Tuesday, October 30, 2018

My Progress Almost a Year After Surgery

Hi everybody. I'm sorry it's been so long since my last post. Between working and going to school full-time, my blog has been on the back burner since July.

https://www.recorder.com/Arts---Culture-Calendar-Oct-11-to-Oct-17-2018-20734283

One question I get asked a lot through email and on my Facebook page is whether surgery for PF is worth it. That depends on a few things:

  1. Everyone is different. PF surgery may work for one person and not the next. 
  2. What else have you tried? Have you tried cortisone injections? Physical therapy? Custom orthotic inserts? Oftentimes surgery isn't necessary because these methods can provide relief from PF. 
  3. What kind of surgery you have. I had the Tenex procedure. Some surgeries are more successful than others. That is something you will want to discuss with your doctor. 
  4. How long you wait before having surgery. Most doctors will want to wait until all other options are exhausted before trying surgery, if they even agree to it at all. But, as my doctors have told me, the longer you wait to treat PF, the harder it is to get rid of it. 

If you are considering surgery to treat your PF pain, I will repeat what I said in my last post: yes, I do think surgery is helpful. 

The last time I wrote a post, in July, I had only just started feeling better. I was still doubtful of my success with surgery overall. In a little over two weeks, it will be one year since my surgery. I figured this would be the perfect time to let you all know that I am so glad I went through with it!

At this time last year, I was in an incredible amount of pain. I'd been wearing a walking boot (or Franken-boot, as I called it) for a few months. I could hardly walk, let alone stand for very long. Even driving wasn't easy. I no longer have those problems.

Here are the best things about having had surgery, almost a year later:

  1. It feels like I don't have PF at all most days. That's not to say that the pain is 100% gone; it isn't. If I have a long day of walking (and by long I mean a few miles or more) or standing, I will still be in a great deal of pain. But I don't feel it with every single step that I take, as I used to. 
  2. I can wear shoes other than sneakers! (But I got so used to wearing sneakers that I still wear them most days. 😆) I have worn flip-flops, flats, short heels, boots, etc., all with very minimal pain. I no longer wear my orthotic inserts or heel lifts. My doctor probably wants me to still wear them (and I should, considering PF could come back), but I haven't in months. If you do have surgery, you will want to ask your doctor how long you should continue wearing your insets afterward.
  3. As my right foot (the foot which was operated on) got better, so did the pain in my left. At one time the pain in both feet was equally severe. My doctors and physical therapist suggested this was probably because I limped for so long (leaning on my left side to relieve the pain in my right foot.) In doing so, I developed PF in my left foot. Most days, like my right foot, there is little to no pain at all in my left foot. 
  4. I no longer have to turn down fun plans with family and friends because of the pain in my feet. This by far is the greatest success I have had with surgery. There were so many things I missed out on before my surgery - pretty much anything that involved lots of walking and long periods of standing. I'm so thankful I don't have that problem anymore.
If you have had surgery for PF, was has been your experience? What procedure did you have? Did you have success? Any reduction in pain? Please let me know!

In my next post, I will talk about heel lifts and how they can help relieve PF pain.

I can be reached with any questions on my Facebook page: https://www.facebook.com/plantarwhat/
or through email: wsmalls12194@gmail.com.

Thanks for reading,
Becky

Wednesday, July 25, 2018

Surgery: Worth It?

https://pixabay.com/en/question-mark-note-duplicate-2110767/
Welcome back. :)

You're probably wondering by now: "So, surgery...was it worth it?"

My answer to that question is yes - at least for me. Did I see amazing results right away? No. Did I feel better right away? No. My experience was quite the opposite, actually. Things got worse before they got better.

But wait a minute - before you get discouraged, let me explain - and remind you, again, that everyone's experience will be different.

My doctor told me that it would be at least 6-8 few weeks before I noticed any results. Until then, I would feel about the same as I did before surgery, which is exactly what happened. Unexpectedly, though, I went through a brief reduction in pain for a month or two before the pain came right back, as sharp and persistent as it was before the surgery.

