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Question for Robert J

Posted by Curt on 12/13/04 at 10:35 (165558)


I was wondering about trying what you did for your feet. I also have no first step pain. My pain is in the front of my heels somewhat in the arches. The more I stand or walk the worse it gets. But if I rest them a long time or when I get up in the morning they feel the best. If I use orthotics it basically hurts where the arch support presses on my feet. Without orthotics I notice the pain more in my heels. Did you have this when you quit your orthotics? Also, did your feet hurt a lot more when you started this program and then slowly get better? I can put up with more pain for awhile if I know I'm helping them in the long run so I was wondering how much yours hurt when you started working them.



Re: Question for Robert J

Robert J on 12/13/04 at 12:52 (165561)

That's an interesting question about the degree of increased pain at the start of an exercise program. In the New Yorker article about the Harvard back clinic, the doctors said patients had to be prepared for an initial increase in pain that would subside in fairly short order. I don't recall them attempting to quantify the pain but clearly the amount of increased discomfort is an issue.

So how much is too much, and how does anyone compare feet to lower backs? I'm afraid I dunno. For me, the issue did not arise because 1) I started the exercise regime at a very conservative level and 2)I did not experience any increase in pain. I EXPECTED an increase but didn't get it, which, I think, is important. For months I had been protecting my feet at all costs, even sitting in the shower, in the belief that rest, rest, rest was the way to recovery. In that mentality, the flip side says that any exercise, or stress, is bad.

For me, it didn't turn out that way. I was intially startled that the exercises didn't produce any increased pain reaction. In the beginning the paid remained about the same as before. Then slowly--I'd say over a month to six weeks--the pain went into decline. I kept increasing the exercise level and walking level. Finally, I was out of the woods.

As for orthotics, they never helped me and never particularly hurt. I wore them for months. I also went through periods of taping 2-3 times a day. The tape helped very briefly but then stretched, even the non-stretching type.

I think both orthotics and tape functioned--for me--like a back brace. They helped a little and temporarily but, in the end, they left the muscles and other tissues weaker. At least, that's my theory.

When I stopped the taping and orthotics, I was careful and took it very easy for several days. But, again, I did not have a bad reaction.

On the whole, my experience seemed miraculous, as if the answer had been sitting there all the time. Irony of ironies, this approach of increased exercise was simple and free. I figure I spent $3000 on various docs, orthotics, tests and remedies over 2.5 year. And none of it helped.

I'm still not sure if I am unique, or what. If you give this approach a try, I would love to know about the results.

Re: Question for Robert J

Curt on 12/13/04 at 15:49 (165570)

Thanks for the response. I'm not sure what I'm going to do. When I started walking without the orthotics and walking around the house barefoot, I have to say it hurt more and got worse. So today I put my mild orthotics back in and it feels a little better although it still hurts like always. But like you, I've been babying my feet for two years will nothing to show for it so I figure I have nothing to lose except maybe making them worse. I thought maybe yours got worse before they got better so I would have some hope! I try not to be negative about my feet but it's hard when nothing works and the cryo procedure on had on my right foot actually made it worse, even though I was assured it wouldn't do that. I think about the ESWT but I'm afraid it will really screw me up with my luck. What's the saying, '!@@#$ if you do, !@#$ if you don't'!

Re: Question for Robert J

Julie on 12/14/04 at 04:33 (165596)

Robert, from all you've said it sounds to me as though you worked out the right kind of exercise, and that was strengthening exercise. I hope everyone read and took in your post, which addressed an issue I feel is increasingly important: there is simply not enough emphasis on *strengthening and too much on stretching (that can be important too, though not in every case, but strengthening is surely important in every case.)

I don't think I agree that orthotics and taping contribute to the weakening of muscles and other tissues. Both function as support, so giving the injured fascia a chance to heal; and as a corrective (especially orthotics) to misalignments which worsen the problem. It is perfectly possible to work on strengthening the intrinsic foot muscles while using orthotics and/or tape), and it might even be the case that once the feet ARE strong enough, the correction will no longer be needed (I doubt that, but it's possible). I would guess that if you experienced weakening of muscles, the complete rest that you now realise was a bad idea, was the more likely cause.

