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I have had pf for 2 years, both feet, right one much worse than the left. Last year I got custom orthotics after a year of trying various shoes and otc orthotics with occasional, albeit temporary, improvement. About 6-8 weeks after I began wearing the custom orthotics, I began to notice the pain in my heels changed, and I began to have pain/tightness on the inside of my right ankle. I stopped wearing the custom orthotics at work, using a pair of otc ones I bought in a pinch which actually didn't feel to bad, at first... To make a long story short, my pf got increasingly worse until this fall when I sought the help of an orthopedic surgeon with whom I work. My arches just burned and my heels ached by the end of the day as well as my right ankle. We did a cortizone shot directly into the plantar fascia through the bottom of my foot, which took the inflammation down enough to feel the other symptoms of numbness and tingling in the foot/toes, leading the Dr to believe I may have tarsal tunnel syndrome. After wearing an immobilization boot for 5 weeks without much improvement, I went for an EMG/NCV test which did show some slowing of a nerve branch into my foot. After weeks of physical therapy including ultrasound and iontophoresis patches, 2 more cortisone shots, and stretching every chance I get, my dr. referred me to a foot and ankle orthopedic surgeon. This dr prescribed more physical therapy and night splints. Within 2 nights of wearing the night splint I developed a neuroma in the ball of my foot and all of the shoes ($700 worth) I have purchased to support my aching feet irritate the ball of my foot. I can't go barefoot because of my heels but don't want to wear shoes because of the neuroma. I am not wearing the splint anymore. It's getting to the point I feel surgery may be my only option . Does anyone out there have any suggestions or have had similar experiences? I really don't want surgery, but I can't keep living with this. I'm surprised I have any stomach lining left as I have lived on NSAIDS daily for 2 years.

I don't have a neuroma, but my condition sounds like yours. I am a teacher and on my feet most of the day too. I have noticed my left ankle getting worse as the weeks go on. I am having an EMG/NCV test next Monday and hoping for some results that will help. This is the most frustrating condititon since it involves walking, and who doesn't walk for at least part of the day. . . .

These boards have helped me cope with it by just seeing that there are others out there witht the same problems. I like the frozen water bottle trick I learned here. Freeze a bottle of water and roll it under the arch and heel of the foot while you are seated. It helps for the PF part, I am still struggling with the TTS part (if that's what I have).

Cheryl

hi nursenpain,

you have my complete sympathy, as i had a similar story.

i suffered for several years before finding something called yogatoes. i've written a few
posts about my experience w/ them in this thread (look for my second post on this page):
http://www.plantar-fasciitis.org/talk/topic9-30.html#p58

thx to the yogatoes, i no longer have foot problems, but i've been posting here in hopes of helping people who are having problems like the ones i once had.

you can read my story and you can read the testimonials on the product website. you can
also read the reviews at overstock.com, where "211 of 226 (93%) customers said they would recommend this product to a friend". here's a recent one:

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Overall Rating: 5 out of 5
Great for foot issues!, Nov 21, 2008
By Dnelson76 from North Pole, AK (read all my reviews)

I have used these for almost 2 years and reccommend them to anyone/everyone! I have severe plantar fascitis, a painful bunion and sciatica. A lot of issues. When I first got these I had a sciatica episode that was flaring to the point that it was hard to walk. within a week of using these daily, it was gone! returned recently when I slacked on using them. Again, I went back to regular use and it has gone away. My toes have straightened and seperated to releieve pressure on the bunion and fascia. You'll feel tingling in your lower legs when you first begin, so follow instructions on increasing usage time. They feel good. Everyone should own a pair of these!!!
How often do you shop at Overstock.com?: Few times a year
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
http://www.overstock.com/Health-Beauty/Yoga-Toes-Toe-Stretchers/2658171/product.html


yogatoes are definitely non-conventional "therapy", but as a nurse you probably know better
than most that doctors and surgeons do not have all the answers!

best, gina

I have had PF for almost two years now. I've had the cortisone shots, and I also have a brace that I wear, along with the night splint. I've done the icing and stretches, however, although the doctor suggested I regularly take aspirin for inflammation, I have not done that, except for extreme pain because I don't want to load my liver up with that stuff. My current problem is aside from having PF in both feet, but most severely in my left, the pain in my left foot has now shifted upward towards the outer portion of my ankle, to where sometimes it feels as if there is something "ripping" in there, and the elasticity is gone. Has anyone else experienced this, also, or am I just a strange bird? Also, if you have had it, what exactly is it?

