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The right PT after ESWT or surgery

Posted by Buck T. on 4/18/05 at 15:55 (173370)

Trying to think of things that helped that might help others with PF. After 2 rounds ESWT on one foot, the improvement was about 60 percent. Two surgeries on other foot really aggravated condion. As last resort POD sent me to physical therapist who handles patients with difficult problems. He specializes in PF.

After seeing him six weeks the 'ESWT' foot is about 90 percent well and the 'suregery' foot is at about 70 percent well. I am at a place where I slowly improve each day. The pt is very strong male, ex body builder, and he started with ultra sound, followed by some electric impulse machine, and then topped it off with deep massage. I mentioned the body-builder thing, because we are talking really deep massage. I think Dr. Z asked in another post on ART about massaging the insertional area. Yes, the PT focused on the insertional area, but also the lateral area where the pain was reflected.

Be happy to elaborate for anyone, but I was wondering if many surgery and ESWT cases would benefit from the right PT protocol as standard proceedure.

Sincerely, Buck T.

Re: The right PT after ESWT or surgery

Dr. Zuckerman on 4/18/05 at 16:21 (173371)

Buck T
Thanks for responding. I just want to make a comment off the top of my head. It is not possible to confirm this without an examination or complete history of your foot problems. How do you know that the physical therapy isn't treating something that was never addressed with the ESWT in the first place. When a patient presents with central, lateral band plantar faciosis I treat both areas and not just the typical medial band that most pfers have and is treated with ESWT.
I have always stated that ESWT and Physical Therapy are adjunct treatment. Not every one needs Physical therapy post ESWT but there are some that must have physical therapy. A good PRE-eswt plan is very important to the success of the over all treatment.

Re: The right PT after ESWT or surgery

Buck T. on 4/25/05 at 19:03 (173725)

Hello Dr. Z. You are perfect person to respond.

I had PT 3 years before surgery and ESWT. I had pt 1 year after both -- all with do results. As last resort sent to physical therapist who takes difficult pf cases. Wonderful results.

The difference:

1. He starts with ultasound. Does it himself -- in all other clinics this is left to interns. This pt actually hit trigger points that made me jump.
2. He used electrical machine next. That's all I know.

3. This followed by deepest massage I ever had. He claimed he could detect inflamed areas with fingers. I faked not knowing where sore areas were and tested him. At least 75 percent time he rain fingers gently over foot and then pressed down on trgger points. He said on surgery foot inflamtion/scar tisse extended almost to ball of foot. This gone now and only mild flare-ups at exsertion area. The ESWT foot almost at 100 percent following intense massage on insertional area.

4. I disagreed with him about weight bearing exercises. He insisted and taught me to use the awful hamstring stretch without hurting myself. I don't believe in it and use board's yoga and your stretch. But to please him I was able to do the weight bearing stretch. He had me put weight on table so no weight was on affected foot being stretched.

Only reason posting this is that maybe it will help someone else.

Sincerely, Buck T.

Re: The right PT after ESWT or surgery

Buck T. on 4/27/05 at 15:15 (173832)

Hi all: Much of what I described as different pt exercise fits in the ART category -- same principles, but not exactly the same treatment.

Sincerely, Buck T.