May 4, 2010 10:49 AM
Orthotics, stretching & night splint out the window...
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I've been treated for PF for approximately a year and a half now. Treatment: regimen of ibuprophen, stretching, night splint, new shoes, orthotics. From what I've read on this site and the Net my treatment was par for the course. My PF cleared up and I began training (over training) for a half and was sidelined with shin splints. During my shin splint rehab I reinjured my left foot [I believe it was from walking on my heels too much and a lot of upper calf exercises]. Shin splints cleared up but PF came back in a new form - omnipresent pain just forward of my left heel in the arch. It ranged from constant dull pain to sharp pain. ![]()
I laid off the running completely, continued seeing my foot doc, continued stretching, orthotics, meds, swapped shoes, shot in heel, researched Morton's Foot, etc. Daily gym workouts consisted of cross-training (bike), abs and stretching - staying completely away from running didn't yield any relief. ![]()
In a desperate and last ditch effort to avoid a cutting procedure, I decided to go back to square one. I removed my orthotics and stopped stretching my calf/achillies. My feet took about a week to adjust and the pain lessened. I continued to sleep with my night splint but wasn't getting any relief so I dumped that; pain levels dropped again. Aside from my 2140s, I'm just about back to where I started almost a year and a half ago!!! ![]()
Is it possible that all the remedies I instituted actually added to the problem? Can I actually overstretch an injured foot causing more damage or inadvertantly prolong the healing process? Could it be that my orthotics helped at first but my foot has adjusted and I no longer need them? ![]()
I'll stop short of saying that my foot pain has cleared up completely. I still "notice" my foot after runs but for where I was two months ago, this is a 1000% improvement. I'm curious if anyone else has had a similar experience or has any insight as to why my remedies seemingly led to continuous pain...
2011 Frederick Half 1:53:15
Damien Howell, a PT who frequents these boards, advocates exactly what you're saying: That some cases of (fill-in-the-blank: PF, Piriformis Syndrome, etc.) are a result of OVERstretching.
Your story is a very interesting example of that possible scenario.
Congrats!
Jim
http://jimhaselmaier.blogspot.com/
"Kick off your high heel sneakers, it's party time."
-- From the song FM by Steely Dan
D.Snipes, yes I have seen similar observations. Take a look at Stretching Delays Time to Recovery, Foot Posture - Foot Pain, Should you stretch it out, and Arch Support, Orthotics, Shoe Inserts - Use and Abuse. When I started running coach's would say "don't drink water when you exercise you will get cramps". Well that coaches myth was blown out the window by the money made by Gatorade. You could consider that the coaches myth "that you need to stretch to prevent injury and treat injury needs to be thrown out of the window. I am not one who believes in conspiracy, but Willie Sutton said follow the money. Who makes money from prescribing stretching exercises? The concept of evidence based medicine is slowly becoming the standard. Christie Aschwanden wrote a very interesting article discussing why evidence based medicine is not widely accepted. In her article she discusses the controvresey of evidence based medicine regarding mammogrophy, but also discusses the evidence relative to Ibubrofen and long distance running.
I do believe the manner in which you run plays a significant role in the development and alleviation of injury. Take a look at Shin Splints - Shock Absorption and Stride Length, and Powerful Treatment for Running Injury. A common running form fault which I believe is often related to heel pain and shin pain is too long a stride.
Damien Howell PT, MS, OCS - www.damienhowellpt.com
Great, thanks so much for the replies! Your articles were very interesting and I plan on sharing them with a couple running buddies. I have a buddy who rarely ever stretches and runs all the time - it was frustrating to continually stretch and go through the motions of rehab and still be in pain. Perhaps I can let my foot heal completely then gradually introduce stretching again and see how it goes. If the pain in my foot returns I'll know to avoid that particular stretch and move on.
It's interesting that both of the foot docs I sought treatment from never mentioned that stretching, night splints and/or my orthotics could be the underlying issue. I was considering an invasive treatment whereby the doc actually cuts into the bottom of my foot (presumably to remove scar tissue or excess fiber...). I didn't bother asking for specifics because that was a procedure that truly would have been my last resort.
Anyway, I hope others see this thread and consider the other issues at play before they spend more than a year like I did tirelessly "rehabing".
Thanks so much again
I'll be sure to keep this thread on hand should I see other folks struggling with chronic foot pain that's refractory to the various types of treatment.
2011 Frederick Half 1:53:15
Wow! Aside from your chiropratic visits (which I was contemplating) our attempted remedies are almost exactly the same
Kudos to your husband for putting up with your continued aches and pains for more than a year - I know my wife was getting tired of me complaining about the pain and not being able to run...
I too had to wear orthotics/shoes all day everyday around the house but can now go barefoot and/or in flip-flops for days straight without any pain!!!
I hope you find the same relief I did by removing all of the remedies you've come across. Looking forward to my 3+ miler today at lunch!! Be sure to let me know how you're doing - glad I'm not the only one out there with this ![]()
2011 Frederick Half 1:53:15
D. Snipes,
Yes, kudos to my husband for putting up with this whole PF thing. It's been quite a downer for the whole family considering that we are so active. What shoes are you wearing during the day, and what shoes are you wearing when you run? Since you threw all remedies out the window, how long did it take for you to start feeling some improvement? I'm really curious about your "come back" because I haven't heard many success stories.
