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2 days post op

Posted by suebee on 2/10/05 at 17:43 (168857)

Had my open fasciotomy on Tuesday, Feb 8. I seem to be doing ok, with the exception of sore muscles from the crutches, a little swelling of the foot and a little pain. Reading all the stories here scares me a bit because my POD said I would be good as new in a few weeks with only 2 weeks off work. I do work in a veterinary clinic so I am constantly on the run helping the vet. Now I wonder if I will ever be the same. Kinda scary. I am doing everything the POD told me to do.
Thanks for listening.

Re: 2 days post op

bryn on 2/11/05 at 11:46 (168897)

Had my open fasciotomy on Feb. 3 last Thursday. I am doing fine pain wise.
I also had a nerve snipped in my other foot so i am on crutches trying to balance on one heel. I am a nurse and will be going back to work in 2 weeks. I am on my feet all the time to. I will be in a boot cast at the time. I am also interested in recovery times and what to expect. Reading the posts here have made it kind of scary.
Thanks

Re: 2 days post op

Mike C on 2/12/05 at 17:53 (168944)

Bryn-
I hope your recovery goes well and your symptoms resolve completely. Once you begin weight bearing again several issues:
There is no reason to wear a cast boot. If you do not work at improving you ankle range of motion your plantar fascia will heal and your calf will be even tighter. The heel pain may start all over again.
The other important point is you must pay particular attention to how your foot feels. With the plantar fascia nolonger intact other structures in your foot must compansate and may be overloaded.

Stretch you calves and take it slow!!

Re: 2 days post op

Julie on 2/12/05 at 19:11 (168949)

Bryn, are you really thinking of returning to work in two weeks? I would sincerely advise you to reconsider. You have had major surgery on the main supporting structure of your foot. If you had a sitting job, it might just be possible, provided you had help getting to and from work. But nursing, on your feet all the time, is NOT a good idea. I hope one of the doctors here will see your post and comment on your plans, but it sounds very unwise to me. Full recovery from this kind of surgery can take six months to a year. Please take care of yourself.

Take great care with stretching. No weightbearing stretching exercise until you are fully healed. When you're ready do exercise (check with your doctor) look at the yoga foot exercises, which can be done sitting or lying down and will strengthen the foot musculature as well as stretch the calves. Also look at the Plantar Fascia stretch.
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Re: 2 days post op

Mike C on 2/12/05 at 19:42 (168951)

Julie-
Have you had this surgery as well?

Re: 2 days post op

Julie on 2/13/05 at 03:18 (168955)

No, Mike, I haven't.
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Re: 2 days post op

Pat on 2/13/05 at 14:51 (168987)

I had this surgery on 11/3 and I'm still not 100% and don't expect to be for a long time. Whoever wrote the post about not wearing the boot cast to long was right. I had this surgery ten years ago on my left foot and was in the boot cast for a month - when I started walking without it was just a long road to recovery and everything was tight. Then ten years later I developed PF on my right foot. I would not even consider going back to work after two weeks. I was out of work almost two months and I have a sit down job (my right foot was the surgery foot so driving was very hard). While you're walking with the crutches and air cast and everything else you have a false sense that everything is o.k. but when you have to start walking without this stuff you really will see that it takes a long time to heal. Both of you have jobs where you're constantly on your feet and you need to let your foot heal before you start running around or you will have all sorts of complications. And I love the doctors that tell you that you'll be up and running in two weeks. Ask them if anyone has every cut the supporting structure of their foot and see how it feels. I'm still at the point if I have to stand in one place for a long time (i.e. the grocery store) my feet get sore.

Re: 2 days post op

Mike C on 2/13/05 at 18:06 (169005)

Plantar fasciitis is caused, primarily by tight calf muscles. improving ankle range of motion is the key. Plantar fascia release does not solve the problem in the majority of cases. If the plantar fascia heals and the calf is still tight, chances are it will start all over again.