So: I felt the same, then felt better...and then went back to square one with my pain level.

(Reminder: my surgery took place the second week of November in 2017. I would say that the little relief I felt was around January of this year, before the pain came back full force between March and May.)

I'm sure that I don't have to explain to you how infuriating this was. If you've been through the same thing, you already know how I felt. Even if you haven't had surgery, you know the pain and frustration of PF all too well.

By this point, I had been through so much - physical therapy, cortisone injections, custom orthotic inserts, numerous doctors, and, of course, surgery, among other things. I didn't know what it was going to take to ever get any relief - if I ever would - from PF. Apparently, as I would soon find out, my doctor didn't either.

I decided it was time to see my doctor again in May. The following month I would be vacationing in St. Lucia, and had planned a few excursions which would require some walking. I didn't expect any miracles to happen before then, but wondered if there was anything else I could possibly try to get a little relief.

If you've never seen your doctor at a loss of words, I hope you never do. It is truly disheartening. I don't put any blame on my doctor whatsoever; he is an intelligent professional with lots of experience. Unfortunately, I just happened to be one of the worst cases he (and my 3 other podiatrists) had ever worked with, and when I went to see him in May, he admitted that there wasn't much left to try.

We discussed 4 possible options:

  1. Using a TENS machine. (TENS stands for "transcutaneous electrical nerve stimulation.") I'd never used a Tens machine until my aunt, who suffered with PF pain for a long time, told me about it. For whatever reason, no doctor had ever recommended it to me, which is why it's so important to do research on your own. A TENS machine uses light electric currents to stimulate damaged nerves - in this case, the plantar fascia. (I will discuss this more in a future post.)
  2. Contacting a pain management specialist, which I never followed through with. To me, a pain management specialist meant the prescription of pain medications, and that was not something I wanted to deal with. Don't misunderstand me - if a pain management specialist is something you'd like to try, or has worked for you, that's great. I'm sure they can be a lot of help to people suffering from PF. Personally, it just wasn't something I was comfortable seeking out. 
  3. Cork heel lifts. When my doctor suggested these, my first reaction was, what?! But I'm already wearing custom orthotic inserts - you want me to wear these too?! It sounds counterintuitive. Adding a heel lift to your already sore foot seems like a terrible idea. Isn't your heel under enough stress with PF? Well, yes, but as I explained in my Physical Therapy post, the heel bone is connected to the Achilles tendon, which attaches to the calf muscle. (The plantar fascia meets the Achilles tendon at the heel bone, and runs along the underside of the foot.) By lifting the heel, pressure on the plantar fascia is relieved. This can also release tension in the calf muscle, which, for people suffering with PF, is usually very tight. 
    http://www.footmedictechnology.com/stretching-and-plantar-fasciitis.php
  4. Achilles lengthening surgery. Lengthening the Achilles tendon could possibly alleviate tension in the plantar fascia. You're probably thinking the same thing I was when my doctor suggested this: another surgery?! Unfortunately, in persistent cases of PF, multiple surgeries may be required. But, as my doctor said, surgery should always remain a last resort option. I think that, at the moment, I would rather deal with a foot that is about 50% better than go through another procedure. 
Admittedly, I left my doctor's office feeling pretty discouraged that day. It seemed that there was very little left for me to do, and I began to accept the fact that I may have pain in my feet for the rest of my life.

But then something unexpected happened. Within a few weeks, I started noticing less pain in my foot! Other than wearing the heel lifts I hadn't done anything differently, so this came as quite a pleasant surprise (and just in time for my vacation.)

What happened? Honestly, I don't know. Do I think it was the heel lifts? No, and I'll explain that later. It's now the end of July, and I haven't seen or called my doctor since the beginning of May. I think that it's possible the healing process took much longer than expected - at least 6 months. I'd be interested to hear from any of you who have had a similar experience with PF surgery, or any other surgical procedure, that had a longer recovery time than expected. Any thoughts?

In my next post, I will discuss heel lifts more in depth.

