PF or not PF, that is the question....

It is important I would think that each person would get their own program of exercises relative to their own particular injury. I do not have fallen arches. I have something along the lines of "Posterior Tibial Tendon Dysfunction" leading to flat feet deformation - NOT flat feet!

I have access to medical journals and have read up on the condition and treatment in "Foot & Ankle International" specifically "Stage I and II Posterior Tibial Tendon Dysfunction Treated by a Structured Nonoperative Management Protocol: An Orthosis and Exercise Program" Richard G. Alvarez, Andrew Marini, Coleen Schmitt and Charles L. Saltzman Foot Ankle Int 2006 27: 2.

The physio I was sent to by the Consultant gave me the details of this source. You might be able to get it online through google.

The exercises are very specific and tedoius. My concern is that IF I don't have the diagnosed condition, that it might be doing harm. I reckon it can't get much worse in my case so what the hell.

I have to sit with my feet off the ground (on a table). I bring the soles of my feet together (turning the feet inwards) and hold for ten seconds, relax for 5 seconds and repeat 10 times. This is ONE set - I have to do 4 sets - takes about 15mins and this I am doing 4 times a day. (Some days I only get 3 sets done but I'm working on it and I've only been on the program for 10 days now). He also want's me to stretch teh muscles concerned - difficult to describe - Have to have both hands on the ground and one foot (say left foot) with heel stuck hard to the ground , the other foot resting just behind my knee.  The left leg has to be straight and then I have to arch my bum upwards - or increase the arch in my lower back. its a killer!.

Be careful - I'm used to stretching and exercise of all kinds - a new exercise may cause more injury than good and I am going back to the physio on Aug 22nd  - so I'm under medical supervision. THe physio is also in direct contact with the Orthapedic Surgeon so there is a chain of command associated with this treatment. In two weeks he is going to add to what I have to do - all this will continue for 4-5months before any other action will be taken.

Symptoms.....

August 17th 1998 whilst warming up for a Rugby match, felt a 'ping' (tear) in both arches. it was teh start of professionalism and we were being paid per match so I kept going. It wasn't particularly sore during the match but afterwards the pain was noticeable. The rest of that season I got the physio to friction them before each training and to tape them. After running/playing I used to stand in a bucket of ice until numb - that eased the pain!

I really can't remember the type of pain 16 years later but the reason I went for the surgery was the burning pain in the heels and eventually over the soles of the feet. It would get worse the more I walked but if I had been resting for a 4-6week spell (only doing what I had to do) I could get by for an hour. After te operation it would only take 5minutes to get to this mind-numbing burning pain. I've been using crutches on and off for the last 4 years since the op. If i try a short quick walk/run say to cross teh road - I can get a short sharp stabbing pain somewhere between heels and arches but that is not a real problem - it is the aftermath - the non-ending burn, throbbing pain that can really be mind-numbing. when I've set the process going then even the shortest walk - 20feet - can aggrivate it to the point of it not being worth moving. The crutches do help even though I don't really weight bear - it seems to help just to walk at a dead-man's pace and short steps. I've never had the first-step-in-the-morning pain that I read is associated with PF but often my feet will be painful befoer I get out of bed. I've always associated this with inflammation. I did manage to get orthotics made (about 7 different pairs - 6 of which were a waste of money) and they do seem to help a little - as in I wouldn't be able to take 5 steps without them. I'm now taking oxychontin 5mg slow release pain tablets - prescribed by a pain management doctor. These are morphene derivatives - they do allow me to walk for about an hour-and-a-half twice a week - I went down this road to try to get some exercise to prevent other muscle wastage. The curious thing here is that I would have thought I should be in bits after teh hour+ walk but no - sometimes its as if there is nothing wrong at all.