Re: 2 days post op

Dr. Z on 2/13/05 at 18:26 (169006)

Mike C
I agree that good range of motion is very important along with an equinus condition, however once we area pass the fasciitis and into the fasciosis state of this condition the patient need to address the fasciosis as well as the ROM and equinus. I have seen failed pf releases as well as ESWT cases due to not addressing the additional deforming forces. I have seen plantar fasciitis without lack of range of motion and equinus so I have to conclude that the primary cause is not only lack of ROM and equinus but they ara very important in my opinon. To routinely stretch without equinus could be harmful

Re: 2 days post op

Mike C on 2/13/05 at 20:49 (169016)

I agree with you. I have seen 3 or 4 patients in 7 years with atypical plantar fasciitis. I have to say I am very concerned with the number of individuals posting that have had or are planning to have plantar fascia releases. I find it difficult to believe that the individuals doing this surgery understand the significance of the plantar fascia and the complications associated with releasing this tissue. I am also amazed and disgusted to read about individuals who have had this procedure a second time and are then diagnosed with tarsal tunnel and scheduled for a tarsal tunnel release or worse yet told by their doctor that they don't know what to do.
97% of patients improve after performing weight bearing calf stretching 3 times daily and using a night splint over 12 weeks. If a compliant patient fails to improve I would consider a gastrocnemius recession. Tendinosis resolves once the plantar fascia is unloaded.

Re: 2 days post op

Ralph on 2/14/05 at 17:04 (169057)

I'm relative new and have been reading many of the older entries posted on this site. There is a good search area here. In the short time that I've been reading I came to the conclusion that surgery is the standard treatment for this condition. Some people, however, posted that they had bad outcomes.

I find that confusing. If it's a normal treatment and doctors do it, why do some posters report that they are in worse condition than before their surgery or still have pain.

Is or isn't it safe to have P.F. surgery? What exactly does the plantar fascia do?

My own doctor told me mine is tight. He has offered to cut it, but so far I haven't had that done. Can you tell me more?

Re: 2 days post op

Mike C on 2/14/05 at 18:57 (169060)

The plantar fascia is a ligament that spans the bottom of the foot. It origin is from the bottom of the heel bone and its insertion is the region of the toes. This structure is under tension when the heel rises from the ground. The function of the plantar fascia is to aid in supporting the arch of the foot. This is referred to the windlass mechanism described in 1954. The arch is supported by a balance of the bony architecture, ligaments (including the plantar fascia) and muscle. Loss of integrity of any of these risks failure of the entire system. Plantar fascia release should not be a consideration in the treatment of plantar fasciitis. Conservative treatment is successful in over 95% of patients.

Re: 2 days post op

Dorothy on 2/14/05 at 19:08 (169061)

Mike C -

I like your posts. They are reassuring in their clarity, factual simplicity and apparent authority. They make sense to me. If I recall correctly, you are the same poster who advocates weight-bearing calf stretching as a - or perhaps as THE - key treatment for plantar fasciitis. If so, this position is in contradiction to what some other, also knowledgable, people here recommend. I may be misinterpreting these positions, but I don't think so. In any case, I would like to request a civil discussion of these two points of view: yes - weight-bearing stretching vs. no - weight-bearing stretching. If you are the person who recommended a particular calf stretch a few weeks ago, I have been doing that stretch (with others)occasionally and seem to be having no adverse reaction so far. But each time I do it, I am SURE I am hearing the sound of an Achilles tendon rupturing or the plantar fascia becoming more damaged.....It seems to me that any stretching regimen should be more comprehensive than just one stretch because I think of our bodies as integrated units, made up of connected parts and interconnected actions and reactions and compensations.

I am not asking this so people of opposing viewpoints begin arguing but only for a civil discussion and perhaps enlightenment on this controversial subject. Thank you.

Re: 2 days post op

Mike C on 2/14/05 at 19:42 (169062)

I appreciate your perspective.
The treatment is based on the history (when does it hurt? where does it hurt? what does it feel like? what makes it better? what makes it worse?) and physical findings. There are a number of things that cause heel pain. Proper diagnosis is the first step.

All things being equal, a large percentage of individuals with heel pain have plantar fasciitis. This is usually a result of overload due to tight calf muscles restricting ankle range of motion. Barring other medical conditions or metabolic problems which can compromise soft tissue, the most efficient way to stretch the calf muscles is while weight bearing.

The sensation you speak about concerns me.

Re: Another view

Julie on 2/15/05 at 02:37 (169068)

Mike, I too have appreciated your posts (and I have concluded from then that you are a podiatrist, though you haven't said so - am I right?)

My view on weightbearing calf stretching has developed from my own experience as a former PF sufferer; from my reading here over nearly five years of the experiences of others whose PF has been worsened by weightbearing stretching, and from my experience as a practitioner and teacher of yoga.