I can be reached with any questions on my Facebook page: https://www.facebook.com/plantarwhat/ or through email: wsmalls12194@gmail.com.

Thanks for reading,
Becky

Tuesday, July 24, 2018

Recovery: Weeks/Months After Surgery


https://physiqz.com/sports-hernia-surgery-recovery-time/

Hi everybody. I'm sorry it's been more than two months since my last post. I've been pretty busy between going on vacation, switching jobs, and moving. In this post, I will discuss how my recovery was in the weeks and months following my surgery.

I wore the boot for at least a month after surgery, per my doctor's instructions. About a week or so after the procedure, my doctor removed one stitch from my foot (the only one I'd had.) If you've never gotten stitches removed before, don't worry! :) That was the first time I've ever had a stitch removed, and was pretty grossed out by the thought of it. It's so fast and doesn't hurt at all. It actually tickled for a second.

I developed a pretty big bruise on the underside of my foot that first week, which my doctor said was completely normal and to be expected. Until he told me that, I was nervous that I'd done something wrong, or was putting too much pressure on it, but that wasn't the case.

My doctor wanted me to use heat, not ice, while I recovered. Like most people, I prefer ice over heat when it comes to treating pain, but I was told that heat is better for healing after surgery. I got one of those packs that can be heated or frozen. 30 seconds in the microwave and it was hot - and stayed hot for a while. I found it easiest to sit on the couch with my feet on the floor, and rest my foot (gently, not with too much pressure) on top of the pack. Do whatever is easiest or most comfortable for you.

I did not do any clinical physical therapy after surgery. My doctor asked if I would like to (not recommended it, necessarily, but asked how I felt about it) and I declined. If you read my post about the PT I had months before this procedure, you already know that I had a fairly negative experience with it. This is why I decided to not go through with it post-op. Some doctors highly recommend it after surgery; others, like mine, are neutral. Do whatever feels right to you, whatever you can handle.

This is not to say, however, that I didn't do any physical therapy on my own. At home, I did some of the things I learned from my physical therapist, when my doctor gave me the OK to begin these exercises. Mostly I did lots of stretching - lots and lots of stretching, followed by heating.

I continued to wear New Balance sneakers after my surgery, along with my custom orthotic insets. If you haven't, I recommend that you read my post about inserts and how they can help relieve PF pain before and after surgery.

There was very little scarring after surgery. Today, eight months later, I have a tiny mark (probably about 1 cm in size) on the side of my foot, which is only visible under a lot of light. As with any post-op mark, this was a bit larger (maybe 2-3 cm) immediately after the surgery, and raised. If you notice anything unusual about the way your wound is healing, be sure to contact your doctor right away.



Your doctor will likely tell you not to take certain pain medications for a while after surgery, as mine told me. I was only allowed to use Tylenol for at least a few weeks. (I think this is standard for a lot of procedures, but I'm not sure.) When enough time had passed, I was able to take naproxen (prescription strength Aleve, basically) for pain as needed.

I want to thank those of you that have reached out to me via Facebook and email with questions. I'm happy to help and offer advice in any way I can, so keep in touch and let me know how you're doing! :) For anyone who hasn't, please visit my Facebook page: https://www.facebook.com/plantarwhat/

If you're not into social media (and I totally get that), send me an email: wsmalls12194@gmail.com.

In my next post, I will discuss the overall outcome of my surgery and how I am doing almost a year later.

Thanks for reading,
Becky

Monday, May 14, 2018

Recovery: First Few Days After Surgery

https://www.shutterstock.com/video/clip-4544480-stock-footage-waking-up-from-surgery.html

Before I was released from the hospital, I was shortly kept for observation to make sure I came out of anesthesia okay and didn't have any other complications. Dr. Shah had wrapped my foot in Ace bandages told me to wear my walking boot until I got home. As I was getting dressed and ready to leave, I didn't feel any pain at all, hardly. In fact, I was able to put pressure on my foot right away, getting in and out of the car and into my apartment.



