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Not sure what to do? Please help if you can.

Posted by Dud on 1/11/05 at 13:35 (166902)

Here is my long story. I am a 31 M, and 2 years ago I developed PF in both feet during my training for a marathon. Prior to then, I never had any problems with my feet. I have always been extremely active, including long distance running.

For 1 and 1/2 years, my doctor tried most of the conservative treatments - orthotics, strething, anti-inflammatories, ice, rest, etc. It never got better. He did a nerve test in March 2004 to rule out a nerve problem and it was negative. In 06/2004 I had ESWT on my right foot. In 09/2004 I had ESWT on my left foot.

Here we are several months post ESWT. In 08/2004 I developed this burning sensation on the Top of my right foot which is still going on. It doesn't burn all day..but most of the day. Also..I can walk about a mile on my feet and then they get incredibly 'crampy' and very sore - Like I have been running all day on them. After walking for awhile my feet get so sore I can barely walk on them.

I have a new doctor, and in the last 2 months, he has performed an MRI on both feet, a comprhensive nerve test on both feet, and a complete blood test to rule out anything underlying. The good news is that everything is 100% normal - no nerve damage, no entrapped nerves, normal blood test, normal MRI, and both of my fascia are the normal thickness.

So..the good news is that from a medical standpoint, all tests are negative. But why do my feet hurt so much?? My doctor recommended that I 'mix it up' a little by trying to go without orthotics for a while, and try some light jogging, and extensive stretching.

Can anyone relate to this? I have really babied my feet for the last 2 years and could they just be really weak? Could strengthening my feet be my cure??

Re: Strengthening should help you

Julie on 1/11/05 at 14:24 (166904)

You might be on to something, Dud (in fact I'd be willing to bet on it). If you've really 'babied' your feet for two years the muscles have weakened, and could certainly benefit from strengthening exercises, whatever the outcome. But I wouldn't myself recommend jogging, or indeed any weightbearing activity until you've improved the strength situation.

Have a look at the yoga foot exercises (click on the link) and at the Foot Trainer website, http://www.foottrainer.com . The foot trainer would be a good investment: the exercises are specifically for strengthening the intrinsic foot muscles. The yoga exercises are also very specific, and stretch as well as strengthen.

Strengthening might not be the final solution, but it certainly can't hurt to try.

If you have found your orthotics helpful, I would be inclined not to go without them - but that's my bias: others might disagree.

Take time to read the heel pain book.
.

Re: Does anyone know anything about "Medrol Dose Pack"

Dud on 1/11/05 at 14:39 (166905)

thanks for your response. I have been back on anti-infammatories in the last few weeks and they don't seem to help. My doc prescibed a 'medrol dose pack' today. I think that is an oral steroid. Since there is no medical problem per se, but just pain, I feel reluctant taking new drugs? Do you know anyting about these??

Re: Does anyone know anything about "Medrol Dose Pack"

Julie on 1/11/05 at 16:14 (166909)

No, but I'm sure you'll get a response from one of the doctors, to your question on the Ask the Doctors board.
.

Re: Does anyone know anything about "Medrol Dose Pack"

Cyndi on 1/11/05 at 22:17 (166940)

My feet hurt also Dud,

I am trying water walking and I think it will have to help. I cannot do weight-bearing either, so my DR asked me to try this. I did PT for awhile but to $, so I am joining the Y and same fee as one DR appt. So I am praying! They also have the noodles at ' Y ' to use to exercise your legs and feet like you are riding a bike, cross country skiing,etc. Just don't walk on your toes. Even the cement hurts my feet, but I am trying this.

Re: Does anyone know anything about "Medrol Dose Pack"

Cyndi on 1/11/05 at 22:18 (166941)

I also took this, but, saw no difference. Good luck, maybe it will help you!

Re: Not sure what to do? Please help if you can.

Robert J on 1/12/05 at 12:32 (166968)

Dud--

Your case sounds a bit like mine, which went on for 2.5 years as result of running and resisted most conservative treatments. I also babied my feet for most of that time. Eventually I benefited enormously from strengthening exercises and a gradual return to walking.

You did not mention many specifics about your symptoms. Is your pain worse on your first steps in the morning, or does it develop gradually through the day? Is it centered at the front of the heel or does the pain spread generally under the arch? In my case, I did not have first-step pain and I never had much pain in the heel but rather under the arch. From reading these boards, I have found that people like me seem to have little success with conservative treatments and even with ESWT. But, in my case at least, the progressive exercise approach did the trick, and I concluded I could have recovered fairly quickly from my injury if I had adopted a progressive exercise early on and then kept at it. My eventual recovery took several months once I started, but the recovery was steady.

Re: Not sure what to do? Please help if you can.

Dud on 1/12/05 at 13:53 (166973)

Thanks for replying Robert..

I do not have any first step pain in the morning. In fact, the pain is best in the mornings. My pain gets worse the more I am on my feet. I don't have much pain in my heel either. It seems to be a general pain over my arch and the outside of my foot. After walking on my feet for awhile, they are very very sore and very tender - like I have been walking for miles. If I sit down for awhile, the pain goes down a little, but never really goes away.

I have not run in 2 years...But.. I 'feel' like I could jog for 1/2 a mile or so, and the pain wouldn't be any worse - but I cannot get my nerve up to run.