Thanks Cheryl,
Yes it is frustrating! I am a nurse working in the recovery room and stand on concrete a good portion of the day. Standing absolutely kills me! Walking is better, but with the neuroma it definately makes that more difficult. I can't go barefoot because of my heels and I don't want to wear shoes because of the neuroma. I have spent so much $ on shoes, not to mention orthotics, etc. I have done the ice bottle, different balls (golf ball, tennis ball...) It's getting to the point I'm considering looking for another job but with this economy, I don't want to lose my seniority. Besides, like teaching, there are few jobs in nursing that can be done sitting down. Good luck with your EMG/NCV test, it's not as painful as some say it is. I hope you find some answers! Let me know what you find out!

To Gina
I have been intrigued by your luck with Yogatoes and am currently searching to find the best price and coupons. It sounds like they are definately worth a try! I have tried so many things and was almost ready to schedule the surgery but I will give anything a try if I can avoid that. My doctors and physical therapists are close to giving up on me! Thanks for sharing!

Dear chrisnfia,
My TTS began with a pulling/stretching or tightness on the inside of my ankle right behind the ankle bone, especially when I would walk down stairs. I continued to have aching and burning pain in my heel. I eventually discovered that part of my heel was numb. I could feel pressure, but no pain when touched with something sharp. After my first cortisone shot in October, I discovered I could feel numbness in the tips of my toes as well. I had what was called a positive "Tinel's sign", I could feel kind of a subtle shockwave run down the nerve when the nerve was tapped or pressure was applied behind the ankle bone. My achille's tendons were both very tight, which has improved with the stretching. It sounds like you definately have something going on with your achille's. All of the research I've done on TTS indicates the discomfort is on the inside of the ankle and the heel. When mine gets really bad, it hurts on both sides of my ankle. As for not wanting to take aspirin or the like, I understand. However, it would help with the constant inflammation. I thought the ibuprofen was doing nothing for me, so I stopped taking everything for a few days. Then I was really in a world of hurt! Hope this has helped, Good luck to you!

hi nursenpain,

i'm so glad you've decided to try the yogatoes!!

i found the following comment posted earlier today on retailmenot:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
YR778
Coupon still works, paid $41.94 total instead of $49.95+6.99 shipping. Go for it! I'm excited
to get my Yogatoes, can't wait to use them
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

[that's for buying them from yogapro.com, which i'd recommend in any case for the lifetime
guarantee and customer service.]

i'd advise getting the larger size, unless your feet are really small or narrow or your toes
teeny (contrary to their recommendations).

please keep us posted!

best, gina

Gina-
got my yogatoes yesterday, they're pink! tried'em last night for the first time, felt pretty good. Strange at first, but I definately felt something:) Will let you know how it goes! Thanks for the tip!

Real help to relieve the suffering.

Tarsal Tunnel is very much like Carpal Tunnel. In many ways it's worse. Your feet bear active moving loads much more often than your hands. In both cases you have too many tendons moving through too small an area. Mother Nature's way of getting you to stop doing something is to swell up and make the activity difficult. We must also consider the wound healing process that is activated every time you have pain. Your body sends building materials like proteins to the site of injury or pain in an effort to stabilize it and prevent further injury. This can cause greatly reduced mobility, adding strain to tendons that already have too much of it, which obviously causes more pain. The crude analogy is that these tendons are much like the bunch of spaghetti that someone threw into a pot and didn't bother to stir. The treatment for tarsal tunnel, is basically to gently separate the tendons, release the adhestions to the tarsal ligament, and then stretch the muscles that drive them. Once this is done, you perform MET (Muscle Energy Technique) to the involved muscles to retrain them to allow proper movement. Please note that this is the quick & dirty description.