I was more tired than anything when I returned home, having been awake since 6 AM that morning, and went right to bed to nap. Per Dr. Shah's instructions, I kept my foot elevated with pillows and blankets. I was given Oxycodone for pain, of which I was to take 1 to 2 tablets every 4 to 6 hours as needed. I only needed the painkillers the first 3-4 days or so. They worked (wonderfully) at eliminating the pain those first couple days, but were not without side effects. I became very bloated and constipated, even after drinking plenty of water and Metamucil and eating fibrous foods. They also made me drowsy and a little dizzy (I am prone to vertigo, so that wasn't unexpected.) I was not able to take ibuprofen (such as Advil) or Naproxen (like Aleve, which Dr. Shah had prescribed me for PF pain.) When I stopped taking Oxycodone, I was able to take acetaminophen (Tylenol) for pain. Once I tapered off the Oxycodone, the side effects I'd had subsided.

The hardest part of my recovery was walking. Every recovery is different, but for me, walking or putting even the slightest amount of pressure on my foot was incredibly painful. My doctors insisted that it was okay for me to walk, and even encouraged me to do so, but it was, at times, nearly impossible. The first few days, I hobbled to and from the bathroom with intense pain, holding onto doors and furniture (and my boyfriend) to maintain my balance. Finally, I'd had enough and decided to get crutches, which were a lifesaver. If your pain is as intense as mine was after surgery, I highly recommend getting them. It's important to the healing process to put a little pressure on your foot, but if you're struggling just to walk to the bathroom and fridge, don't suffer. Get crutches.

https://www.amazon.com/DMI-Crutches-Adjustable-Handgrips-Accessories/dp/B000CSQJBY?th=1

The other part of recovery that was particularly hard was showering. I was told not to get my foot wet. As you can imagine, it was nearly impossible to stand on my good foot in the shower without losing my balance and soaking my bandages, so a shower stool was a must for me. I sat on the stool with my wrapped foot sticking out of the shower. I've heard of some people wrapping their feet with plastic bags or garbage bags to ensure that no water gets under the bandage, but I didn't find this necessary. Here is a link to a shower stool like the one I used: https://www.amazon.com/Tool-Free-Assembly-Adjustable-Anti-Slip-Stability/dp/B06ZYW53V5/ref=sr_1_1_sspa?ie=UTF8&qid=1526314164&sr=8-1-spons&keywords=shower+stool&psc=1
If you get surgery for your PF pain, you won't be able to drive for a while. I wasn't able to drive for at least two weeks, because it was my right foot that was operated on. Be ready to spend a lot of time in bed or on the couch with your foot elevated. There's not much to do, so I recommend using the down time to read a book (or a couple, if you're an avid reader like myself), get into a new Netflix show or documentary, or do Sudoku and word searches like I did. I wasn't as ready for all the free time as I thought, and went stir crazy pretty quickly! The first time I went out was to a store (with my crutches and walking boot, driven by a friend) toward the end of the second week. It was probably the most exciting shopping trip I'd had in a long time, after being cooped up for so long!

https://collegecandy.com/2015/02/23/going-out-in-winter-pros-and-cons/

Looking back on those first few days after surgery, I can say the recovery wasn't as bad as I'd expected. Having help and support from family and friends is very important, as well as listening to your body. No one knows your body better than you do; if you feel something isn't right, or you feel like you're in too much pain, talk to your doctor. Keep them updated on how you're doing. If you're struggling to walk, ask your doctor about using crutches until you can move comfortably on your own. Do whatever you need to get better.
In my next post, I will discuss the weeks and months following surgery, including follow-up appointments with my doctor, and how I am doing now, 6 months later. As always, I can be reached on my Facebook page, https://www.facebook.com/plantarwhat/ or via email (wsmalls12194@gmail.com) to answer any questions.

Thanks for reading,
Becky

Wednesday, May 9, 2018

Preparation for Surgery

https://www.spectator.co.uk/2018/01/patients-like-being-told-they-need-an-operation-it-doesnt-mean-they-do/

After no pain relief from 9 sessions of physical therapy (and many other non-surgical forms of treatment, including cortisone shots, custom orthotic inserts, night splints, and a walking boot to name just a few), my podiatrist, Dr. Shah, dropped the "S" word - surgery.