I have been walking barefoot a little, but I have almost forgotten how to walk barefoot because I have always had shoes on the last 2 years..and I mean always -even in the shower.

My doctor is now recommending that I jog just a bit and do some strengthening excerices.

What kind of progressive excercise approach have you done..and do you take any pain medicine??

Re: Not sure what to do? Please help if you can.

Ejack on 1/12/05 at 14:49 (166975)

Robert,

Yes, please give us specific information about your progressive exercise program. I have the exact same symptons as both of you (and sadly have not been running for two years). I have no pain in the morning, have tried every conservative method it seems. I am actually having EPF in a month, but it reassures me that someone else out there with my symptons is seeing progress with just exercises.

Re: Not sure what to do? Please help if you can.

Robert J on 1/12/05 at 18:15 (166987)

Ejack and Dud--

About a month ago I posted a decription of my progressive exercise regime, and you can find it by searching under Robert J. As I said at that time, the specific exercises are all taken from other sources and are commonly discussed on various websites that you can also find by searching this board's archives. I dont think there's any 'magic' exercise. Any set of exercises that strengthen the intrinsic muscles of the foot will probably suffice.

My own approach was to start VERY gradually but build up steadily, even if I experienced an initial flare-up. I would not have considered jogging any distance in the beginning. After a short time of the exercises I added a progressive walking regime, again starting with very short walks and buuilding up. For me, the crucial thing was doing the exercises consistently every day and increasing the stress level on a measured basis. I measured the exercises by the number of reps. I measured walking by timing them, starting at 6 minutes (and that's one short walk). I now walk or hike anywhere I want, sometime for hours. I still haven't tried running.

Good luck with it. At some point I also posted a link to a New Yorker story on a Harvard Med School doctor who uses the same kind of progressive exercise for chronically bad backs. The story describes the theoretical basis of this approach, and it inspired me to give it a try on my feet.

Re: Not sure what to do? Please help if you can.

Kathy G on 1/13/05 at 10:06 (167038)

Dud,

Have you tried only one type of orthotic? My orthotics were modified a few months ago, and they seem much better right now. Could it be that the ones you've been wearing aren't appropriate? Have you seen a C.Ped or a Pod specifically for opinions on orthotics?

I took a Medrol dosepack a couple of times, many years ago, when my allergies were very bad. It's very good for reducing inflammation anywhere in the body because Medrol is cortisone. The problem people have cortisone is that it can make one very hyper. In my case, it didn't bother me in the least but I have a friend who painted his entire house in two days on a medrol dosepack, and he has a very big house. I think, as with all drugs, the reaction varies from person to person.

I can imagine how frustrated you are but it is good that you don't have any underlying medical problems. Now you just have to figure out how to get rid of the pain.

Re: Question for Robert J.

dud on 1/14/05 at 20:00 (167196)

Robert..I have been doing some strengthening excercises over the last few days and for the most part have been wearing my shoes with no orthotics. I have been wearting orthotics for nearly 2 years and I was kind of scared to take them out..but..the good news is the pain is not any more without the orthotics, but it is also not any less.

I have a high arch foot. When I am not wearing the orthotics with shoes..it feels like I am walking only on the outside of my feet and the heels..it feels like I am a little 'wobbly'.

I swear that both my feet now are tilted to the outside..and I know they were not like this before I started orthotics. I wonder if the orthotics could have stretched my arch too much and that is what is causing my pain? Did you have anything like this happen.

I read an article a few weeks ago that said that the first thing most Podiatrist do when the suspect PF is prescribe custom orthotics..almost out of habit. This article was from a running magazine and stated that for runners (like I was) PF is often brought on by tight hamstrings and if this is the case orthotics are NOT needed..only a good stretching program and rest. As I think back to when I developed PF, I was lifting leg weights on the days I wasn't running and I guarantee you my leg muscles were super tight..which may have lead to the PF. I am just guessing..but I bet orthotics were NOT the answer for me and by wearing them over the last 2 years I have made the problem worse.

Sorry..I am rambling now..but let me ask you, did you quit your orthotics cold turkey and have you had any 'NEW' pain since quitting them.

I have about made my mind up that I am going to shed my orthotics during the day unless my feet start killing me and I absolutely need them.

Re: Question for Robert J.

Dorothy on 1/14/05 at 20:05 (167199)

The Aaron Mattes stretching programs address this, and also the Michael Young program (he followed the Mattes' program). Young says his methods help PF and Achilles problems. Mattes is actually an educator and trainer and has a reputable name in this field. I think Mattes preceeded the Whartons and their work is based on his. You can do a search on this site for those names and find info. about them if you are interested.

Re: Question for Robert J.

Ralph on 1/14/05 at 21:53 (167211)

Dud,
I'm not a doctor but I thought that's what orthotics were designed to do, change a persons gait by realignment and redistribution of weight.

A bit of humor, but it sounds like you've been riding the orthotic horses too long:*) I wonder if your feet switch back if you avoid them.

I kind of agree with that article you mention. It seems like most of us on this site have purchased at least one pair of expensive orthotics from our Pods. Some have mentioned they tried several kinds.

I already posted about mine, can't wear them and they sit in the closet.
It certainly makes one wonder about the need for them.