I am a medical massage therapist with 24 years in the field, my first 5 working for an orthopedic surgeon, doing hip, knee, and ankle injury and surgical re-hab. Cortisone injections were rare, fewer than 2% of patients had one. We simply did not do surgery or shockwave for plantar fasciitis or tarsal tunnel syndrome. We didn't need to. 3-6 sessions, @ 30 minutes per foot was sufficient. Most patients took 4 treatments. No patient we treated in this fasion required surgery in the 5 years I was there. Undertand, this is NOT standard, Swedish, "Calgon!., take me away" massage. It is firm, VERY muscle specific, and can sting a bit. If the treatment is properly done, you will absolutely feel results your first session, often as soon as you stand up. Some patients, usually those heavily involved in competetive sports, will do a "tune-up" every 6-12 months, but it's uncommon. I am a firm believer in giving people the tools they need to help themselves. If you see me or any competent medical therapist, you WILL be given homework, and we WILL expect you to actually do it.

While the pain of plantar fasciitis is caused by micro-tears of the plantar fascial tendon at it's insertion on the heel, there is an unsung underlying cause, that is responsible for a large percentage of cases, namely hypertonicity and adaptive shortening of the flexor digitorum longus, tibialis posterior, and flexor hallicus longus, combined with overall reduced and/or improper mobility in the ankle. This most commonly occurs in people who have had one or more serious "rollover sprains" to the outside of the ankle. In a rollover sprain/strain, the tendons of the outer muscles of the calf are damaged, and there is no counterbalancing force for these flexor muscles whose tendons run along the inside of the ankle. As a result, these flexor muscles adaptively shorten. Add this to the necessary wound healing mechanisms affecting the whole ankle, and you get significantly reduced mobility.

How does this result in plantar fasciitis you ask? Each part of the leg and foot takes on a part of the movement load every time we walk, turn etc. When the ankle can't move properly, the tarsal bones (which are right behind the toes) have to take a lot more movement, they splay out both forward, and in a spreading motion. The plantar fascial connective tissue attaches to the bottom of the toes, so it's being pulled both harder and further with every step. The whole reason arch supports can be helpful is that they artificially reduce the distance the tendon can be stretched. Now a tendon's job is to concentrate all the force of the muscle or connective tissue in one place to create movement. This means that a great deal of the force you generate while walking gets spread throught the tarsals, then concentrated by the plantar fascia to the small point where it inserts on the heel. Folks, it's a LOT of force. The pain you feel is the micro tears. Good arch supports are definitely needed in the healing process, but the ankle has to be freed up to move properly, which reduces the load on the plantar fascial tendon. Using massage treatment, you don't HAVE to stay off your feet, but it speeds the healing process.

Improper ankle and foot movement can and often does create pain that travels all the way up into your hips and back, especially if you are unfortunate enough to need a "walking boot"after an injury. Please note that a walking boot is easier on your body than a cast any day of the week. (Casts are now rare except in certain types of leg fractures with a steep angle.) I've been there personally, and I've treated thousands of people in the same boat. I promise, the end is in sight.

So, the next queston is usually, "Can I do this at home?" For Tarsal Tunnel? Almost always. For plantar fasciitis? Sometimes. The only reason this is a "sometimes" is because there are angles that are very hard to reach on your own body. If you have a helper with a good sense of touch who is willing to follow detailed instructions, it makes home treatment much easier. If people are interested in specific home massage techniques, I am willing to post a DETAILED guide and "how to". It's LONG, with diagrams and detailed instructions. I don't know if I'm allowed to post the URL to my own website here, but if the moderators allow it, I can put the entire thing on my website in a few days time.

Kaelyn
That would be great if you could. I just had an eval with a new therapist. As I said in one of my other postings, my therapist was about to give up on me...well, she did. But I think it was a good thing. This new therapist has given me a new hope as her eval was much more extensive. She identified weakness in my leg as well as my hip and believes this to be a source of the overpronation I have. I recently returned to my foot and ankle specialist who was much more helpful during the 2nd appointment. According to him, I don't have TTS, but entrapment of Baxter's nerve. We are going to try not only more stretching, but some strengthening exercises as well. Also going to try the Graston technique, (similar to ASTYM). I have my first treatment tomorrow. I am guardedly optimistic, for the first time in weeks. Thanks for your reply!

nursenpain,
Entrapment of Baxter's nerve is certainly possible, and if so the fix is easy. Any competent DC can do a distal traction adjustment to release that. Us therapists aren't supposed to do those things..... but we are allowed to stretch. Often, good distal traction works wonders with that type of nerve entrapment. Keep me posted. If you want me to post directions for MET, I'll do it, you'll be amazed @ the results. I'm in NC, where are you?
Kaelyn

