(…Or just about anything else we tell ‘em.)
Patients are predictable I’m sorry to say. Non-compliance is a very large problem with patients.
I give approximately 85% of my patients explicit, written directions to do calf stretching and – even with the most compelling reasons – they leave the office sold on the concept and the exercise and then… more than 50% of them won’t do it. Did I say my directions even have pictures?
I don’t know, maybe they go home saying, “What? I paid for an office visit, and this guy just told me to stretch? He must be crazy.”
Then, they come in for their follow-up and some version of this conversation occurs:
“Doc, your stretching is not working.”
“What’s wrong with it? ?”
“Are you DOING the stretching?”
“No. Should I? Did you really mean it?”
“Yes I meant it! What about, ‘the calf stretching is the ONLY thing that will FIX your problem,’ did you not get?”
C’mon, people. I’m telling you what, 95% of the time, is effective! However, the stretching is effective 0% of the time if they are not done.
I’m asked why I focus so much on calf stretching. It’s simple. It works. Stretching is prevention and cure rolled up into one. If you have pain now, this stretching will make it go away. If you don’t want pain later, KEEP STRETCHING.
Five to 10 new patients every week are ones I saw 10 to 15 years ago for plantar fasciitis, heel pain, or other ailments. I prescribed stretching, they complied, and the pain went away. However, I told them to continue with stretching, but for whatever reason, they didn’t. Now, a decade later, they show up for something else, like mid-foot arthritis or achilles tendonitis.
They think that one has nothing to do with the other, but I say they have EVERYTHING to do with one another. When it comes to stretching your calf, compliance is key.
Calves get tighter as we get older; the calf contracts as we age. It’s just a fact and there are many reasons this occurs. (More on that later…)
Frankly, if you don’t do the stretching, it’s okay by me. I get more business that way. Don’t stretch and we’ll be cutting on you soon enough. But I’d rather send you away from my office fixed for good instead of creating a repeat customer.
Thanks for the share!
Nancy.R
thanks…you are right – I explored issues, even option of surgery and special shoes…then I started stretching…duh. No surgery, no special expensive shoes, no more doctor visits!
When will your device for stretching be available? A friend of mine needs it desperately.
Thanks!
Love this site!!!!
I’ve been prescribed calf stretching for PF — but with no indication of how to tell if I’m doing it correctly (until I feel a slight tightening? Pain?), or how to tell if I need to do more or less of it. Are there no guidelines?
Meg
Hi Meg. Here is my stand on this for the last 26 years. Calf stretching is THE answer for PF. Simply put, my stretching protocol is a moderate stretch, usually both forefeet on a step, hanging your heels off so that you feel the stretch mostly in your calves. No need to be too aggressive. Do this 3 min. 3 times per day, everyday, and be patient. Also do them like resistance training sets, do them back to back with a short rest in between, that way you will remember and get them do for the day. Relief will come because you are attacking the problem, your calves. -AO
I have struggles w plantar fascitis for around 2 years now. Stretching/ice/boot night splint/ orthotic…I just got measure by a friend of mine today(a very good PT) and my range of flexure w reguard to my ankles and calfs is WNL. Back in Nov another friend gave me an injection(steriod) and w/in days I was completely better. Fast forward to march pain returns but different. Before it would hurt in the morning for about 15-30 minute and I wouldn’t notice it the rest of the day. Now- It lingers w me throughout the day(not specifically in the morning) and instead of hurting as my heal strikes the ground it’s hurts more when I’m pushing off as I step. Any recommendations for me. Any help is appriciated in advance. Thanks
Joe
Do the stretching exercises apply to tendon pain/twinges across the bottom of the foot as well or is that something different than pain that occurs in the heels. I think I may have plantar fasciitis but not in my heels. I just get “twinges” that are becoming painful now as time goes on across the bottom of my foot, usually when I step on uneven ground. I’m just not sure where to start or who, if anyone I should see about it. Thank you so much!!