(I had an "S" word of my own, containing 4 letters.)



The only surgery I'd had up until this point was a tonsillectomy and a wisdom tooth extraction (all 4 in one day, without anesthesia - a decision I now regret!) I was mixed with emotions at the idea of getting surgery for my PF. I'd heard of other people who'd had success with it, including my aunt, so I thought it could be the one thing that would finally work for me. That was exciting. But every opertation, of course, comes with risks, which made me nervous. I was already in enough pain; the thing I feared most was an unsuccessful procedire that would leave me with new complications. Needless to say, I had a million questions.

Dr. Shah recommended the Tenex Health Procedure, which is, according to the company's website:

"[A] minimally invasive technology [which] eliminates chronic tendon pain by precisely targeting and removing damaged tissue...and helps stimulate a renewed healing response." - https://tenexhealth.com/product-overview/
https://www.massdevice.com/tenex-health-wins-510k-tx2-microtip/

Thanks to ultrasound imaging, which makes it easy for doctors to pinpoint damaged tissue, the procedure was very fast; Dr. Shah and her partner, Dr. Wendolowski, had me out of the OR in about an hour. I have read online that for some Tenex Health procedures, patients are sedated but kept awake. I, however, was given enough anesthesia to sleep the entire time. On Tenex Health's website it states that no stitches are required, but this was untrue in my case, as I needed one stitch in my foot that had to be removed a week or so after surgery. (This may depend upon the location and depth of damaged tissue in the body; I'm not sure.) Recovery from the Tenex Health procedure takes 4-6 weeks but will vary patient to patient; I was off crutches and able to walk and drive after two weeks. (I will discuss my recovery in more detail in a later post.)

Here's a video with more information on the Tenex Health procedure for PF:

https://www.youtube.com/watch?v=RIgAe9-YzaY

If you've ever had surgery, you know just how much PAPERWORK is involved. I felt like I was doing nothing but filling out forms in the weeks leading up to my surgery: temporary disability forms for my job, medical clearance forms from my general practitioner, forms for my health insurance company, etc. What's worse is that everything is on a deadline; I had to make sure MetLife received the paperwork from my doctor promptly two weeks before the date of surgery, and so on. If you ever have to get surgery - for anything, not just PF - I highly recommend keeping a folder to organize all your paperwork. I bought one of those cheap folders from Staples that is now just about filled to capacity.

https://betanews.com/2016/12/14/paperwork-wasted-time/

One of the first things I had to do before surgery was get "medically cleared" by my regular doctor. This is really silly, considering I'd just seen him for a yearly physical only three months or so before - and, not to mention, my podiatrist (a doctor!) said the condition she was treating me for required this procedure... Nonetheless, it was something I had to do and wasn't a big deal. My doctor gave me a quick physical exam and I was in and out of the office in 15 minutes with my signed form.

I also had to go for pre-op testing at the hospital. This included an EKG, a urine test, a blood test, and a chest X-ray. Like getting medical clearance from my doctor, this was not a problem, and all my tests came back just fine - but the cost of all these appointments started to add up quickly. If anyone has any tricks for getting around any of these steps, by the way, please share!

Fast forward to the night before the operation: like most other procedures, I couldn't eat or drink anything (or even chew a piece of gum) in the twelve hours prior to my appointment. I was told I couldn't have nail polish on my fingernails or toenails, and couldn't apply any hair products the morning of. (Side note: my hair needs some sort of product in it every day, so I went to the hospital early that morning looking like a mess!) Luckily, I did everything I was supposed to and went in to surgery on time.