Re: Question for Robert J

Julie on 12/14/04 at 04:37 (165597)

Curt, if walking barefoot hurts you, I think that really is a sign that you shouldn't be doing it. But on the other hand, complete rest does lead to weakening/atrophy of muscle tissue, so you do need to exercise. I'm sure you could do worse than follow Robert's exercise programme (did you see the post in which he described the exercises he used?) The exercises he described are good strengthening exercises; so are the yoga foot exercises. And have you investigated the Foot Trainer. If this doesn't come up as a link, the website is http://www.foottrainer.com .

Re: Question for Robert J

Curt on 12/14/04 at 08:37 (165606)


Thanks for the response. Yes, I did see Robert's exercises and have looked at the foot trainers. I have trained with weights for over 25 years so I know quite a bit about strength training but it's different when you are dealing with an injured area. Increasing strength on a healthy bodypart is a matter of overload and then adequate rest. There seems to be a fine line on an injured area between enough overload to get an adaptive response or too much to reinjure. But I'm going to keep trying and hopefully work out a program that helps without hindering.

Re: Question for Robert J

Robert J on 12/14/04 at 12:01 (165617)

Curt and Julie:

I agree that orthotics can indeed help some PF people, as can taping. Right or wrong, it's my theory that we group several injuries as 'PF' on this board and tend to generalise about them rather than recognizing that different people have significantly different injuries that will respond to different treatment approaches. In my case, I know that SOMETHING went wrong with the bottom of my foot but I am not at all sure that it was the plantar fascia. I have those doubts because my symptons were significantly different from many of this board and I failed to respond to a host of remedies for PF that were offered by doctors and others. Yet I did respond favorably to a treatment that, I suspect, would worsen the condition of others.

Anyway, I will try to find the link to the New Yorker article for Curt. It was fascinating to me because the approach is based on a theory of orthopedic injuries that I had never seen before. That theory being that some injuries become self-perpetuating through rest and other protective approaches. If this guy hadn't been from Harvard and hadn't demonstrated the results of this theory, I would have thought he was a kook. I'll send the ref if I can find it.

Re: Re:Robert and Curt

Julie on 12/15/04 at 02:23 (165644)

Robert, I think you are right. A lot of generalising goes on about 'PF', a loosely used term which probably does encompass varous conditions. Apart from that, people arrive at this message board with different sorts of heel pain and other foot pain, perhaps having been misdiagnosed by inexpert doctors, or not having been diagnosed at all, and proceed to make assumptions about what is the matter with them and how they should treat it. They self-diagnose and then start trying whatever helped someone else - a scattered approach to healing which has always concerned me. It has ceased to surprise me that so many people get nowhere with their self-treatment. There probably are many cases of genuinely recalcitrant PF, after years of reading here I have come to suspect that problems frequently arise from the hit-or-miss approach to self-treatment.

I am so glad that you found an approach that worked for you, and if you do find the link to the New Yorker article, I will be very interested to read it. It has been really refreshing to read your posts. The big thing that I hope others who have read them have taken away from them is that it is vital to work at strengthening the foot muscles. For you, walking barefoot worked, for others it might not, but there is plenty of non-weightbearing strengthening exercise for feet and it would be wonderful if more folks turned in that direction.

Curt, you're absolutely right. I think strength training for injured feet is a very different matter from strength training for other body parts, because that 'fine line' is not available in weightbearing exercise: if you're walking for strength, for instance, ALL your weight is on the injured foot: there's no way of finding the fine line. So if weightbearing exercise is wrong for you, you need to sort out a non-weightbearing strengthening programme for yourself: ergo, most of Robert's exercises, the yoga exercises - and the Foot Trainer, an excellent device.