Like almost everyone else who consults a podiatrist for help with PF, I was advised to do the classic wall stretch. My calf muscles weren't tight (I don't agree, incidentally that tight calves are the sole cause of PF: the cause of mine was overpronation) but I followed instructions and found that the stretch exacerbated my pain. I stopped, continued with the non-weightbearing yoga foot exercises that I have practised and taught for many years, and my PF got better and resolved completely within five months (with various other conservative treatments - custom orthotics, taping, Birkenstocks, and relative rest).

Exercise is of course vital for stretching tight calf muscles, and equally vital for strengthening the intrinsic foot muscles. But - I believe - most weightbearing calf stretching, such as the commonly recommended wall stretch, is too strong for most people with PF. It puts an additional strain on the already over-strained, injured, inflamed structure. I have lost count of the numbers of people who have reported that stretching in this way (and even worse, by hanging off a stair) made their PF worse.

I believe that this is true even when the exercise is done correctly; and most people do not know, and are not instructed, how to do it correctly. (The instructions I was given were minimal, and although I knew the stretch, and knew how to do it correctly it still was a bad exercise for me to do, as I quickly discovered.) There is the matter of controlling one's body weight, for example: most people put too much of their weight into the stretch, overloading the plantar fascia - and the achilles tendon, which will also suffer. If the knees aren't aligned accurately between the ankles and hips, there will be strain on the knee. And if the pelvis isn't held correctly, there will be strain on the lumbar area.

I am not saying that weightbearing calf stretching is always ill-advised. I do think it is a bad idea for most people with PF. You may be familiar with the work of Mike Wilmot. His website, http://www.foottrainer.com has a section describing why most of the commonly recommended exercises for PF are wrong. He believes that what is most important is to strengthen the intrinsic foot muscles. So do I. Stretching is important too, but for most people with PF, non-weightbearing stretching will be safer, and effective.
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Re: Another view

Mike C on 2/15/05 at 06:21 (169075)

I am not a podiatrist not do I think tight calf muscles are the 'sole' cause. However, plantar fasciitis is not the only cause of heel pain. I have had a small number of individuals with plantar fasciitis not improve with weight beariing stretching but, I honestly, have not had anyone report worsening in just over a thousand patients. Again, this may go back to the diagnosis thing.

The foot is a very complex structures and there many things to consider in its evaluation. I am an orthopaedic surgeon with fellowship training in foot & ankle reconstruction. My traning and my interest is in applied biomechanics. I am currently involved with a strong biomed program at a major university. I apply principles of biology and biomechanics in my approach to treating my patients.

Re: Another view

Mike C on 2/15/05 at 06:50 (169077)

I am not a podiatrist not do I think tight calf muscles are the 'sole' cause. However, plantar fasciitis is not the only cause of heel pain. I have had a small number of individuals with plantar fasciitis not improve with weight beariing stretching but, I honestly, have not had anyone report worsening in just over a thousand patients. Again, this may go back to the diagnosis thing.

The foot is a very complex structures and there many things to consider in its evaluation. I am an orthopaedic surgeon with fellowship training in foot & ankle reconstruction. My traning and my interest is in applied biomechanics. I am currently involved with a strong biomed program at a major university. I apply principles of biology and biomechanics in my approach to treating my patients.

Re: Another view

Julie on 2/15/05 at 07:02 (169078)

Thank you, Mike. I am glad that we now have an orthopaedic surgeon who specialises in feet and ankles posting! Please stay and give us the benefit of your experience and knowledge.

One question. Your experience with people who have not worsened due to weighbearing stretching is at variance with the reported experience of a great many individuals on these boards over the years, who have - or thought they had - PF. Of course PF is not the only cause of heel pain. But when you suggest that 'it may go back to the diagnosis thing' do you mean that people who were made worse by weightbearing stretching were misdiagnosed and did not have PF after all?
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Re: 2 days post op

Dorothy on 2/15/05 at 10:19 (169083)

Mike C - My apologies for my comment about being 'sure' I hear the sound of the Achilles rupturing. It's just my (sometimes quirky) sense of humor and I sometimes forget that it doesn't always translate the way it was intended. I don't actually hear any sound like that. All I hear is the sound of my own inner Voice of Fear saying: Danger! Danger! Something Bad is Going to Happen! It hasn't (yet...) I am sorry that my sardonic ways might have caused any undue concern.
Thank you for your responses. They are informative.

