel stretch. I do like Dr. Z's stretch, it's easy and doesn't require a thing and can be done basically any where. I'm thinking of those long car/plane rides everyone will be taking over the holidays.

Re: PF stretch

Scott R on 11/23/04 at 18:38 (164627)

A lack of flexibility in the calf muscles is well-known both theoretically and experimentally to be a cause of plantar fasciitis and achilles tendonitis. I have been helped a great deal by calf muscle stretching and the injury returns if i do not keep it up. Night splints help because they stretch the calf muscles.

Some studies show surgery is 90% successful. Surgery is not generally a 90% success so i wonder about this study eventhough they kept the methodology simple and the reporting clear and complete. I would like to see follow up research by doctors who expect calf-muscle stretching to be better (since this group expected the plantar fascia stretch to be better).

I had 5 complaints with the research:
1) If more patients had tried and been helped by calf muscle stretching than fascia stretching before the start of the study, then this biases the study against calf muscle stretching because those who had been helped by calf muscle stretching were automatically excluded from the results. They did not say if the patients had tried calf muscle stretching before the start of the study (other than night splints or possibly lumping it in 'exercises) and they did not list calf stretching as exclusion criteria. It is impossible to say if this was a lack of competence or integrity on the part of researchers and article reviewers.

2) All patients had to be very sensitive to pressure. This means they did not study plantar fasciitis, but they studied a subset of patients with plantar fasciitis. I do not think 'sensitive to the touch' is a prerequisite defining symptom of PF or 'chronic heel pain' as stated int he title of the study.

3) Inserts were used that may have raised the heels. This would have made stretching the calf muscles less beneficial since a raised heel makes up for and masks the need for calf muscle stretching. Heel pain would return if the insert use is discontinued.

4) Wall stretching was used which is sure to be the least effective method of calf-muscle stretching.

5) They expected plantar stretching to be more beneficial.

Re: PF stretch - ScottR

Julie on 11/24/04 at 02:07 (164653)


Thanks for posting these points, Scott. But I hope your reservation about the research doesn't mean that you aren't going to give Dr Z's plantar fascia stretch a permanent home on the board (I see you haven't posted it yet at the end of the yoga foot exercise post)? Although shortened calf muscles play a contributory part in so many cases of PF, strong (i.e. weight-bearing) calf muscle stretching is not necessary or appropriate for everyone, and several people have already found the exercise described by Dr Z and in the article helpful. I was asked to write clear instructions for it, and have done that - now it needs to be put somewhere where people can find it, and I thought the end of the yoga post, to which there is a long-established link, was a good place for it.

My view is that stretching, though important, is over-emphasised as a treatment for pf. Strengthening (of the entire foot musculature) is equally important, but is almost never suggested. The Foot Trainer, and the yoga exercises, especially the toe curling/stretching one, which are strengthening exercises, are the exception. However, the new PF stretch, which was first introduced by Dr Z, has been found helpful by people here, and I do think it should be given a permanent place on the board.

Re: PF stretch - ScottR

Scott R on 11/24/04 at 09:19 (164662)

I'm unable to add it to the yoga post. I can make a link to it like yoga, but you have to choose a link phrase.


Re: PF stretch - ScottR

Julie on 11/24/04 at 11:18 (164665)

Could you make it possible for me to revise the yoga post as you did once before? I think it belongs there if at all possible.

If that's not possible, I'll try to think of something. It shouldn't be anything with PF or Plantar Fasciitis or Stretch in the title, as those words appear in practically every post and the boards would become irritatingly sprinkled with links.

Re: how is everyone, post eswt?

Tiger on 11/26/04 at 02:57 (164724)

Thank you Lori and Tina H for the encouragement. You have given me hope again.I have an MRI early December and I will have to take it from there. In the meantime, hopefully, it IS the storm before the calm! thanks again. Tiger

Re: how is everyone, post eswt?

joeW on 12/09/04 at 15:11 (165405)

Dornier last Thursday, I feel better already, 30-40%.

Re: PF stretch update for Tina and scottr

Les S on 2/03/05 at 20:15 (168444)

I will try the strech and see how it goes. If I am on my feet all day, I can hardly walk by 3pm.