To answer your point - I'm still in the come back phase... I ran on Monday (5K), biked on Tuesday (20 min) and my foot is sore this morning. It was kind of sore after my run but nothing like before. Still no use of orthotics or the night splint and have not been doing the runners stretch. As for how much time before I started feeling pain relief, I'd say a week or so. Taking the orthotics out of my shoes left my feet feeling funky - strange gap between sole of shoe and foot and general readjustment. Once I stopped the night splint I felt almost no pain within a day or two... I've been orthotic-free now for about three weeks.
That said, I was up around 3am this morning and my first couple of steps resulted in the tell-tale PF pain... I debated putting on my night splint since I only had another two hours to sleep but decided against it.
I ran 2.5 miles today and am currently icing my foot. Good practice would have me lay off the running completely, but after all this time (1.5 years) I'm wondering if that will really help. I figure I'll take off the next couple of days from running so that should give me some time to rest.
As for my shoes, I wear Clarks http://www.clarks.co.uk/womens/unstructured during the day. I purchased these shoes back in November and wasn't overly impressed with them. They felt good for a couple of weeks but the throbbing and burning in my left foot eventually returned. I work in an office setting so the shoes are pretty clunky looking. For what I paid for my Clarks, I've heard that Eccos are incredibly comfortable - like walking on clouds... From what I remember, they weren't very dressy looking though.
As for my running shoes, I use Asics 2140s. I've found these to provide a lot of arch support and support around the heel. PLUS they're right around $80-90 which is a price that I'm comfortable paying for running shoes. I may end up trying gels next time around...
Well, I have a kickball game tonight - no need to laugh, I know, kickball
- so I'll see how my feet feel tomorrow morning. Hoping the ice works and I'll probably start taking my Volterin again to see if I can knock down the inflammation...
What shoes have you found helpful? Where are you in dialing back your remedies?
2011 Frederick Half 1:53:15
ligaments have probably stretched, isn't the PF a large tendon or ligament like structure? You want inflammation so don't ice and no anti-inflammatories, and no stretching, tightening things is what you want....these are the doctrines of prolotherapy, revolutionary, game changing. Sorry to be controversial.
You had me until I read .......Kickball.......
Thanks for the post - so by your own admission, and by the info posted above, I should continue to run (ostensibly reinjuring/inflaming the ligament) until my pain goes away? ![]()
I've read about prolotherapy and it sounds intreging but I'm not to the point of paying for something unless it's covered by my insurance.
The pain in my left foot has returned, albeit not nearly as bad as what it was. I continue to run, stretching only my hams and quads; my left calf is REALLY tight, but I hesitate in stretching it for fear that everything below my calf will also stretch (e.g., plantar ligament). Once I warm up (5 min walk) and get running everything feels good. I guess all the muscles have loosened up - including my foot...
Curious turn of events. ![]()
Mileage: 3.25 - 3.5 Monday/Wednesday and hopefully Friday this week.
2011 Frederick Half 1:53:15
Prolotherapy does not do its work by mechanically (running) re-injuring the ligament. It injects an irritant that the body reads as damage and thus the billion year old evolutionary collagen fix is laid down..................our hope lies in when this begins to really integrate and dry out, shrinking and tightening the ligament. So if you have read this, you'd instinctively know that some movement like walking would help things move along but putting the ligament to the test while all this is happening is like adding chaos to an organization effort. Your choice.
As an update to this thread - I've been steadily increasing my mileage and I'm up to 4.5 miles 3x a week. I have very minor foot pain and only on an occasional basis. When I do experience foot pain (tightness in my plantar) I found that if I bend my toes back and hold for a couple of seconds, a couple of times, my foot loosens up almost immediately.
I feel strong again in my first couple of miles and find that I'm having to control my breathing as my legs are outrunning my lungs instead of the other way around ![]()
Planning to increase to 5mi runs (@ 3x/week) next week and will start incorporating long runs on the weekends. Hopeful that my lack of pain will continue - trying hard not to push it and risk injury...
2011 Frederick Half 1:53:15
That's outstanding news. It's fantastic you're able to build up like that. Congratulations!
My quick update: I started ASTYM treatments about 3 weeks ago and they've made a HUGE impact. I've been discussing with my PT the phenomena that Plantar Fasciitis, after a while, becomes Plantar Fasciosis. If I understand things correctly, when it reaches this point, the inflammation is gone, but the pain emanates from the tissue having degenerated and being weak. In this mode the tissue *needs* exercise to strengthen and rebuild itself. That seems to support your experiences, DS, with being able to ramp back up.
Keep it up!
Jim
http://jimhaselmaier.blogspot.com/
"Kick off your high heel sneakers, it's party time."
-- From the song FM by Steely Dan
Thanks for the update - ASTYM looks like an interesting approach to breaking up what's underneath the skin. I wonder if the gel used is something akin to biofreeze.
I've heard (read) of the term plantar fasciosis in my search for pain relief but am just now reading about ASTYM... Certainly looks much less evasive, and potentially more effective, than hundreds of tiny needles. Although I guess someone else could weigh-in and argue the other way. Yeah, I'd guess that after running for more than a year with untreated PF and then everything after that, I probably have a good amount of scar tissue. It appears as though what I'm doing is working so I'm almost holding my breath waiting for something to happen.
I'm starting my 5 mile runs this week (MWF) and am excited - well, not excited but looking forward to my time outside; humid weather and 90+ degrees makes it difficult to be excited about any sport outside...
Still relatively pain-free; some soreness/tightness in my foot but a couple of very short toe stretches and I'm good to go.
Thanks for the update on your ASTYM treatments and it's certainly an approach to consider should my foot decide to rebel again ![]()
Dave
2011 Frederick Half 1:53:15
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