Re: Another view

elliott on 2/15/05 at 12:27 (169093)

Julie, I know your views about stretching, but I know people with PF personally whose docs ordered specific stretching exercises, often right away, and they've had a tremendous response, and avoided getting chronic. This includes those overweight and out of shape. I don't think it's the over-the-stairs thing, but definitely includes the wall stretch and others, and is somewhat aggressive in nature, although not crazily so. I'm guessing that it's more likely to work for those PF sufferers whose tight heel cords and other connecting muscles are the culprit for causing the PF. One can argue at what stage stretching should be tried (maybe a night splint first would make sense), but if other things aren't working, I think there's enough positive info out there that the potential gain likely exceeds the risks, so it may pay to try it at some point rather than never and back off if it seems counterproductive.

Re: Another view

elliott on 2/15/05 at 12:33 (169094)

One more thing about stretching. A guy I know who had PF and was given doctor-supervised stretching and got better real fast told me the stretches killed at first and then gave tremendous relief within a few weeks. So one may have to suffer some pain before the improvement comes. So admittedly, when to back off may be tough to figure out. Obviously, if someone is in agony for a week after a single bout of stretching, that wasn't a good thing...

Re: Another view

Julie on 2/15/05 at 14:03 (169096)

Hey, Elliott, read my lips - I mean my post. I have never said 'no stretching'. Stretching is vital. It is possible to stretch effectively, and I believe more safely, without bearing weight.
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Re: Another view

elliott on 2/15/05 at 16:29 (169101)

So, Julie, you'e a Republican, eh? :-)

In context (e.g., 'somewhat aggressive'), I do in fact mean weightbearing stretches. I asked the PF guy at the time what stretches the doc had him do. I can't remember it all (maybe I'll ask him again when I see him--wish I could walk aready!), but at least some were weightbearing, and he said they hurt like hell when he first did them, but within two weeks, he was much improved. He did have classic first-pain-in-the-morning PF.

Re: Another view

Julie on 2/16/05 at 01:02 (169128)

Sure I'm a republican (lower care 'r').

I wish you could walk too, Elliott. But please don't try just yet.
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Re: nerve snipped?

chrisb on 2/16/05 at 08:55 (169140)

Bryn you mention you have had a nerve snipped. Which nerve? Is this perhaps a neuroma near the ball of your foot, or a calcaneal nerve near the heel?
Chris

Re: PF, yoga, and achilles problems

Colleen P on 2/19/05 at 10:16 (169413)

Hi, Julie--I have read many of your recent posts, regarding yoga, PF, and achilles tendons. You seem like you might have some insights relevant to my current problems. About a year ago, I started having heel pain, mostly upon waking and after sitting. Thinking perhaps I was just getting old (49) or not stretching properly, I continued my normal exercise program of walking the dog a couple miles 3x a week (hilly terrain) and yoga 2x a week. I tried more stretching, exercising more and less, but nothing seemed to have an effect on the heel pain one way or the other. I guess you could say I 'exercised through the pain'. Gradually, beginning this fall, my achilles tendons began bothering me, eventually becoming painful and swollen. I finally decided I need to see a podiatrist, where I discovered that I had plantar faciitus (heel spurs apparent in the xrays), in addition to my achilles inflammation. The podiatrist recommended starting treatment with heel lifts, better shoes, anti-inflammatory medications 3x daily, and icing my tendons daily. I asked about stretching and exercising, but he was not clear about what I should do--said I should do what felt okay.

So, 6+ weeks ago I bought expensive shoes (ecco brand) and wore them with my heel lifts most of the time, which did seem to take the pressure off the tendons and decreased the pain. Being a dog-owner and an active person, I kept walking and doing yoga. I haven't been very good about the icing--do it occasionally. Recently, I have had a lot of yard work to catch up on so have spent a couple weeks digging and working in the yard. Also my yoga class a couple days ago included some vigorous squats (not a normal thing). Now my tendons are inflamed and swollen again.

Most of the 'causes' of PF do not seem to relate to me--I am not overweight, and I am very well-stretched and flexible from doing yoga for 2-3 years. Perhaps my arches are falling (I love to go barefoot), or my old shoes are of poor quality and created my foot problems. Or perhaps I have worsened my problems by over-stretching (e.g. the 'downward dog', warrior poses, etc.). I am wondering if you might have any suggestions as to what I should or shouldn't do and where I go from here? I would appreciate any help getting this problem under control and avoiding surgery!
Colleen

Re: PF, yoga, and achilles problems

Julie on 2/19/05 at 11:06 (169427)

I hope I can help, Colleen.