There are soooo many things that could be the cause for all of us foot-sufferers - I really do urge people to get more than one opinion. I've been to 6 or 7 different specialists doctors and its only the latest who has suggested it is not PF

Wow...I just read your second post about circulation and that sounds like me Ray. I have a left leg that has always been a bit swollen and red due to poor circulation. My MD said it's chronic....no way to really fix it. I'm not diabetic either but I have had weight issues all my life. Then about 3 yrs ago that leg got so much bigger and is swollen from my knee down to my toes...sometimes it flares up with cellulitis and i have to take an antibiotic to kill that but it comes back periodically. Then about 10 months ago I got this PF...so they say...I rolled both feet on frozen ice bottles and it went away in my right foot but has remained in my left foot...which is also the swollen leg. So...you are saying it could be circulation? I need to know more don't I...but it's depressing to know that would be chronic as well. Sometimes I am bedridden with the pain and can't walk at all. It has changed my life totally. I even had to purchase a scooter just to go out in public. God help me. Help us all. Please keep me informed.

One of the problems I face here in Ireland is that even though we have good specialists, they are so specialised that they seem to know nothing (or don't want to) about areas outside their specific training. Ultrasound guided injections I had (not into the PF but the tendons) have had no effect. however as I wrote before, they showed up calcification of the arteries in the feet. The foot orthapedic specialist doesn't feel this has anything to do with my feet !!!! Maybe so but I now have to get copies of the scans and bring them to my General Doc to find someone who will investigate. The Radiologist who performed the scan feels that my feet look like those of a 70yr old so something is wrong and the burning feeling I have MAY be related to blood pooling. I had high cholesterol above 7.7 but have reduced that to about 5.4 (diet). Without a doubt losing weight is a must - lose it or die! (maybe a bit dramatic but if not literally then in the sense of what life offers). I was always heavy and went to 18stone 7lbs when I was a professional Rugby player but now about 14st 7lbs (mostly muscle loss) - I reckon I could be 13stone. I'm now just trying to cut out any added sugar to see if that has any effect and maybe lose some weight too. I can still do upper body weights so that is crucial to weight loss and I can do some cycling as long as I keep the arch of my foot and not the toes on the pedal.

I described the exercises in a reply to someone else but again I repeat these were no for PF as diagnosed 16yrs ago but for tendons as of: http://www.innerbody.com/image_musfov/musc58-new.html

Another site worth a read:

http://www.footeducation.com/

"MI" ..... I assume you refer to an MRI

So have you had an x-ray?

There is no way except a physical examination to check for PF that I am aware of other than an MRI as only it will show up the different density of scar tissue compared with the surrounding natural tissue. I suspect an ultrasound scan may indicate some tissue differentiation but I'm not sure it would go deep enough for PF. I am fortunate to have medial cover so have seen a number of "specialists" over the years - even they seem to differ so its a question of finding one that has the experience of many different issues. I was on the verge of going to the States to find someone and have already been to London investigating Tarsal Tunnel syndrome but without the MRI (which showed NO PF damage - even after the operation to partially cut it!). It seems to me there are so many different structures in the foot and lower leg that may cause a problem that your average foot specialist seems poorly trained. For me, even if I didn't have insurance, I would be searching for someone who could diagnose the problem as life is passing by without my partaking in so many different ways.

Yes I meant MRI but didn't see the error until after I sent it. And yes...that's my point exactly...they tell me I have it but no one has requested an MRI... XRay is not enough!! As I told you, my coverage is thru the County Hospital which means in the states it's a medical coverage but only for the County facilities which is usually overrun with lower income bc it's funded by the government.  So I am not getting the care I would get if I had private insurance. I had to stop working 3 years ago due to my leg and circulation issues, and so no more insurance thru my job. So I am limited. 

Yes, my brother lives in the States (17years now) and whereas its a great place (if you have money), I can see how it could bring you to your knees!

In the States they call it a Handicapped Sticker and yes I have 1. My Dr. wrote a prescription for 1 a couple of years ago bc my knees were so bad. And I was working then too. Here...if your Dr approves it, then you take the permit request to the Health Depot office and they give you 1. So it's basically up to the Dr.