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 lying 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

Night Splints

https://www.facebook.com/Caring-Podiatry-157613897611885/

If you're like most people, you don't wear anything on your feet when you slip into bed. Your shoes are where you left them, by the door, when you came home. Your slippers stay at your bedside, ready to go to the bathroom at 2 AM when you wake up to pee, or get out of bed to make coffee in the morning. Socks are maybe the only thing you'd wear on your feet in bed, especially in the wintertime. Otherwise, isn't it just nice to feel the sheets on your bare feet after a long day?

Unfortunately, those of us with PF rarely get to enjoy going barefoot, anywhere, anytime. You either wear clunky sneakers stuffed with custom orthotic inserts or a walking boot all day. (I call my walking boot “the Franken-boot.”) It would be nice to just let your sore feet go free at night, but nope – there’s something to be worn at night, too. Night splints.

So, what is a night splint?

"Plantar fasciitis night splints are a device for pain relief from plantar fasciitis. A heel splint is a brace that attaches to not only the foot, but also the ankle and the lower leg and is worn at night when you go to bed. Its intended purpose it to stretch the plantar fascia ligament while you sleep." (www.heelthatpain.com)

When I started wearing night splints, at my doctor's recommendation, it felt like I was going to bed with a tall boot on. I'll include the link to the ones I ordered on Amazon at the end of this post.

There are different kinds of night splints. The kind I have, as you see below, have three straps to secure my calf and foot into the splint. There is also a detachable foam wedge to raise my toes, which stretches the plantar fascia ligament a bit more.

https://www.amazon.com/BraceAbility-Plantar-Fasciitis-Night-Splint-L/dp/B00BWQ3XNM?th=1

The other kind that I know of, which I haven’t tried, looks like this:

                                                           

https://www.amazon.com/Futuro-Plantar-Fasciitis-Adjustable-Stabilizing/dp/B0057M3TWC/ref=zg_bs_7491807011_5?_encoding=UTF8&psc=1&refRID=0JQYR2DFZSN8E7MBGCJR

So, what’s my take on night splints? They're a bit uncomfortable and can make your foot mildly numb, especially if you tighten the straps too much; but once you get in the habit of wearing them every night, you get used to them. Unfortunately, like most things I’ve tried so far to treat my PF pain, night splints are on my list of things that haven’t helped. Keep in mind, though, that my case, according to the four podiatrists I have seen, is an unusually difficult one. If you’ve read my other posts, you know that I encourage anyone suffering from PF to try anything and everything you can, after consulting with your doctor first. The one thing you think won’t work could be the thing that will, and night splints can be especially helpful if your PF pain is worst when you first get up in the morning.

In my next post, I will discuss my experience treating my PF pain with physical therapy.

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

Custom Orthotic Inserts

https://www.conehealthmedicalgroup.com/chmg/medical-services/sports-medicine/the-benefits-of-orthotic-devices-/

After almost a dozen cortisone injections in both of my feet, my doctor decided the next thing to try would be custom orthotic inserts, which I have now been wearing since April of 2017. (Side note: I've been wearing a walking boot on my right foot on and off since my surgery, at the end of 2017, without the orthotic insert; but if I skip the boot for a day and wear a regular shoe, I wear the insert.) Here is a picture of the inserts that I have:

Top

Bottom

The only type of inserts I'd tried up until this point were the cushiony, gel kind made by Dr. Scholl's, which soothed my sore heels, but did nothing to give my feet the support they needed. As I've been told by more than a few podiatrists, feet are like fingerprints; that's why custom orthotics provide the best support you can get. The downside? They are very expensive and uncomfortable. They aren't soft or pliable (which is why I don't believe they fit in any shoe, as advertised), and they take some time to get used to. My doctor suggested wearing them for maybe 2 hours the first day, then 4 the next, and so on, until I was acclimated. I wound up not following his advice on that. While uncomfortable, the orthotics weren't painful in the beginning. For whatever reason, the orthotics didn't cause any pain until after a couple weeks. That's when I started wearing them for only a few hours at a time. Once my feet were fully used to them, I went back to wearing them all day and have been ever since.