All kinds of things can lead to PF. We can eliminate one of the main ones - tight calf muscles - in your case. But several of the things you mention can have contributed, especially if you have one of the other main ones, overpronation. Did your podiatrist evaluate your biomechanics by at least watching you walk?

If you do overpronate, you would probably be helped by properly made orthotics - or you could first try the much cheaper Powersteps, which the doctors here speak well of. The heel lifts are helping you, you say, but your arches may neet more support.

I'm not sure about your shoes. I hope the new Eccos you've bought are more substantial than the ones I wore for many years, which I loved because they were like gloves: soft, pliable, flexible - exactly what my feet didn't need. I know Ecco do other styles, and I hope you've got a pair that actually support your feet. Check where they bend. A good shoe should be flexible and bend only at the metatarsal, not in the middle or anywhere else.

Best to stop going barefoot. Really. You do need to wear good footgear all the time, even in the house for tiny walks to the toilet in the night. Keep a pair of Birkenstock sandals beside your bed and slip into them before your feet touch the ground, and wear them all the time. You might be able to return to barefoot living eventually, but for now you really need to do everything possible to reduce the inflammation.

Try taping. See the heel pain book (and read all of it: it's full of good information). In part 2 there are instructions for simple taping techniques, with illustrations. Taping can relieve the pain, but it also has a therapeutic effect: it supports the arch and rests the fascia.

You might also find an elastic ankle support helpful - I did - especially for the achilles tendons.

And now to yoga. I think you'll have to be careful with all the postures, and stretches, than stretch your calves and achilles tendons. You will note that others - Elliott, Mike C - disagree, but this is my opinion born out by almost everything I have read here over five years, and by my own experience of PF and of teaching yoga to other people who have PF. I would avoid the standing postures for awhile - depending on what kind of class you go to this might be difficult. When the class is doing standing postures, either do something else, or if you feel you have to do them put your trainers on (explain to the teacher that you can't go barefoot for now). Certainly avoid the squatting poses, which you've already found inflame your tendons. You'll be able to do them again, but for now make it your priority to avid things things that are going to over-stretch them tendns and exacerbate the inflammation. Yard work that involves squatting is also a bad idea - find another way to do it. A stool on which you can sit or kneel would be useful.

Look at Mike Wilmot's website http://www.foottrainer.com . The product he sells is excellent for strengthening the intrinsic foot muscles, and there is good information on the site about why the commonly recommended exercises for PF are no use, and potentially harmful. You will learn something from it about exercise even if you don't buy the foot trainers.

Lastly, you could have a look at the yoga foot exercises I posted some time ago. They will keep your muscles working, and your circulation going, while gently stretching your calves, and strengthening your foot muscles. There is also the plantar fascia stretch. Click on the links.

No, really lastly, it might be a good idea to cut down on the walking. Three miles is quite a lot, and I would say that you need to go easy on it. But you'll have to see what the dog says about that, won't you??

I hope at least some of this is helpful. Let me know.
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Re: PF, yoga, and achilles problems

Colleen P on 2/19/05 at 15:24 (169449)

Thank you so much for your time and suggestions, Julie. I needed to hear what I already suspected about avoiding squatting, standing yoga positions, walking too much, and going around barefoot. I will try some of the more gentle foot exercises you recommend.

My Ecco shoes have good support in the middle/are stiff, and bend where they should under the ball. The salesman had PF so knew what I needed. They are good for light duty, but not good for yardwork or walking on hilly terrain, so I use other shoes with arch supports and heel lifts, which seem to work pretty well. I will now keep a pair of Birkenstock-style sandals next to the bed so I can try to avoid ALL 'barefooting' around the house.

I don't think I have pronation, as I have pretty high arches. The podiatrist looked at the way I stood but did not watch me walk. My father has unusually high arches and has always worn special shoes with good arch support. He started having PF problems the same time I did, and we both are thinking our arches have fallen, as our shoe size has increased. Does this sound right?

I don't understand the hows and whys of taping or an elastic ankle support, but will try to find info on that.

Again, thanks, Julie. No more heavy yard work or yoga class for a while...

Re: PF, yoga, and achilles problems

elliott on 2/19/05 at 20:10 (169463)

Well said, Julie. My opinion is to make sure *not* to be careful with all the postures and stretches. :-)

elliott

Re: PF, yoga, and achilles problems

Julie on 2/20/05 at 02:33 (169481)

I'm glad that was useful, Colleen.

