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Posted by Hazel on 5/22/05 at 10:38 (175465)

I just want to thank everyone who takes the time to post and respond to posts on this site. It was here that I discovered 2 things (among others); it is possible for custom orthotics to irritate PF and that ART can offer relief for PF sufferers.

I went for physical therapy 2 days a week for 7 weeks this winter and had mild relief. Ultrasound was performed on my foot as well as TENS and I did stretching exercises. I also had 2 cortizone shots from my Podiatrist. The pain was back in full force a month later.

I was bummed out when I discovered that my insurance wouldn't cover ESWT. However, one of the posters mentioned how ESWT didn't help him but ART did (though I wonder if the ESWT helped in the long run). Anyhow, I did some research and found that 2 ART practicioners had offices within a mile from me (I live in NYC). 8 visits later, while I'm not 'cured,' my foot feels
better than it has since September '04. I recommend to anyone suffering from PF to check out the website http://www.activerelease.com/
and see if you can get treatment in your area. My Dr. is breaking the pattern of pain by stripping or breaking up the scar tissue and lengthening the tissue and muscles in my foot. Techincally, the ART technique is different from deep massage (maybe an ART practicioner can comment on this) but it certainly shares some similarities (there's a feeling of mild pain and great release while it's being performed and the area worked on feels better the next day).

So, if you've been thinking about trying ART, I highly recommend checking it out. I hope it makes you feel better.



Terry on 5/22/05 at 16:17 (175486)


Is ART anything like reflexology? I currently go to a massage therapist that does relexology and I go every week. It seemed to help but I'm now having a flare up of PF.


Ron on 5/22/05 at 16:44 (175491)

No, ART has nothing to do with reflexology.


Elyse B on 5/22/05 at 18:27 (175500)

Hazel which doctor did you go to in NYC? I live in NYC. Thanks.


Robert J. Sanfilippo, DC, CCSP, ART on 5/22/05 at 20:33 (175510)

Hazel, I am so glad to hear that you've gotten relief from your PF using ART. If you don't know already I am an ART doc here in lovely westchester county; just 20 miles north of Manhattan. I know many of the ART docs down in Manhattan. I've explained the theory behind ART before on here and if you have any specific questions feel free to ask. Take care and good luck.


Elyse B on 5/23/05 at 04:56 (175516)

I have had ART done before and I have found only one doctor in Manhattan that accepts insurance other than him, the charge is extremely expensive asif not covered by insurance. Thanks. Dr. Safko is the one that takes insurance.


lara on 5/23/05 at 08:08 (175520)

Does ART help TTS?


Robert J. Sanfilippo, DC, CCSP, ART on 5/23/05 at 08:41 (175525)

Elyse, unfortunately insurance is becoming increasingly more restrictive. Basically insurance companies don't want to pay and doctors have to make choices. It costs alot of money to learn these techniques and many hours of practice honing your skills. The bottom line is that they get results and you get what you pay for. I don't know Dr. Safko, but I do know Dr. Schneider and Dr. Duke.


Robert J. Sanfilippo, DC, CCSP, ART on 5/23/05 at 08:42 (175526)

I've used ART to treat TTS and had many good outcomes.


Elyse B on 5/23/05 at 09:03 (175530)

thanks, I have already spoken to them. I understand how restrictive insurance is, but frankly to pay $250 for an ART session is out of my price range


John H on 5/23/05 at 11:20 (175535)

An Orthopedic Foot and Ankle Surgeon advised me that any type of serious foot massage has the potential of doing damage to one who has a trapped nerve in the foot. This seems to make sense even to a novice like me. It is very possible that the massage of any type could further irritate a trapped nerve.


Robert J. Sanfilippo, DC, CCSP, ART on 5/23/05 at 21:12 (175570)

Elyse, they are charging you $250 per session???? Are you kidding me. Dr. Leahy doesn't even charge that kind of money and he invented the technique. I thought I was alot when I charged $75 a treatment. That is outrageous and I'm sorry.


Hazel on 5/23/05 at 22:03 (175574)

I want to talk with my doctor before I put his name out on the internet. I forgot to call him today.

I have BC/BS and I found 2 ART practictioners in Manhattan that accept my insurance.

I hope to get back to you soon with more information.



elliott on 5/23/05 at 22:38 (175584)

John H,

What you say about the dangers of serious foot massage possibly doing damage to one who has a trapped nerve in the foot may well be true. But what would you say about the following two scenarios:

1) Suppose someone already was in chronic nerve pain post-op TTS, possibly a result of scar tissue, and the massage might be the only chance to loosen things up? I had a TTS post-op flareup of sorts, and a few years later(!) I started deeply massaging my TT area. Each time I got somewhat worse over the next day or two, but then felt better than I did before the massage. Repeated that several times in very spread out intervals (it was hard to face the increased pain!) and then over time my foot settled down that I now call the surgery a great success. I'm not 100% sure how much the massage contributed, but it may well have.

