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Monday, April 25, 2016

Plantar Fascial Tear: Email Followup

Hello Doctor Blake,

I hope you are doing well and enjoying the spring so far.

I am way overdue giving you an update on the recovery of my right foot from the torn plantar fascia. 

I've been out of the boot since mid-March (just over a month).  For the most part, I'm pain free when walking just around the house and the office.  My stride is becoming more normal as I try to remember how to walk.  

I'm still wearing the tape, except for the last few days when I simply didn't put it back on yet.
Dr Blake's comment: Support the Foot tape

Right now, I can walk about 3/4 of a mile to a cafe, sit for a while, and walk back with relatively little discomfort.  I have no discomfort when I walk, but when I'm home, I feel a little bit of tightness and soreness in the arch right where it meets the heel bone.
Dr Blake's comment: At this stage of weaning out of the boot, I have not let him begin plantar fascial stretches, so this tension is normal. Also, not sure how much icing he is doing. 

Last Sunday, I put my foot to the test: I walked about 1.5 miles to a local cafe, then took the long way home (~2miles).  I felt little discomfort while walking (and I felt elated to be able to do this), but when I got home, I had some intense soreness in that exact same spot (where arch meeting heel bone) that reminded me of the pain I felt walking around Europe in October, before the MRI and the boot.  Icing and massage didn't make it go away much, but the next morning I felt no discomfort and took it easy on Monday - Wednesday.  Thursday was my follow test: walked 3/4 mile to a local cafe and back.  I felt no discomfort while walking and only a tinge of tightness after I got home for the rest of the day.  That seems to be about the right amount of distance for now.
Dr Blake's comment: This is also normal, and not considered a flareup, if the pain resolves in several days. We have to have patients test it and work through good pain, and try to avoid bad pain. 

The Emeryville PT folks have been great.  They feel that I need to work on two things: [1] ankle flexibility and rotation and [b] gluteus muscles.  They say I have a dipping hip on the right side when I walk, so they've got me working with a band to do all kinds of gluteus strengthening exercises.  They also have me doing calf and hamstring stretching and finally have me doing calf lifts to strengthen those muscles.  I'm getting stronger on these muscles, but it's a slow process.

What do you think?  Are these the right exercises to be working on?  Should I be doing other things?
Dr Blake's comment: Avoid negative stretching, but begin doing plantar fascial stretches gently 3 times a day. the upper and lower hamstrings are also important. See the below videos.

Any advice about walking too so I don't feel that soreness at my arch/heel bone connection?
Dr Blake's comment: Make sure you work on distance covered, not speed or hills just yet. Walk 3 days per week with the longest walk on one of the two weekends. If you bring the removable boot in a backpack, you can continue to weekly push the envelop and stop if the pain begins during the walk. Whether you hurt or not, ice for 15 minutes after each exercise walk. Besides the exercises above, you should be strengthening with the following exercises each evening to get your feet and ankles strong:

  1. met doming
  2. single leg balancing
  3. posterior tibial theraband
  4. peroneal longus theraband
The PTs can show you if you do not understand them on the videos below. Give me another email in one month. Rich

Thanks and I hope you're doing great.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.