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Plantar faciitis

Posted by Nel on 4/30/05 at 15:24 (173994)

I have been suffering for about two years with this neverending pain. I am a RN, and needless to say on my feet all day. I don't wear cheap shoes, mainly Birkis, Merrills or Stegmann clogs/slippers. I have tried all treatment modalities, from custom orthotics, which made it worse, to stretching, physical therapy and most recently cast for three weeks to rest my foot and light duty at work. Nothing is helping. I have been seeing an orthopedist after initially seeing a podiatrist. I don't know which direction to turn to next. This is severely impacting my life. Thanks for input

Re: Plantar faciitis

Dr. Z on 4/30/05 at 15:37 (173997)

Hi
I would read the heel pain book. I will get an ultrasound and or MRI to determine that you do indeed have pf. You probaby have plantar fasciosis which is the later stages of plantar fasciitis. The difference being that fasciosis is degenerative non healing. ESWT can be very effective for this stage of this very painful condition.

Re: Plantar faciitis

Mar on 5/01/05 at 07:04 (174009)

Wow - In all of my medical journey these past few years, I have never heard of plantar fasciosis nor of there being a degenerative, non-healing condition. No one ever mentioned this to me. It sure makes sense. Unfortunately ESWT didn;t help, but maybe the cryosurgery will. Thanks for the info. Mar

Re: Plantar faciitis

Nel on 5/01/05 at 07:06 (174010)

DR. Z

I had an MRI and indeed did tell me it was plantar fasciitis. Thnak you for the advise, and I plan to persue ESWT with my physician.

Re: Plantar faciitis

john king on 5/01/05 at 17:02 (174043)

Dr. Z

Tell me more about Plantar fasciosis. I have had PF on and off for 20 years and now have it constantly. I have pain whenever I walk or stand for more than 10 minutes. No first step pain or limping when I get up anymore just constant pain upon standing or walking.

Re: Plantar faciitis

john king on 5/01/05 at 17:14 (174046)

This may seem strange but my lower legs used to be quite hairy but as my feet have gotten worse I have lost all the hair on my lower calfs and ankles. One doctor seemed to think this was a symptom of nerve degeneration in my lower extremities. My feet are in really sorry shape.

Re: Plantar faciitis

Ron on 5/01/05 at 23:32 (174061)

Please, do yourself a favor and try Active Isolated Stretching (AIS). Static stretching may not have done the trick for you, assuming you've tried stretching at all.

I'm trying AIS right now after just having learned of it and it *looks* promising. I emphasize 'looks' because I've read so many great stories about this and it makes so much sense. My feet already feel better. If you don't mind me saying so early on in my treatment, if feels very airy, as if more blood is getting to the area.

AIS theory, according to AAron Mattes, the creator of it, is that static stretching inhibits blood flow, and hence healing, by creating a counter-resistance during the stretch. This means that any stretching isn't always better than no stretching.

Also, icing and orthotics (and possibly even aspirin) may inhibit healing. Icing, by inhibiting blood flow to the area; Orthotics, by inhibiting the plantar fascia from stretching normally while walking.

His technique adds three different flavors to this old age process:

1) Stretching should only last for less than two seconds, before the body responds negatively to what it *may* perceive as an imbalance of muscles and tendons. By keeping the stretching short the body doesn't have time to react negatively to your intentions.

2) Stretching only occurs when the muscle is loose or relaxed. The best way for this to occur is if you tighten the (or a) opposing muscle. E.g, to stretch your thigh you would contract your hamstring (and possibly your buttocks), then stretch your thigh.

3) This last one is only a general condition of the other two. That is, increase blood flow to the existing area. There's a good possibility that lack of blood flow alone could cause pain in your feet. If you doubt this, then look at the theories behind Extracorporeal Shock Wave Therapy (ESWT).

Some URLs:
http://www.stretchingusa.com/aboutAIS.cfm
http://www.runnersworld.com/article/0,5033,s6-78-80-0-567,00.html
http://members.fortunecity.com/bodywork/heel_spur_my.htm
http://www.mrtherapy.com/articles/article2.html

Good Luck!!
Ron.

Re: Plantar faciitis

Julie on 5/02/05 at 02:52 (174064)

Ron, thank you for this post and for the links. They're all interesting particularly http://www.mrtherapy.com/articles/article2.html . The blood flow theory is perfectly sound, and one of the techniques (the first one described on the mrtherapy website) is basically the plantar fascia stretch.

