Plantar fasciitis orthotics or not ? - Page 2 - Health + Injury

Andrew Ryals

30/12/2011 at 18:36

I've read this discussion with some interest. I'm a Podiatrist. Just a few quick comments. You should never have surgery for plantar fasciitis for the simple reason that the procedure that is performed actually weakens the foot further and pre-disposes the foot to further PF at some point in the future. Secondly you should never have a cortisone injection into your foot for several reasons. Injections are usually done blind so are you really getting the cortisone into the correct area. Cortisone only masks symptoms, a diagnosis of the underlying pathology is more powerful than whacking a steroid injection into your heel

. NSAIDS/painkillers are pointless, by the time you've got PF it's too late for them to be effective. Never have an X-ray for PF, you'll probably find a calcaneal spur which believe me or not is a perfectly common finding, you should always have a soft tissue scan Ultrasound or MRI to determine which structures in your feet are damaged. Finally, orthotics, they do help and should cure PF. But, they are written to a prescription, which is unique, you REALLY REALLY need to understand WHY your foot is going wrong and then the orthotic can be tailored to correcting the dysfucntion. Every anatomical structure in your foot has a job to do, if it fails your foot fails, understanding why it fails is key. Mis-understanding leads to incorrectly prescribed orthotics and failure! Just a few quick thoughts.

Cpt.Jack sparra pirate

pirate

30/12/2011 at 18:48

Andrew , a few weeks ago I couldn't stand the pain any longer so decided to try and wear my work boots for work instead of my trainers . The pain that evening was really bad but the next day the pain was minor ! So I tried wearing the boots again and my feet were great until late afternoon they started to ache . I carried this on for a week and the heel pain virtually went completely only occasionally coming back . I was almost considering cancelling my podiatrist appointment as I feel stupid going now when the pain is minimal , BUT now I feel I have pain in a different part of heel , the outside , and also if feels as if I'm wearing a ski boot , I feel like there is pain in heel and now in ankle but it also feels like I have lost movement in the ankle ?? If that makes any sense ?? Hard to explain in a message !!

Cpt.Jack sparra pirate

pirate

30/12/2011 at 18:50

Also if it is now an ankle problem will the podiatrist send me away to go and see someone who deals with ankles ?

Jeepers

30/12/2011 at 20:28

Cpt Jack, the chap who sorted me out is a foot and ankle specialist, but I had to go privately as the local NHS were useless. My cortisone injection was done following MRI scan where X marked the appropriate spot on my foot.

They may be able to advise you of someone in your area, when I moved from London to Hampshire and couldn't make it into London, they were able to refer me to someone more local, from whom I've had excellent service.

You could try them to see if they know anyone, though I appreciate it it's a bit of a long shot.

Perhaps Mr Ryals could suggest someone.

Cpt.Jack sparra pirate

pirate

30/12/2011 at 20:47

I've still got my appointment on 3rd of jan at Warrington rugby stadium so hopefully that will all go well , especially if they deal with the Warrington players I would imagine if they can't sort it then they may point me in right direction , I'm just hoping that after most of the year being in pain they can sort it !!

Andrew Ryals

30/12/2011 at 20:56

Just a few quick responses.

Captain Jack,

It may sound harsh mate but learn from your experiment! What it should teach you is that footwear is a misunderstood tool that we can use to help treat foot pain. So, your foot type will respond to a firm stiff shoe, have you had your running shoes checked, are they compatible with your mechanics? No disrespect meant if I sound a little straight to the point! Podiatrists are specialists of the foot and ankle, so a good Pod should be easily be able to help you. It what happens at the ankle what controls the rest of the foot The pan you describe is probably medial calcaneal aphohysists, which is not PF, it's an inflammation of the medial septum of the plantar fascia and achilles tendon as it inserts into the medial calcaneal tubercle of the calcaneal bone. It mimics PF and as a consequence is often misdiagnosed, and shed loads of time is wasted with NASIDS, GP appointments etc etc. ( hope this helps).

Jeepers,

the "foot and ankle specialist" is an orthopaedic surgeon who takes an interest in feet. All Podiatrists can order and interpret diagnostic imagining (X-rays/MRI etc) and give cortisone injections, it's not that specialised!! Its basic Podiatry. I'd be more than happy to recommend someone but I dont know where Cap JAck lives.

Andy Ryals - Podiatrist

Jeepers

30/12/2011 at 21:39

Andrew Ryals wrote (see)

Jeepers,
the "foot and ankle specialist" is an orthopaedic surgeon who takes an interest in feet. All Podiatrists can order and interpret diagnostic imagining (X-rays/MRI etc) and give cortisone injections, it's not that specialised!! Its basic Podiatry. I'd be more than happy to recommend someone but I dont know where Cap JAck lives.
Andy Ryals - Podiatrist

Well, I guess I know a bit more about him than you do, but he only operates on feet and ankles, hence my use of the term "specialist", so we'll just have to disagree on that point.

Andrew Ryals

31/12/2011 at 18:25

I think the fact that he introduces himself as a consultant orthopaedic surgeon on your link says it all. He has an interest in foot and ankle surgery, he's trained to operate on any bone in the body.

Cpt.Jack sparra pirate

pirate

31/12/2011 at 18:36

Feels like back to square one !?!?!? Did a 4 hour bike today and can barely put any weight on my heels now I'm home and sat down for an hour ??? To say I'm pissed right off is a mild understatement , thought I was starting to get somewhere by changing my footwear and now cycling is bringing back on ??