Kaelyn -

would you please post the MET? I am very interested in stretches and not surgery for tarsal tunnel syndrome.

thanks!

clatbu

Here's the MET instructions. Note: With Tarsal Tunnel, you will still need to release the flexor retinaculum, and the deep flexor tendons so everything moves right. The MET will help. This is LONG for a post, if you want the guide, go to my website, fill out the contact page and ask me for it, it won't fit here. http://www.kaywarren.org

MET Basics

MET stands for Muscle Energy Technique. It is a type of Neuro-Muscular Re-education. We discovered it in the 40s and 50s when we were working with polio patients. Why many Physical Therapists have stopped using it, I don’t’ know. It’s pure gold.

Throughout your muscles are little receptors called Golgi Tendon Organs. The highest concentration of them in each muscle is where the muscle thins down into the tendon. They tell the muscles how far they are allowed to stretch, and how fast. If they think a muscle is going to far too fast, they will contract, with great force, in an effort to “save” the muscle. Unfortunately, this will usually tear it. What MET does is teaches these receptor to accept the longer muscle length. This can be done with just about every skeletal muscle in the body. The best part is, it’s easy to do.

To do MET, you have to figure out what muscle you have to stretch. In the calf, the two big muscles you need to worry about are the Gastrocnemius, and the Soleus. The gastrocnemius is the muscle everyone thinks of when they think of the calf, it starts ABOVE THE KNEE, and attaches to the back of the femur (thighbone). About halfway down to the heel, it turns to tendon, and joins up with the tendon of the Soleus, to form the Achilles Tendon. The Soleus starts at the top of the tibia and fibula, (the shin) and looks sort of like a mountain. It is thick and long, and turns to tendon about 1-2” above the heel, depending on how tall you are.

You will need, a chair or a couch. A long yoga strap or old tie, pretty much anything that is 1.5” – 3” wide, and 5 –6 feet long. It should NOT be a stretchy material.

Specific Directions, MET for the Calf

v STEP 1: M.E.T. to Soleus
Ø While you’re sitting in a chair, with your leg bent and your foot on the floor, place the strap across the bottom of your foot so that it’s partly on the ball, but partly on the toes as well.
Ø Stretch the foot and toes by pulling the foot up toward your body until you feel a little resistance.
Ø Breathe in and hold it
Ø Press gently down with the ball of the foot using ONLY 10% of your strength. If you feel the muscle going “flutter, flutter, twitch” THIS IS NORMAL, don’t “power through it”. This little “flutter” means you’re actually feeling the Golgi Tendon Organs re-set themselves. (YAY!)
Ø Hold for 7-10 seconds
Ø As you release both breath and muscle tension, take the foot gently but immediately into further stretch. Do not wait, do not pass go, and do not collect $200. Don’t slam it into position, but don’t release the pressure either, just take it into further stretch.
Ø Repeat for a total of 3.

v Step 2:
Ø With the strap still in place, lift and point the foot all the way back and forth with gentle additional stretch and the lifted end of the range of motion.
Ø Repeat for a total of 5.

v Step 3: MET to Gastrocnemius
Ø While you’re sitting in a chair, or on the floor, with your leg straight out in front of you, place the strap across the bottom of your foot so that it’s partly on the ball of the foot, but partly on the toes as well.
Ø Stretch the foot and toes by pulling the foot up toward your body until you feel a little resistance.
Ø Breathe in and hold it
Ø Press gently down with the ball of the foot using 10% of your strength
Ø Hold for 7-10 seconds
Ø As you release both breath and muscle tension, take the foot gently but immediately into further stretch.
Ø Repeat for a total of 3.

v Step 4:
Ø With the strap still in place, lift and point the foot all the way back and forth with gentle additional stretch and the lifted end of the range of motion.
Ø Repeat for a total of 5.


How long do I keep this up? Every day for 2-3 weeks.

Good, precise, muscle specific, deep tissue massage will help break up the adhesions sticking the fascia to each other and to structures, but stretching without MET will get minimal results. I have a self-help guide for Plantar Fasciitis, just e-mail me and ask for it.

Thanks for letting me help you!