The process of making custom orthotic inserts is a bit messy. My doctor took casts of my feet by wrapping strips of wet plaster around them. The strips were left to harden for maybe 10-15 minutes each, and then they were sent out to a lab in Washington. I went home with bits of plaster stuck to my skin, but the process was relatively quick and completely painless. Here's a link to read more about the how these casts are made: https://treadlabs.com/blogs/insoles-reach-your-stride/how-are-orthotics-made.

https://www.podiatrytoday.com/article/7201

https://www.exportersindia.com/creative-orthotic-prosthetic-3751938/orthotic-insoles-for-flat-feet-2103572.htm

I know the average price of custom orthotics is between $400 and $600, depending on what your insurance will cover. I'd have to look over my paperwork to say for sure, but I believe that mine were about $400 each, with a little help from insurance. You can read more about the price of these inserts here: https://treadlabs.com/blogs/insoles-reach-your-stride/116218053-the-cost-of-custom-orthotics .

The conclusion? Custom orthotic inserts didn't do anything to improve my PF pain. I wouldn't say they were a waste of time, though, because when you're treating PF, it's important to try everything you can to see what will work. It's possible that inserts could eliminate or at least alleviate your pain, so if you're thinking about having custom orthotics made, I'd say talk to your doctor. They could be just what you need.

In my next post, I will discuss my experience with night splints, including how much they cost and where to order them.

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

How My Plantar Fasciitis Started

The location of the PF pain in my feet hasn't changed since it began. It's always been directly in the bottom of both my heels. The first time my podiatrist pressed his thumb into that squishy part of my heel, I realized just how centralized the pain is. He pressed in the middle of my foot (halfway between my heel and toes), near my ankles, and against my Achilles tendon (that bone-like thing that connects the bottom of your calf to your heel) but none of that hurt at all. 

The first time I noticed pain in my feet was probably around the beginning of 2016. It started as a dull ache that I thought was because I was wearing the wrong shoes. I mostly wore leather riding boots in the colder months, and either sneakers such as Vans, cheap slip-ons from Target, or flip-flops in the warmer months. I didn't know yet, of course, that the pain I had was from PF, so I kept wearing these types of shoes, unaware of the damage it was causing. (Side note: I can and do wear flip flops in the summer, to the beach or around the pool, as long as they are the thick memory-foam kind like in the picture below. Doctor's orders.)

It got really bad when my boyfriend and I went on vacation to the Dominican Republic in May of 2016. While we had an awesome time, the worsening pain in my feet put a damper on the week we spent there. I remember him telling me, "When we get home, you have to see a doctor. You can't put this off any longer." And he was right.

When we got back to the U.S. I made an appointment with a podiatrist right away. The first thing he told me (I believe I showed up in flip flops to that first appointment) was to get used to wearing sneakers; there were X-rays to be done before we could be sure what was going on with me, but the first step would be to start wearing the right shoes for foot pain. This doctor (and a few I saw after him) recommended New Balance sneakers over any other brand. While NB doesn't offer as many colors and designs as other sneaker brands, I've never had a problem finding a pair that I'm okay with wearing. I mostly go for black sneakers, anyway, and the first and favorite pair of New Balance sneakers I owned were black with a white sole/bottom.

Once the X-rays came back, we were able to rule out the possibility of a heel spur (which is, according to WebMD, "...a calcium deposit causing a bony protrusion on the underside of the heel.") Heel spurs are often painless, but they can cause heel pain. That's when my doctor said the two words I'd been dreading: plantar fasciitis.

At this point, I knew very little about PF other than it was painful. Recently, my aunt had had surgery for it, and so my anxious brain when into overdrive with thoughts like: Oh God, I'll need surgery, too, then. It's inevitable. It's probably super painful. Will it even help? What if it doesn't help? I think my doctor saw this on my face, because he brought me back to the present moment and said, "Okay, now we know what it is. Let's work on it."

One of the first things he did was give me a cortisone injection. He pinpointed the most painful spot on both of my heels, marked it with a pen, and gave me a shot. If you've had even just one of these injections, you don't need me to tell you how painful they are. For those of you who've never had one, and may need to, I don't mean to scare you but I can't lie: cortisone shots are no piece of cake. The doctor sprayed my foot with this numbing stuff, which did nothing to alleviate the pain; it basically just makes your skin cold. Then, he injected the needle and held it there for maybe 20 seconds or so. Meanwhile, he tried making small talk with me - So how's work? What do you think of this weather? - as if that would distract me from what he was doing! The picture below is an accurate example of how my face looked with a needle in my heel.

He repeated the same process on my other foot. Needless to say, this was not a pleasant appointment, and the big plate of pancakes I ate for breakfast at the restaurant next door afterward was much needed. (Cortisone injections are always a reason to treat yourself.)

After the shots, the doctor put a Band-Aid on both of my heels, just as you'd get with any other injection. There was no pain or soreness (from the needle) after I left the office. My doctor told me I might feel a spongy, squishy sensation when I took a step, which I did, in both feet, for the first couple of hours, but that wore off.