Ted Edwards

31/12/2011 at 20:28

Cpt.. if you look through previous thread on here concerning PF injury you will see that I too have been suffering from it for nearly 6 months now and just like you and the rest of us suffering to say I am feeling p ed off would be an understatement.

I have tried resting it, brought the night shoe, which I am still using, brought 2 books that were recommended

and although reluctantly now had 6 physio sessions at £40 a visit and I still can see no improvement so I might now knock them on the head.

However the support I have had on here as been just phenomenal and its been really appreciated.The books have also been worth buying as they both contain useful information and on your point about cycling which I too do it says that if you cycle rather than use clipless pedals you should use flat ones and use the flat of your foot as using the toes can exacerbate your PF problem so I hope that you find the info useful.

I will post this also on the other thread as well but I am now wondering whether it would cause any further damage to the PF if I bind it up with tape, which the physio did on my last visit, and as this relieves the pain and start to at least go for short runs.As anyone tried this !

This must also be the worse time of the year to be unable to run because of an injury because the papers are full of how to get fit in the New Year and as we all know there is no finer way of doing this than going for a run.

Happy New Year everyone and may it be injury free.

bess40

01/01/2012 at 17:26

Richard Worrall 4 - please could you let me know the name of the podiatrist in Derby that you recommend? Many thanks

Andrew Ryals

01/01/2012 at 20:42

Strapping your foot helps by keeping the bony integrity of the foot. It stops pronation. This is what is causing your PF! Limit the pronation and you limit the pain, this is also occuring when you wear your stiff work shoes, your limiting pronation. You need bespoke anti-pronation orthotics but they need to address the reason why you are pronating!

Ted Edwards

02/01/2012 at 17:12

Thanks for your advice Andrew I appreciate it very much.Are you based either near Croydon or East Sussex.

Many years ago now when orthotics first come into being I travelled up to Stoke on Trent from Croydon and that's how difficult it was to find a local podiatrist was at the time and he made me some custom made ones.Anyhow after trying them and finding them uncomfortable I eventually discarded them and ran without them.

Everything seemed to be ok and being a fan of Ascics I progressed over the years to wearing GT2150's which after a while I found to be making me run on one side of foot and rather than change them I ended up with this injury.

Because of this injury I have learnt of two things in particular one being never to run through pain and the other being if you are going to buy trainers go to a small outlet rather than one of the big on line stores as the advice a proper running shop can give you is well worth any money you may save from going to a bigger store.

Being a bit of a cynic and wanting, even though I am still injured, to at least feel that I was still a runner, I know I know but I am just a silly old man so bear with me,several months I went to two separate shops and had Gait Analysis carried out and they both came up with the same answer in that I was suited to a neutral trainer so I now have a pair of Brooks Ghost 4s and a pair of New Balance 759s in there boxes waiting for me to wearr them once this blasted injury clears up.I have also got pair of Footdisc insoles which will also give me any extra support that I may need.

But waht is also interesting about the GA I had is even though they both agreed on waht shoe I should use the Physio on my initial appointment felt that I need a pronation shoe so thats set my mind running again.

However Andrew I think that given you a Podiatrist and you do not seem to have disagreed with my idea about strapping it up and going for a run I amgoing to give it a try. And unlike before if I should get any pain whatsoever I will stop and walk.Thanks for giving me a glimmer of hope.

Cpt.Jack sparra pirate

pirate

04/01/2012 at 22:06

Right , had my long awaited visit to the podiatrist , he said some of my symptoms definitely point to plantar fasciitis and after much turning , pressing , looking , feeling , getting me to walk and move in many different ways ......he said certain symptoms I have are NOT related to PF !! He thinks it's more of a biomechanical problem . I had my gait done the other week at decathlon and the computer said I was a supinator so i bought asics gel nimbus 13 however the podiatrist said I was a slight pronator and should have neutral shoes BUT he said I should keep the shoes as the cushioning will help , and he also made me some custom orthotics . He said basically my plantar is doing the same motion as if you were hold a towel with both hands and wringing it out so it's twisting as apposed to stretching , he went on to say that there is not lots of elasticity in the plantar as it's a ligament and the action of me twisting it is what's causing the damage SO he's advised me to wear the orthotics , not run or cycle for 4 weeks , carrying on with the stretches and iced water bottle rolling daily and also to hook a towel round the ball of my feet and pull back to stretch when I wake up in the mornings before I get out of bed ?? I'll let you all know how it goes

Ted Edwards

04/01/2012 at 22:13

Cpt that sounds like good news.Yes please let us all know how you get on.

Jeepers

05/01/2012 at 13:03

Good thing is that you've got a diagnosis and suggested treatment for recovery.

for the next few weeks - and permanent recovery

josph ping

27/03/2013 at 17:34

do they need to have arch supports like these arch support plantar faciitis insoles? or is it not needed?

Cpt.Jack sparra pirate

pirate

27/03/2013 at 19:17

Josph I didn't know this thread had popped back up again , I failed to do an update on it but basically since I seen the podiatrist and had my custom insoles made ( both different right and left btw ) they hurt for a couple of months whilst I was seeing him BUT I have been totally pain free since ! I've posted on another thread regarding PF outlining what happened

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