Here are some tips if you are preparing for PF surgery:
  1. Start preparing early. Surgery day comes super fast. Make sure your paperwork is filled out, handed in, etc., on time. Your doctor will likely give you a prescription for a painkiller and antibiotic some time before your procedure, so getting those filled quickly will save you time (and pain) after you leave the hospital. 
  2. Do your research and ask lots of questions. Be sure you know what type of surgery you're getting. That might sound silly, but I'd never heard of the Tenex Health Procedure until Dr. Shah mentioned it to me. Your doctor should explain every step of the process with you, as well as provide paperwork to take home and look over. If there's something you're unsure about, ask questions. That's what your doctor is there for.
  3. Carefully follow all pre-op instructions. If your doctor tells you to wear your walking boot in the weeks leading up to surgery, be sure to do that. I did. Also, your doctor may adjust any medications you take prior to your surgery, as they could affect your recovery and response to anesthesia. Be sure to tell your doctor about every medication you take. Some things your doctor may tell you not to do - such as having nail polish on your fingers or toes on the day or surgery - may sound frivolous, but there is a reason for these instructions. As long as they are followed, your surgery should go smoothly.
In my next post, I will discuss the first few days of my recovery after surgery. As always, I can be reached on my Facebook page, https://www.facebook.com/plantarwhat/ or via email (wsmalls12194@gmail.com) to answer any questions.

Thanks for reading,
Becky

Monday, May 7, 2018

Walking Boot

My "Franken-boot"

By late September of 2017, my podiatrist, Dr. Shah, decided the next thing for me to try before surgery would be a walking boot. Over the past year or so, I'd tried the following with no success: cortisone shots, custom orthotic inserts, physical therapy, and night splints. PF can be extremely painful, as you know, so to have gone this long without any relief was really starting to wear me down not only physically but mentally. A big part of the reason that I'd left my job as an activities assistant at a nursing home was that it was worsening my PF pain; I was on my feet almost 8 hours a day, walking around and pushing residents in wheelchairs. I was now almost 6 months into a sit-down office job that put no stress on my feet and was still having pain, so Dr. Shah was almost certain surgery would be next if I didn't have success with the walking boot.

Getting a walking boot was far easier than getting custom orthotic inserts. Your doctor will give you the size you need depending on your shoe size (I believe walking boot sizes run S, M, L, and XL), and will make sure everything fits properly and comfortably before you leave the office. The boot I have has two pieces of fabric that go across the top part of my foot, just below my toes, secured by Velcro. There are another two pieces of fabric that secure (again, with Velcro) at the bottom of my leg, just above my ankle.

Bottom Velcro strap

Top Velcro strap 

The next piece that goes on is a detachable plastic shell which looks like this:

Top part of the shell

Bottom part of the shell

Once that is in place, two straps secure the shell to the boot, like this:

Lower strap

Upper strap

There are these little "airbag" things (using my own terminology here) on the inside of the boot, just above the ankle. These can be inflated or deflated via a little pump if the boot fits too loosely. They maintain air well; I'm pretty sure I've only had to inflate them once or twice in the past 6 months.

Air pump

Originally, Dr. Shah wanted me to wear the walking boot for only a few weeks to see if it would lessen my PF pain. It helped a little bit, but I was still at a level of pain that she decided I would need surgery. (I will discuss the type of procedure I had and what was involved in a future post.) After my surgery on November 15, 2017, I wore the boot through my recovery and was told I would no longer need it after November 29. I would still need to wear sneakers with good support (my doctor recommended New Balance) and custom orthotic inserts, but that was fine by me. As you can imagine - or already know, if you've worn it - I was more than ready to get rid of my walking boot, which I call "the Franken-boot."


One good thing about the boot is that I could wear it on my left or right foot, depending on which one was hurting me more. As you know by now, my right foot has always had a significantly higher level of pain then my left, so I never had a reason to wear the boot on my left foot. (I'm not sure if this is possible for all walking boots, so this would be something to discuss with your doctor if you're looking to buy just one.) My doctor told me not to drive with the boot, since it was my driving foot, but I did anyway. It's probably not the best idea, I know, but it never caused me any problems. It just felt like driving with a big snow boot on, once I got used to it. I'm not saying that driving with a walking boot is okay or even safe to do, so please follow whatever your doctor tells you! 