You don't have to give up yoga. You can opt out of the things you feel you shouldn't be doing, or adapt. If the class is an Iyengar class, and there is a preponderance of standing postures, or an Ashtanga class, which is dynamic and fast-moving, you might do better to look around for a different type of class, that focuses more on the classical postures. (Most people are unaware that in classical hatha yoga there is not a single standing posture! That style of yoga developed quite recently, with the need for weightbearing exercise in a largely sedentary culture and community.) Such a class might also give greater emphasis to breathing and relaxation and, if you're lucky, meditation. And of course you can always develop a home practice that will nurture you without compromising your feet.
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Re: PF, yoga, and achilles problems

Julie on 2/20/05 at 02:35 (169482)

Everyone is entitled to his opinion, dear Elliott. :-)
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Re: safe exercises?

Colleen P on 2/20/05 at 12:10 (169497)

Yes, I agree I don't want to give up yoga altogether. I need it to help keep my back flexible and to relax, among other benefits. I may just quit the classes for a while--one is Yogafit, very athletic, the other is hatha but has many standing postures. I will find yoga postures that are easier on my achilles tendons and TRY to discipline myself to do them at home. I will have to have a long talk with the dogs about why I will be locking them out of the room and not going on such long walks!

I feel I need some aerobic exercise, though. It is winter and I'm not real enthused about swimming in the outside pool at the fitness club. If I cut back on walking and vigorous yoga, and have to be careful with exercises that might injure my feet and ankles, what is left? Any ideas?

Re: safe exercises?

Julie on 2/20/05 at 14:27 (169501)

Yes. In the yoga tradition in which I practise and teach, the Satyananda tradition (Bihar School of Yoga) there is an important group of practices known as the Shakti Bandha (energy block) series. These work on the organs and the cardiovascular system, and have a strong aerobic effect. Most of them are done from a seated position. They aren't widely known, and you would be introduced to them only in a Satyananda class, taught by a teacher trained in this tradition, but I've had a look at google, and have come up with this website, which gives good instructions, with illustrations, for the series.

http://www.yahooyoga.com/yyh1204.htm

If you get interested, the full range of Bihar School practices are collected in an excellent book: Asana, Pranayama, Mudra, Bandha, by Swami Satyananda.

I would also recommend swimming, if you can possibly manage it, indoors of course, in this weather - is there an indoor pool you can get to?
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Re: safe exercises? PS

Julie on 2/20/05 at 14:34 (169502)

Colleen, I should have said that you should practise only the first four exercises in the Shakti Bandha series. The remainder are done from a squatting position.
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Re: safe exercises? PS

Julie on 2/20/05 at 14:40 (169503)

On the same website, you'll find many other practices from this tradition. I wasn't aware of the website until I searched it for you, but it seems to contain just about the whole of the APMB book. If you go to the section I gave you the link to, you'll find a link back to the entire series.

Try the anti-rheumatic group. This is a series of exercises that work through all the joints of the body. It's the series from which the yoga toe and ankle exercises I've posted come.

http://www.yahooyoga.com/yyh1202.htm
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Re: safe exercises? PS

angelas on 2/23/05 at 20:54 (169749)

HI Julie,
I got lucky in finding this thread and your input! I wanted to say Thank you :-) And now I realize I also have a few questions.

About 3 years I had very rapid onset foot pain in both feet. I saw as many specialists and podiatrists as possible with my $$$.
I finally had TTS surgery in December on my right foot mostly because no-one could find anything that pointed to something else and I was ready to try that instead of a wheelchair I saw coming my way!
Six weeks later the Pod said it failed. And he could not do anything more.
So I can not go to him for help. There are only 2 in this town. I got a first TTS opinion from the other.
My primary doctor will not refer me to any more PT. GRRRRRR!
So here I am :-)
I can only walk about 200-300 feet or stand the usual 10 minutes that most people with TTS seem to be able to take and this is with heavy pain medication. I know the more I use them the more it will hurt later.

My foot hurts and is more sensitive than it was before surgery. The ankle feels worse than it did about 2 months after the surgery also.
This concerns me also.