2) Suppose you have had a neuroma for years and can feel the lump of mass at the bottom of your foot. You are considering surgery, but try a massage therapist, not the light stuff which dodn't do anything the first visit, but rather she digs in as hard as she can at that area and at the ligament further proximally that is said often to be the cause, you reasoning that if it triggers a bad nerve reaction, you'll just get it cut out at surgery anyway. You hold back from screaming uncle for the next 8 minutes or so until her fingers need to rest and it's wise to stop. For the next few days, you feel some increased pain due there due to the deep tissue work, but sort of feel that it might have done something. A week later, your pain has been reduced by more than 50%, and at 3 weeks it's still holding, and you've gone from being resigned to surgery to thinking it's not so bad anymore and maybe another session and you definitely don't want surgery. Well, that's where I'm holding right now with one of my feet.

I realize things can always be worse, but sometimes it may be worth the risk, and when these things work, I begin to wonder if the docs really know everything.



Ed Davis, DPM on 5/23/05 at 22:44 (175585)

Medicine is an art (did I mean ART?), not a science... :)


elliott on 5/23/05 at 23:08 (175593)

Dr. Sanfilippo:

I once went to a chiro (whose office had awards, plaques, and newspaper articles praising him plastered all over his wall) who claimed he had an 80% cure rate for TTS doing just chiro alignments (including on the foot). I mentioned that to the prominent PT I was seeing and he had just one word to say: 'Bullsh1t!!!'

Do you have any comments on chiro for TTS?



Elyse B on 5/24/05 at 07:32 (175609)

I am sorry to, I live in NYC that is the going rate. Nothing is worth $250 a sesssion.


Robert J. Sanfilippo, DC, CCSP, ART on 5/24/05 at 09:14 (175612)

Hello Elliott,

I'm sorry to hear that you had a bad experience with a one of my fellow chiropractors. Manual medicine is a blend of art and science. More emphasis is placed on the art because it takes years and alot of practice to be able to treat people's conditions effectively. In my profession there is unfortunately many extremes. I agree with the PT that adjustments in the ankle and foot alone will more than likely not resolve TTS. All of the accolades that a doctor receives really don't mean a thing unless he/she is able to help you with your condition.

I will tell you my way of thinking and how I treat TTS. I utilize many soft tissue techniques in my office so I am able to treat many peripheral nerve entrapments; case in point TTS. So when you think about, an adjustment will not fix the nerve entrapment. So what I do, I assess the functionality of the limbs, pelvis, and lower back. Why do I do that is because all of those structures are part of the biomechanical chain. So if I have a TTS I will assess joint mechanics and adjust areas that are dysfunctional. I am trying to improve the mechanics of the joints in question. Then I assess the muscles for flexibility, fibrotic lesions, and nerve entrapments. I will go to the TT and palpate the nerve and see if it is being 'hung up' by scar tissue or maybe the flexor retinaculum. Then I move up and down the leg and foot trying to see if the nerve is being trapped. If it is, I treat the area then reassess. I've had good success with the condition using my methods. I hope I was able to answer your question.


Robert J. Sanfilippo, DC, CCSP, ART on 5/24/05 at 09:25 (175613)

Well Elyse, I am on your side and I'm outraged by that cost. I am certified in Full Body ART and Biomechanics and I would never charge anything close to that. I guess that is why I practice here in Westchester versus Manhattan. If there is anything I can do for you let me know.


John H on 5/24/05 at 10:07 (175616)

Elliott: I am by no means an expert on TTS. I have had the TTS surgery. I was just reporting what the Doctor told me so one may crank it into their decision making process. There seems to always be a tradeoff in most medical procedures. I made a tradeoff by having TTS surgery when the Doctor told me there was no guarantee that I had a trapped nerve or that the surgery would cure it if there was. Each of us must make their own decision based on our knowledge, the Doctors advice, and instincts. My post on this board are based on my personal experience and reading and are meant to just offer up something to think about. I do not intend to tell anyone what to do or not to do concerning their body. As we all read on this board what works for one may cause pain for another. Over the years I have picked up some good tips that helped me from post on this board. I hope I may have offered some information that may have helped others. Some years ago I went to a foot massage thearpist. Her approach was to create as much pain as possible. She had me hold up my fingers with a 1 being no pain and 10 being the worst as she worked on my feet. About 25 minutes of the massage I was at a pain level of 7-10. My feet did not recover from this for about two months. I tried accupuncture where the needles were placed among other places between my toes. This sort of hurt. I have tried a lot of goofy stuff that my brain told me was foolish but when you are in pain you reach out and try a lot of things that sound stupid. Good luck to you and do what you think will help. I do.