I did not wear my custom orthotic insert in my walking boot. (I still wore it inside my New Balance sneaker on my left foot, as I normally would.) However, the podiatrist I saw after Dr. Shah, which would be my fourth, recommended wearing a cork heel lift inside my boot. (I will discuss cork heel lifts and how they help PF pain in a future post.) 

As I mentioned earlier, wearing a walking boot feels a little like wearing a big snow boot. It's not uncomfortable or painful, just a bit awkward. You might limp a bit in the beginning, having this clunky thing on your foot; but like anything else, you get used to it with time. I hardly notice a difference from my left or right foot when I wear it anymore.

Unfortunately, my surgery was not as successful as I had hoped, so my doctor recently recommended that I start wearing it again, this time with the cork heel lift. I don't wear it daily, and haven't the past two days because it was rainy outside. One downside to the boot, at least the kind that I have, is that it's easy for water to get in. You definitely don't want to wear it in the snow, and if you are able to go without it, you might want to forego wearing the boot when it rains - or at least tie a plastic bag over it when you're walking outside. It looks ridiculous but will keep your foot dry.

Overall, the walking boot has been helpful to me. I still feel pain in my heel with almost every step, but it's much less noticeable with it on. When you have severe PF, wearing a walking boot can be a big help. You might notice a difference in pain as I did, so it's worth discussing with your doctor. 

In my next few posts, I will discuss my surgery - the procedure itself, the recovery process, and my results. 

As always, I can be reached on my Facebook page, https://www.facebook.com/plantarwhat/ or via email (wsmalls12194@gmail.com) to answer any questions.

Thanks for reading,
Becky

Wednesday, April 25, 2018

Physical Therapy

http://www.bayareapt.com/

By the beginning of August of 2017, I'd tried treating my PF pain with cortisone shots, custom orthotic inserts, and night splints. As you already know from reading my other posts, none of these things worked for me. Unhappy with the lack of progress, I decided to see a new podiatrist by the name of Dr. Nazia Shah, who was, at the time, working with Riverview Foot and Ankle Associates in Red Bank, New Jersey. From the very beginning, I had a positive experience with Dr. Shah. She was in disbelief that I'd been in pain as long as I had been and hadn't yet been told to try physical therapy (PT), so she gave me a prescription for PT right away.

It was up to me to shop around for a PT facility. I took recommendations via word of mouth, and when I confirmed what would be covered by my health insurance, I wound up making an appointment at SportsCare Physical Therapy in Red Bank, New Jersey. The facility was very clean and the staff was extremely friendly and helpful. They also had flexible hours, which was important to me considering that I work until 6:00 PM and couldn't make it in most nights until 7:00 PM. 

My therapist, Carl, started by asking me questions about my level of pain, which foot was worse, when I felt the most pain (as in morning, midday, or nighttime), and which activities were hardest for me to do. My level of pain, as it was then and is now, can be anywhere between 5 and 8 (or more, on bad days) on scale of 1 to 10. My right foot has always been worse than my left. The pain lasts from when I wake up to when I go to sleep, but is worse when I stand up after sitting for a long time, and at the end of the day. Walking, without a doubt, is the hardest thing for me. Hearing all this, he knew, as I did, that we had our work cut out for us.

I wound up having 9 sessions with Carl, starting on August 18 and ending September 18. A session ran anywhere from 40 minutes to an hour. We usually started out by wrapping a hot towel around my right calf. That was my favorite part of the night. Why my calf and not my foot? As Carl explained it, some people, like me, experience PF pain because their calf muscle is super tight. Having a tight calf will pull on your Achilles' tendon and put stress on the plantar fascia. 

http://www.footmedictechnology.com/stretching-and-plantar-fasciitis.php

After the hot towel, I did 8-10 minutes on the exercise bike to stretch my calf a bit. Depending on my level of pain that day, I sometimes did short walks on the treadmill. Other exercises I did, usually in sets of 20, included leg presses, bridges, squats, and calf raises. 