The good news is that the cortisone shots made a big difference in both of my feet. The pain went away completely. I still wore my New Balances, as the doctor told me to, but was able to walk without that sharp, stabbing pain I'd been feeling for so long. The bad news is that cortisone injections don't last forever; in fact, for me, they didn't last very long at all. Most of the time, I was ready for another one after 4 weeks. Between both feet, I must have had at least 10 shots (usually 1 in each foot), before I realized enough was enough. By fall of 2016, I decided it was time to try something else. That's when my doctor suggested custom orthotic inserts for my shoes.

In my next post, I'll go over my experience with custom orthotics - how they were made, how much they cost, and how they worked for me.

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

What is plantar fasciitis?

There are blogs for just about everything these days – cooking, photography, fitness, travel, and even sewing. (I’m not sure how much there is to write about sewing, but hey – I’m all for blogging, so whatever!) But one thing I haven’t found are many (if any) blogs about foot pain, particularly my old friend plantar fasciitis (PLAN-tur fas-e-I-tis, PF.)

PF can be extremely painful, and unless you’ve experienced it yourself, it can be hard to understand what it’s really like. Since you’ve found you way here, chances are you’ve either experienced PF firsthand, or at least know something about it, but for those of you who are new to it altogether, PF is, according to Dr. WebMD:

“…one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia). Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move more, the pain normally decreases, but it might return after long periods of standing or after rising from sitting. Plantar fasciitis is more common in runners. In addition, people who are overweight and those who wear shoes with inadequate support have an increased risk of plantar fasciitis.”

Simply, it SUCKS. Imagine having sharp, stabbing pain in the bottom of your heel with every step you take. Considering that the average person walks between 5,000 and 7,000 steps a day, that’s a lot of pain. PF is common with runners, but even sedentary people like myself, who spend 40 hours a week sitting in an office and may only take 1,000 to 3,000 steps daily, can still have PF. Risk factors, according (again) to WebMD, include:

1.  Age. Plantar fasciitis is most common between the ages of 40 and 60.
2. Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue -  such as long-distance running, ballistic jumping activities, ballet dancing and aerobic dance - can contribute to an earlier onset of plantar fasciitis.
3. Foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can affect the way weight is distributed when you're standing and put added stress on the plantar fascia.
4. Obesity. Excess pounds put extra stress on your plantar fascia.
5. Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.

I’m 24 years old; I don’t do long-distance running, ballistic jumping activities (whatever that is), ballet, or aerobics; I’m not flat-footed, and don’t have a high arch or abnormal pattern of walking; I’m not obese, and I don’t have a job that keeps me on my feet. That eliminates me from all 5 criteria, leaving me wondering, as I have been since this all began: why me? Well, as I’ve now been told by four different podiatrists, I’m one of the lucky few who is stuck with two possible risk factors that cannot be changed: 1. genetics (my aunt and cousin have suffered from PF as well) and/or 2. I might have been born with a tighter, inflexible plantar fascia than most people.

One thing I have learned about PF – and if you have it, you already know this – is that it’s one hell of a persistent disorder. I have tried the following (some more than once) to alleviate the pain of PF in both of my feet, with little to no success:

1.       Cortisone injections

2.       Wearing night splints

3.       Wearing a walking boot

4.       Physical therapy (9 one-hour sessions)

5.       Heating, icing, and elevation

6.       Stretching

7.       Exercise

8.       Minimally invasive surgery (particularly the TENEX Procedure, in November of 2017)

9.       Custom orthotics

10.   Heel inserts (both the gel-y Dr. Scholl’s kind, and harder, cork-material kind from my doctor)

11.   Medication (in the form of Naproxen)

When I’ve told my doctors and physical therapists this, the first thing they usually do is raise their eyebrows. It’s not that they don’t believe me, it’s that they can’t believe I’ve tried so many things and gotten very little relief. Most days, I can’t believe it either.

A lot of people have never heard of PF. My response to the question, “Why do you have a boot on your foot? What happened?” is usually met with blank stares and another question: “Plantar what?” But then there are those who just know, those who have been there, done that – and these people have been a tremendous help to me. Knowledge is power, right? I’ve come to find that there’s only so much knowledge I can gain from the Internet, books, or even my doctors; learning from the experience of others is priceless.

That's the point of this blog, if nothing else. I would like to help others by sharing my experience with PF, what's worked for me and what hasn't. It's also a way for me to get the frustration of dealing with chronic foot pain out of my head, and turn it into something productive. I hope that by reading this blog, you will have gained insight into what life with PF is like, and may even have suggestions or your own story to share.

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