Hi fabulous PTs on the board!

[VeloVT]

I am NOT a PT, and don't know much about PF other than basically what it is, so this may or may not be useful, but I thought I might share my experience in case it offers something you haven't tried yet (maybe one of the PT ladies could comment on whether or not it might be useful).

I got peroneal tendinitis while in the later stages of marathon training this spring (thus no marathon for me... grrrr... next year...). It's often an overuse injury like PF, though in my case it was an acute injury from a misplaced footfall. Initially it was quite painful (I couldn't walk for more than 100 yards or so without starting to limp).

My PT prescribed iontophoresis (they tape a pad with contacts soaked in steroid solution to your foot, and then hook it up to a battery pack and run current through it for 20 minutes or so. I guess the solution has a different polarity than the current, which causes it to be pushed deeper into the tissue than would otherwise be the case with a topical application). We did about 12 sessions. I would say the first 3-4 actually helped -- they took the worst of the acute inflammation away and made it possible for me to walk normally (it was really helpful for me to wear super stable shoes to walk in everyday while I was trying to heal -- I wore the Brooks Trail Runners that are uncomfortably stable for me to run in, but they really helped keep my foot from hurting as I went about my daily activities). Anyway, the rest of the ionto sessions really did nothing -- my condition just plateaued to where I could walk and go about my business well (though a full day on my feet would be an issue), but I couldn't run more than two miles without a flare-up.

They did a full eval at this point, to see if orthotics would help. I was told that I have a structural deformity that prevents my heels/rearfoot from moving much at all during my gait cycle, and since I have fairly high, rigid arches, my forefeet are basically left to do all the compensation for this. She said my gait looks remarkably normal given this, but it puts alot of stress on the supporting muscles in my foot since they are always working and doing more than they were "designed" to do. PT was on the fence about whether orthotics were necessary/would be helpful...

So we had to come up with some other course of treatment. It had been almost two months since my injury and I still couldn't run. The woman who evaluated me (a different doctor at my University rehab clinic than the woman who was treating me regularly) suggested -- and I hope I have the name right here -- postural release work, since she theorized that the constant tension in my foot/lower leg might be responsible for my slow healing. Basically, the PT would do a little massage along the affected tendon/muscles, find trigger spots, and then position my foot/leg in such a way as to neutralize the tension (I'm SURE someone can do a better job explaining this). Anyway, although it hurt, it was MIRACULOUS for me. After two sessions I was able to run 6 miles with minimal pain. After two more sessions I was back to running as much as I could (in my out-of-shape state, at that point!) with no pain. I wish we'd started it earlier instead of wasting time & money on ionto... So, I know you mentioned that you'd done massage, but I wondered, if you have not tried this particular technique, if it might be of value...

Sorry this is so long. I hope your condition gets better soon. Painful feet are a real drag.

[KnottedYet]

Postural Release, Active Release, Trigger Point, Strain/Counterstrain, and more! All groovy.

Ionto with dex is niftyy, generally at first.... like you experienced. It's nice for calming down symptoms but doesn't do much for the cause. But it sure can help with symptoms so you can root out the cause without too much misery.

Another cool thing with ionto which I've only had one podiatrist order: acetic acid. When PF was being aggravated by a heel spur, he'd order inoto with acetic acid to help the body dissolve the spur. (we'd also be putting them in good insoles, posting as needed, exercising, teaching them massage techniques, stretches, etc.)

Feet are so cool!

[Sheesh]

My podiatrist had ordered iontopheresis, but the PT though it wasn't really necessary since it's more for inflammation, and my feet aren't really inflamed, just tight. The PT also said that most HMOs won't cover it and it's an expensive treatment, so we skipped it.

While my PT was doing RAGBRAI, I had appts with another PT who had me do some nerve stuff (the sheet says Slump Tibial Nerve Mobilization, and flexing my foot different directions to work on the nerves on the sides of the ankles). That was new, but I can't say whether I saw any benefits...

I do not have footbeds in my shoes. I can't wear tennis shoes to work, so I need to build up a new shoe collection (I wore high heels a lot, so now I have to find cute, comfy, flat shoes that will take a footbed). Any suggestions for comfy but cute dress shoes?

Knot - My PT hasn't given me any exercises other than stretches. Do you have some to suggest?

THANKS for sharing your wealth of knowledge!

[KnottedYet]

Knot - My PT hasn't given me any exercises other than stretches. Do you have some to suggest?

Yes! Oh, my goodness! And footbeds that fit in high heels, too! And shoes! Oh, my!

Do you want me to PM, or post for everyone to read?

[snapdragen]

Share with the group!

[Zen]

I do not have footbeds in my shoes. I can't wear tennis shoes to work, so I need to build up a new shoe collection (I wore high heels a lot, so now I have to find cute, comfy, flat shoes that will take a footbed). Any suggestions for comfy but cute dress shoes?

THANKS for sharing your wealth of knowledge!

Skechers?

I'm starting to think my knee/back problem might be helped by looking at my feet...(must bookmark this thread) I haven't walked pain free for a long time and have just about given up on PT.

[Sheesh]

Knot - I'm okay with you posting for everyone to read. Who knows, maybe someone else will benefit, too. Also, today is "move in day" for our freshmen students, so I'm wearing tennis shoes and I've taken the green superfeet out of my hiking boots and put them in my tennis shoes. I'll let you know how the day goes!

Zen - That's how I ended up at the podiatrist. I have had lower back pain forever, and my new chiropractor sent me to get lots of x-rays and did some deep tissue massage and realized that I have major shin splints. Once the x-rays came back, she said the problem was my feet and that I needed to get that corrected and it would ultimately help me back... no relief yet, but I'm still hoping.

[Wahine]

Zen - That's how I ended up at the podiatrist. I have had lower back pain forever, and my new chiropractor sent me to get lots of x-rays and did some deep tissue massage and realized that I have major shin splints. Once the x-rays came back, she said the problem was my feet and that I needed to get that corrected and it would ultimately help me back... no relief yet, but I'm still hoping.

This is a which came first, the chicken or the egg question. The whole lower quadrant including your low back worked together as a unit and one can affect another. I just wanted to pipe in to say that this makes doing some core stabilization exercises even more applicable for you as well as addressing your feet.

[emily_in_nc]

I've been reading this thread with interest as I've developed a pain after I run (treadmill or trails). The pain is in my right toe, down low at the base, in the joint I guess, more on top of the foot than underneath the toe. None at all in my left foot. I don't feel it while running, but only when walking around afterwards.

My shoes are good New Balance 754 running shoes (not very old). I do not have any kind of insert other than what came in the shoes. I have rigid, underpronating feet so went for the "cushioning" type of shoe as opposed to the stability type. I went up a half-size from my street shoes after a bout of black toenail in my left big toe last year from wearing too-small running shoes just a couple of times. These shoes seem plenty long and have an ample toe box. My feet are medium width.

Any ideas of what this pain could be? It usually lasts for a day or two after a run, then goes away, only to return after the next run. Would Superfeet possibly help, or is a trip to a PT or podiatrist in my future?

Thanks!
Emily