Resistance bands are super helpful when you're in PT for PF pain, and we used them a couple of different ways. First, Carl's assistant would have me sit on a table, my legs laying flat in front of me, and tie a resistance band around my foot. While he pulled on the band, I pulled my foot back toward me, creating resistance. I sometimes did it by myself, like this:

https://guidedoc.com/best-types-physical-therapy-equipment-tools

Second, we did this same exercise from the side, where he'd pull to the left and I'd pull to the right, and vice versa. Third, he would have me lie flat on the table, put a band around my thighs, and have me open and close my legs while keeping my ankles together. (There's a name for this exercise that I can't remember.) 

After using the bands, Carl had me do runner stretches, which look like this: 

https://www.runnersworld.co.uk/health/injury/7-mistakes-every-runner-makes-when-stretching


After my exercises came the painful stuff, starting with Carl massaging my calves. A massage doesn't sound bad, right? But this is a massage from a physical therapist, not a massage therapist. It involves thumbs digging deeply and painfully into your already sore muscles, and it isn't pleasant. He attempted to massage my feet once, until I had to tell him that 1) I'm extremely ticklish (you should see me getting a pedicure), and 2) I couldn't stand to have pain on top of pain. Luckily, he didn't try that again. The worst part of the night, by far, was when he would have me lay on my stomach and use this tool that looked like a butter knife on the back of my calf. I cannot and will not lie to you - this was extremely painful. The first time I saw that thing I was intimidated, as it literally looks like a knife - but I assure you that it is in no way sharp. In fact, it isn't the tool itself that hurts, it's the way it's used that is. You can see a video of how this technique, called the Graston technique, works here: 


(If that video doesn't show up, here's the link: https://www.youtube.com/watch?v=9hn8jPv2ofM)

Conclusion? PT was my least favorite form of treatment for my PF pain. It was expensive and, like everything else I'd tried so far, it didn't work for me. However, like I've said in all of my other posts, don't not try it just because it didn't work for me. PT can be an amazing thing for relieving PF pain, and I know of many people who have had success with it. Mention it to your doctor, if you haven't already. If he or she is okay with it, I say give it a try. If you do, here are some pieces of advice and things to remember:

  1. Do your research. PT is an investment of your time and money. Unless your doctor recommends or sends you to a certain facility, do your research. Prices vary, so shop around. Don't be afraid to ask your physical therapist about his or her experience and/or education. (I did.) You want to make sure that the person you'll be working with is highly qualified. Question the exercises he or she has you do, and why and how they will be helpful.
  2. Don't be afraid to speak up. You know your body and level of pain more than anyone else. If whatever you're doing in PT is too painful, speak up. If you don't, your physical therapist won't know how you're feeling, and you'll put yourself at risk of serious injury. The techniques Carl used on me caused numbness in my second and third toes on my right foot, so I had to tell him to ease up. (This numbness, according to Dr. Shah, was a normal side effect of this type of PT, and went away within a few weeks.)
  3. Know that it will be painful.  If you haven't gotten the point by now, yup - PT is painful. Total honesty here. You'll be moving your muscles in ways that you aren't used to, and leaving most of your appointments feeling pretty worn out. PT is hard work, but if it's done right and safely, it can be very beneficial to you.
  4. Do PT outside of PT. The exercises and stretches that Carl taught me were simple enough that I was able to do them on my own at home or at the gym. Don't just save your PT for your appointment - do it at home, too.
  5. Ice is your friend. Your physical therapist will probably tell you to ice your leg and/or foot after your session. For me, ice was a must after my appointments. Unless your doctor or physical therapist tells you otherwise, don't forego icing.  
  6. PT takes time. Don't expect your pain to be eliminated or lessened after one session, or even two or three. In fact, you'll feel more pain before you feel less pain - and that's okay. That's how it works for a lot of people. You'll need to go multiple times, depending on the severity of your pain, to really notice a difference. Be patient and keep at it.   
In my next post, I will discuss my experience wearing a walking boot to relieve my PF pain.

As always, I can be reached on my Facebook page, https://www.facebook.com/plantarwhat/ or via email (wsmalls12194@gmail.com) to answer any questions.

Thanks for reading,
Becky




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