Elyse B on 5/24/05 at 11:51 (175629)

thanks Dr. Sanfilippo, but I am learning to deal with the pain and have continued to run through it and have accepted that it will probably be with me the rest of my life. Between 6 podiatrists and two pairs of custom orthotics, graston treatment and ART, I have reached my limit on how much more money I am going to put into my feet.


Sarah on 5/24/05 at 21:19 (175668)

Robert - Any chance you know of a good chiropractor in New Hampshire (close to the seacoast is ideal)? I have been dealing with PF, TTS and bursitis and am not convinced that my pod or my physical therapist really understand the root cause. I am interested in trying a chiro and am need of a recommendation.
Thanks, Sarah


Hazel on 5/24/05 at 21:20 (175669)


My ART practicioner is Dr. Steven Levine. He can be reached at 646-522-1732.

I hope he can help you.



Elyse B on 5/25/05 at 08:32 (175686)

thanks Hazel. It is interesting, there are pros and cons to all of this. For example, look at Goose, she went to see Dr. Josh Sandell who was very into deep tissue massage etc. etc. On one hand, I see ART being a good idea, on the other hand, I can see that it could also harm your foot if done correctly.


HilaryG on 5/25/05 at 11:44 (175704)

Elyse- I have had ART done by 6 providers over 2 yrs and I can tell you that while some are better than others, they have never caused any harm. There might be more pain for the first day after the treatment, but after that the improvement is immense. I have finally found a chiro who is willing to treat me twice a wk (the others only wanted to see me once a wk)and hopefully that way I can finally get cured!


Robert J. Sanfilippo, DC, CCSP, ART on 5/25/05 at 15:29 (175719)


The protocol for appropriately treating a plantar fascitis(fasciosis) is 2 times a week until there is resolution. Generally it takes 5 to 10 visits to achieve that.


John H on 5/26/05 at 09:32 (175755)

I do not know how long this board has been on line but I think I was here from the start. The subject of ART seems to come up about once a year. Just from reading the post on this board I have the sense it does not cure many people. This does not mean it does not cure anyone and when you are in pain with PF 'almost' anything is worth a try if there are no significant downsides.

I do not know how many ways there are to massage a foot but there must be a hundred different names given to massaging the foot such as 'cross friction' 'ART' 'reflexology' and on and on. I have tried many of these and I am somewhat skeptical of much of this. A foot massage feels great generally speaking but I just do not see it curing Plantar Fasciaitis. People often report cures from various means but there is little scientific evidence to suppoirt these cures. Massage can help reduce low level scaring but never removes all scar tissue. Many or perhaps most will disagree with my non professional opinion. Like the common cold there is no cure for PF that works for everyone. The statistics remain sort of constant after many years. 90% of PF patients will be cured by conservative treatment protocols used by nearly all Doctors during the first year. The remaining 10% will become a problem and around 3% will become chronic and we all seem to eventually go through the various things seen on this board. ESWT seems to be the only relatively new treatment in some years on which some scientific studies have been conducted.


Cindy W-A on 5/26/05 at 13:15 (175766)

I'm an infrequent poster but wanted to weigh in on the ART issue from California. I've had PF since November '03 due to an injury. I've tried orthotics, cortisone shots, PT, etc. I started ART in October '04 with treatments 2X a week and by mid-November was down to 1X a week. Since January I've been going every 5 - 6 weeks. ART has helped me immensely. I can now go through an entire day doing my regular activities with pretty much no pain. I still have some twinges and if I'm on my foot a long time, it starts to feel a little sore. But compared to what it was, this is tremendous improvement. There are even some days when I hardly think about my foot at all. The chiropractor does both ART and Graston on my foot and it hurts but nothing I can't stand. I ice for 24 hours afterwards and my foot is usually sore - more like a bruised feeling - for a day or so. He charges $55 a session and I'm usually there 20 - 30 minutes. (He also adjusts my back and neck.) Once I meet my insurance deductable for the year, it only runs me $25 a session.


Robert J. Sanfilippo, DC, CCSP, ART on 5/26/05 at 20:22 (175794)

Cindy, that is great to hear and I'm so glad you have gotten relief. I admire your chiropractor because he/she treats the same way I do using the Graston and ART techniques. The treatment regimen he/she has you utilizing is ideal for your condition. That is a very reasonable rate for those procedures. God bless.