I have been doing standard PT exercises for the feet, calves, thighs, and then back, and shoulders starting 3 weeks after surgery.
But I feel like it is making my foot worse now, instead of better. It felt like it was improving where now I am starting to limp again feel more pain even when lying down etc. It seems to aggrevate the ankle area, pretty deep muscles
I am using a 2lb ankle weight. Do you know if this is a bad idea?
I use it for the back strengthening and calves and ankles I think the PT said.
1.Lying on my stomach on my bed, raising the opposite leg and arm.
2. Standing, raising the leg bent behind me.
3. Sitting and raising the leg until the leg is almost straight.
I also do the basic counter (or wall) calve, and tendon stretch, without weights.
I use a orange rubber band (wide ribbon) tied in a knot to form a loop and wrap it around the feet and soles, sitting with legs straight out in front, feet keep the band taught, and turn the feet in and then out, pushing the rubber.
I used to stretch the calves, thighs, back, by squatting. Is this now something I should now avoid? I think you said it IS part of this yoga program to use? I got confused on that part.

Range of motion is almost as good as the left foot and I am very limber and had good range of motion before. I have slight edema in the surgery foot. I have muscle wasting in my legs and it scares me to see my ugly boney legs.I have a lot of other health issues that cause problems also and could contribute to this.

I really loved to exercise. I was a health nut! It is so good for the mood also. Now I can not do any of the types of exercise that I did before. Any pressure on my feet just makes the pain so much worse as the day goes on.
I have to 'save' my on feet time for daily living activities.
I don't think it is PF as I do not have the first step in the morning pain. Is it possible to have PF without it?
I want my feet back!!!
I can not take the heated pool temps. They are too cold for me now with my chronic illness.
But! at least you are able to give me some exerices, expecially some that will give my heart a work out and that I can do sitting or lying down.
I did not know that there were yoga exercises that were completely lying down!
I love to try and relax and meditate. I need it to fight of the fear of being disabled.
I have been searching a long time for some type exercise that I could do without putting pressure on my feet.
I am excited and look forward to reading the link you posted for Colleen !
Sorry if I got the name of the original poster wrong I was absorbing a lot of info!
Thank you Julie for you time in helping others.
Angela PS: I tried on some Birks and they were so hard there is no way I could wear those. Is there some style I do not know about that is softer?
Another option. My feet are WAY too sensitive for 'gym shoes'.
Thanks again!

Re: Angela

Julie on 2/24/05 at 03:34 (169773)

I have to start by saying that I know very little about fibromyalgia, which you said on your other post that you have as well as TTS. I don't want to recommend anything specific for you in the way of exercise which could exacerbate your problems. I will try to answer some of your specific questions, though.

The first thing to say is that if your podiatrist has declared 'failure' and abandoned you, you need to be seen and cared for by another. Ask your PCP to refer you, and if you have to go to another town to see one, do. You can't be on your own two months after TTS surgery.

Regarding exercise, my feeling is that you probably shouldn't do anything that increases your pain. I know this sounds restrictive, but you are dealing with a very painful chronic condition and your first priority has to be not to make it worse. (You are aware, aren't you, that there are many websites devoted to fibromyalgia, some with forums like this one?)

I would suggest that you concentrate on your whole body, your whole self, rather than focus on your foot. Your TTS surgery was only two months ago, and while I can't really argue with your podiatrist's verdict, it may be too soon to say it has failed. It is certainly too soon to be 'exercising' your foot.

But you do need to keep all your joints active and mobile, and your muscles and connective tissue gently stretched, without exacerbating your fibromyalgia. I THINK the anti-rheumatic exercises on the website I gave Colleen the link to should be all right for you, and you can do them all sitting in a chair if it's uncomfortable to sit on the floor. But go gently and above all pay close attention to the messages your body gives you, and respect them.

The Shakti Bandha exercises (the ones I recommended to Colleen) are probably too strong for you. But if you want to do them, DO NOT do the ones that start from the squatting position. (I hope you are not doing squats now.)

I would not use weights.

I would not do the wall stretch. (I don't see how you can be doing it so soon after TTS surgery, whether failed or not.)

Yes it is possible to have PF without first step pain.

Birkenstock do sandals and shoes with a soft footbed which you might find more comfortable than the classic footbed.

Finally, you said 'I love to try and relax and meditate. I need it to fight of the fear of being disabled.' That, I believe, is the way to go.

I hope this is helpful.
.