The stretching technique makes sense, and the exercises work on the same principle as the foot yoga exercises (and, as you say, ESWT) - that increasing blood flow to the affected area will be beneficial. I would be interested to hear what Mike Wilmot thinks about AIS - his approach too focuses on relaxing muscles in order to stretch their opposite numbers.

Thanks again. I wonder whether the technique would be effective in cases of severe, long-term tissue and nerve degeneration, but generally AIS sounds like a useful avenue for PF sufferers to explore.
.

Re: Plantar faciitis

Ed Davis, DPM on 5/02/05 at 10:57 (174086)

Julie:
I am glad to see that the author regards PF as a repetitive stretch (repetitive use) injury because that has very important implications particularly in the industrialized nations. I find little to disagree with but he does not seem to fully comprehend the function of orthotics.
Orthotics can be used a 'crutch' or as a means of biomechanical correction so I find that he is 50% correct in his interpretation of that modality.

In a perfect world we would not use the 'crutch' function of an orthotic but it certainly is not and patients often need a quick fix due to the nature of their employment or avocation.
Ed

Re: Plantar faciitis

Ron on 5/02/05 at 11:57 (174092)

First off, the blood flow theory isn't exactly unique with AIS, but getting there is unique to AIS. The _Plantar Fascia Stretch_ isn't the same because in AIS you only hold *any* stretch for no more than 2 seconds, thus, theoretically, avoiding the body's tendency to react negatively to the stretch.

As for Mike Wilmot, I really don't know. Looking at his site he mentions a few things that I know are different. I really don't trust much of what Mike says to tell you the truth. Looking at his site it reminds me more of a salesman pitch than anything else. YMMV, I just glanced over it.

As for anything Yoga related, it holds basically the same theories as static stretching (at least on the surface), to lengthen the muscles. Even though there are similarities between all these treatments, most have an underlying difference in the theory. A little difference can go a long way.

There's an old Chinese Proverb: If we do not change our direction,
we are likely to end up where we are going. If you're doing something that works, then keep it up until you're satisfied you can't go any further. And if you're like me, change until you find something that works well and spread it as far and wide as possible.

Re: Plantar faciitis

Julie on 5/02/05 at 12:31 (174096)

Ron, re 'anything yoga related', if you look at the foot yoga exercises you will see that they are not static, and are not held. They have helped and are helping many people here - and elsewhere.

Mike Wilmot has developed a product, the foot trainer, that has also helped many people here, but I am in no doubt that he is sincere. His website is good and his foot trainer (which I have used) is a good product.

Spread away. AIS sounds good to me, and I am glad it seems to be working for you. But there's no need to pit it against other techniques that have proved effective. There's room in the PF universe for all sorts of therapies - as long as they are helpful, and not harmful.
.

Re: Plantar faciitis

Julie on 5/02/05 at 12:32 (174097)

Ed

I wasn't happy with his comment on orthotics either. Otherwise, I thought it was a good article.
.

Re: Plantar faciitis

Ron on 5/02/05 at 13:20 (174107)

Sorry about the Yoga comment. I could have sworn it said to hold 10 seconds, which would mean to me very similar to static stretches. And my knowledge of Yoga is that many of the routines are held for a certain time. I've nothing against it.

Sorry about the comment about Wilmot, also. It was just a gut feeling I had. It's just that the net is covered with BS, even though many authors too are sincere.

I'm very cautious about spending the little money I have. Mostly everything you do can help a little, and those who have something to sell will always look at their products only in a positive light.

When I went to Wilmot's site, the first thing I saw was the FAQ and it discussed buying two of his devices, not one. I think it's a little self serving. And it's hardly a secret that most FAQs aren't really a FAQ but something the author would care for you to know.

Actually, I'd like someone to give some hard scientific data on treatments for PF, and that includes AIS, orthotics, night splints, any stretching routine, anti-inflammatories and anything else out there that people try.

As you can imagine I'm quite frustrated in trying to find something that works. ;->

Incidentally, I was hoping I wasn't being too overly optimistic about AIS. I've just started with it. It will take three to six months to know for sure whether it's any good. As any long time PF sufferer (7 years) could tell you, some therapies work at first then things return to the same.

Good luck with any of your therapies. We're all in this boat together.

Sincerely,
Ron.

Re: Plantar faciitis

Dr Ben Pearl on 5/02/05 at 14:05 (174111)

there was a recent study on night splints that was favorable but as with any study bear in mind that the design can influence the results signifigantly. Clinical experience has a big part in selecting a particular treatment for an individual