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Saturday, July 15, 2017

Problems with both feet: Email advice!

Hi Dr. Blake, I hope you don't mind I am in need of your advice. I have written you before for your advice on my left foot. Tenosynovitiis is my diagnosis and plantar faciitis. I did not have the second set of PRP injections on June 30 because I was getting considerable relief in my symptoms. At that time I was wearing the hoka one one shoes with the budin splint. I increased my activity one day at the gym using a eliptical machine that put my weight on my heels and was able to work out for 45 min at a good intensity. The next day I woke and the tenosynovitis was much worse. I realized at this time that I had been curling my toes frequently also, testing to see if they were getting better. I read your blog and came upon a quote " it is not unusal to go 3 steps forward and 2 steps back". So I went back to "Rule of Foot".  I do a 5 min ice massage on the effected area every hour. I do an ice dipping protocol every day 10 sec dip in ice water every 15 min X 2 hours and this seems to be really helping. I went back to a flat firm shoe with my orthotics ( no splint). In an effort to immobolize I do not curl my toes. This foot is responding to this regimen.  When I wake my foot is very tight with the plantar fasciitis so before getting out of bed I massage my foot especially the plantar ligament.
Dr Blake's comment: Good for you. Handling Re-flares successfully is a vital part to any rehabilitation. It is funny how rehab is always presented linear, but really spiral (sometimes we are closer to our goal, and a minute later we can be further away. I love walking the labyrinth. First saw one here in San Francisco at Grace Cathedral. It is a spiritual walk, but can be a guide to rehab also. 
You are mindfully walking, rehabbing, towards your goal (in this case the center). As you walk you find yourself close at times, only to be moved away by the path (or during rehab, a setback).

Unfortunately I now have a new problem. My right foot which also has plantar faciitis has developed symptoms. For the past 8 months I have had a tight , pressure,dry crunchy, feeling right across the ball of my foot. I do not have any heel pain. I have been limping on this foot for 8 months. If you remember I had orthotics that had heel lifts in then putting my weight on the balls of my feet. I replaced them with vionic orthotics. This right foot has some falling of the arch on x-ray. While I have been caring for my left foot I have also been icing my right. I have been stretching my right and it responds to that. My problem is that my right foot likes the hoka shoe. As soon as I went to the flat shoe for my left foot I started getting a real " ache" feeling below my big toe at the bottom inside of the ball. I feel it there occasionally  but when I push around in the area of pain I cannot locate the exact spot of soreness. After reading your blog I wonder if it is muscular? When I wear my hoka on my right foot and the flat on my left, both feet are happy. But I cannot walk anywhere like this it hurts of course. Does this tight pressure symptom accross my left foot sound like plantar faciitis to you?
Dr Blake's comment: No, could be sesamoid. Can you get an MRI on that area? You can try the flatter New Balance 928 that has some rocker. 

I have been resting my left foot with the Tenosynocitis and putting it up. I feel that the resting has been causing the plantar faciitis on the right foot to worsen.
Dr Blake's comment: When you are dealing with both sides, it is easy favor the "better" foot which can cause problems. Also, a lot of foot problems, more joint than muscular or fascial, get very tight with immobilization, even if it is from rest. Try moving the big toe joint ten times up and down per hour to see if that helps. 

I have not been going to physiotherapy because after going twice a week for the past 5 months I got no relief  (in fact all of the pulling and "digging in" on my left foot would make the tenosynovitis so much worse). I did find that the ultrasound helped the tightness in the balls of my feet.

With this sudden pain in my right foot what would you recommend?
Dr Blake's comment: Well, you have to create the 0-2 pain level for the right, without upsetting the left, how about an Anklizer boot on the left, and placing an EvenUp over the right shoe for the next 2 weeks to calm things down. 

What kind of physio treatment am I looking for?
Dr Blake's comment: Really need a diagnosis first before therapy, or they may make you worse. 

Will ultrasound help?

The right foot likes a hot bath with Epsom salt and a massage the area almost feels normal but than quickly goes back to stiff, crunchy, plaque like feeling.

How do I treat both feet with such different needs?
Dr Blake's comment: First of all, you must list the needs of each, and keep them separate. Do for the right what is needed, and separately do for the left what is needed. Send a check list to me what you have found so I can keep these clear in my aging brain. Rich


So thankful for your help,

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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.