Re: Angela

angelas on 2/24/05 at 21:33 (169850)

Hi,
Yes it was a helpful reply, thank you. One correction, it has been 3 months now since surgery.
I think I will slow it down, stick to stretching gently and try and find another primary care doc. who will be willing to refer me to a podiatrist somewhere!
I am also trying to get to see a PT who specializes in pain management who can address my whole body as it is not just the feet that hurt by far, as you mentioned!
Yes I have visited many FM sites but they can do more harm than good sometimes, as there are so many variable symptoms it can get scary!
I have found a pain site that I find very helpful as that is the hardest part to deal with.
Thank you,
Angela

Re: yahooyoga site

Colleen P on 2/25/05 at 14:55 (169898)

Wow! What a great site! I just checked some of the asanas out and they feel really good. I think they will be perfect for my situation. I also sent the yahooyoga/rheumatoid link to a friend newly-diagnosed with rheumatiod arthritis.

Thank you SO much for the research and direction, Julie. I do not have much choice in yoga teachers or classes where I live (rural), so books and the internet are treasures for me! I will try to incorporate the yahooyoga sitting asanas into a daily routine.

Just a side note--I saw my podiatrist again this week, and was disappointed with his lack of interest in discussing proper shoes, lifts and inserts, exercises, causes, etc. His suggestion was keep experimenting and to try physical therapy for my achilles problems. Do you think or have you heard of any success with PT for over-stretched and inflamed achilles?

Re: yahooyoga site

Dorothy on 2/25/05 at 15:05 (169900)

Colleen P -

I think if they are in fact overstretched and inflamed then you would want to try ice and gentle massage; alternate perhaps with some heat and gentle massage. Incorporate some of the Foot Trainer Achilles moves.
Try some Achilles supportive measures - elastic band-type devices for Achilles; a slight show elevation for at least part of the day (e.g. Danskos or a slight lift)to give some Achilles relief, but not to stay in that position all the time so as not to shorten the Achilles further. Alternate the lift/Dansko with your suppportive PF-shoe - that alternation will give a little Achilles exercise w/o overdoing.

(I am not a doctor and I am not a foot surgeon, nor for that matter a surgeon at all. I am also not a Dansko, nor a Foot Trainer, nor am I Achilles. I still have my Achilles intact and I am grateful for that fact every day. They do cause trouble at times.) Good luck.

Re: yahooyoga site

Julie on 2/25/05 at 16:52 (169909)

Oh good, Colleen. I'm so glad you feel these practices will be useful for you. I'm grateful to you, too, for asking the question that steered me in the direction of the Yahoo site: I didn't know it before that, and it really is good.

I can't add anything to Dorothy's good advice about your Achilles tendon. Ice, and rest, are called for with inflammation. If yours are over-stretched, more 'work' is the last thing they need. Let them settle and heal: they will in time. I think sometimes we can 'do' too much in our eagerness to help ourselves, but sometimes not doing is more helpful.

Do let me know how you get on with your new yoga routine, if you feel like it.
.

Re: yahooyoga site

Colleen P on 2/27/05 at 12:29 (170041)

Thank you for your good suggestions, Dorothy. Ice and massage seem helpful, especially after I have (over)worked the achilles. The podiatrist wants me to ice/massage 4-7 times a day. I'm lucky if I sit down to do it once or twice, as I hate to take the time away from other things, but I will try to do it more often.

I have soft/shock absorbtive heel lifts (Anti Shock) that have been wonderful for relief and protection from overstretching my achilles. I now try to wear them ALL the time, as even with them in I am so active I can overstretch my achilles if I'm not careful (property and dogs to take care of). I have been real flexible and well-stretched all my life (genetic tendency?), maybe that's been my problem (over-stretching)...

Anyways, thanks for your support!

Re: yahooyoga site

Dorothy on 2/27/05 at 14:20 (170048)

Colleen -
You are very welcome. And remember the old saying - If you don't make time to be well, you will make time to be sick.... (or something like that.)

:-)

Re: yahooyoga site

Colleen P on 2/27/05 at 19:32 (170081)

I love that yahooyoga site, Julie. There are some great asana groupings there. I have printed out and started to follow some, including the energy block, rheumatic, and abdominal series. This way I can get my exercise without stressing my feet or achilles.

I am finally hearing what you and Dorothy are saying about ice and rest. That doesn't come easily, but like Dorothy said, if I don't take the time to take care of myself, I will take the time to be sick...

Thanks again for all your help. I will keep you posted on my progress with the yoga asanas.