I am very impressed with this website I received from my husband today. I do agree good gastroc/ soleus flexibility is very important with treatment of PF, and also posterior tibialis tendonitis and Achilles tendonitis. In theory I feel if gastroc/soleus is tight patient may compensate with over pronation to achieve the desired dorsiflexion in foot flat to toe off stage of gait. I also feel patient’s need a low load long duration stretch to permanently lengthen gastroc/soleus. I like the leaning on the wall method using a stool that my husband performs, which is the easiest way to obtain this stretch. I have started to give my patients this stretch. I have also used a low die tape to increase arch support for overpronators and if immediate relief is achieved recommend orthotics off the shelf. I can medial post rear foot if significant valgus or medial post forefoot if decent varus. I will also mob/ thrust manipulate talocrural joint if decreased mobility. It is difficult to tell if decreased mobility from end feel but usually an anterior pinch at talocrural joint at injured side. Side note: many of my tri-malleolar fracture patients usually have significant lack of dorsiflexion but feel no gastroc stretch but anterior talocrural pinch – theory that horizontal syndesmotic screw limits tib- fib mobility to distract to allow increased size of talocrural joint with dorsiflexion. Docs that allow earlier dorsiflexion motion with non weight bearing splint usually have superior end stage DF range of motion. Just wanted to say that I also like your decreased need to have MRIs, bone scans etc. I do cringe when physical therapists perform ultrasound, estim for pain relief etc. I wish physical therapists overall have more consistency with treatment; I think good clinical rotations and following evidence based therapy is crucial- evidence is continuing to grow. I also like your willingness to see complicated patients that other docs refuse. Teresa- physical therapist Cincinnati
Just as a side note: does not need to be posted. I can tell from this website that you are a huge patient advocate and that is awesome! There are a lot of good orthopaedics like yourself whose main goal is to get the patient better. I have seen a few with other intentions though, so this is a great outlet where patient’s nationwide can be educated to select a good ortho. My husband’s surgery by you for his subluxing peroneal tendon in 2003 has helped him tremendously, and restored his life to normal. My colleague and I highly recommend our complicated ankle patients to see you. Thanks again! Teresa Wolterman – physical therapist
I have been diagnosed with PTT (Posterior Tibialis Tendonopathy) I have hallux rigidus and acquired flat foot.
I am a keen runner, ran 2 half marathons in 1.39 this year but pulled out of a full marathon because of foot and ankle pain and swelling.
I am 59, 142 pounds.
I have seen 2 surgeons, a few PT’s, 3 podiastrists and now have expensive orthotics. In some of my running shoes they push my feet too far so that my little toe rubs against the show and hurts. So I often don’t run with orthotics.
Should I do calf stretching? I have been doing toe lifts, standing on tip toes. Do you recommend an operation? any other advice? I would hate to give u running.
many thanks
David Michael
Hi David,
So sorry to hear about your situation. Nice race times BTW. I could do better….with a car.
To get to the point, you should definitely do calf stretching and I will send you my protocol by separate email. The isolated gastrocnemius contracture has been linked heavily with starting PPTD and acquired flatfoot deformity, as well as propagation of the problem. In my opinion the isolated gastrocnemius contracture is the one and only cause of PTTD and many other foot and ankle problems. Another is plantar fasciitis and it is a 70% chance you have had plantar fasciitis in the past.
In general custom and OTC orthotics are a personal preference and mostly not well accepted. An acquired flatfoot deformity will likely make the contact forces in your arch higher and cause more pain with a bump under it. Feel free to take them out whenever you want, forever if you choose. In most cases they are a waste of time and money. It would be far better until you get stretched out to put heel lifts in your running shoes. Don’t ask me why, this just works, but will not fix. Just as one final bash on custom orthotics, they are money makers for the docs who rarely ask if they actually do anything. Now everybody whine about that, but it is the truth.
Surgery is your last resort especially if you have not stretched yet. I do a lot of FF reconstructions, but always as a last resort which depends on the stage. You need to know that at 59 the likelihood of you running after this type of surgery is unlikely.
I actually trained at St. Barts in London for 6 months in the mid 80’s and I loved it. So you could say I am a Barts man. There is a great foot and ankle orthopaedic surgeon in Cardiff, a good bud of mine, Mr. Anthony Perara. You might go see him, but he is very unlikely to endorse the stretching angle like I do. Just in case you go to the next level he is likely the best resource around.
Best regards,
Mr. AO
Is your calf stretch on the stair good for Achilles tendonitis or should it be done different?
Ronny,
Good question. I am going to provide a short rant on this subject. First, the answer to your question is yes, especially for insertional Achilles tendinosis. Now for my rant with a bit of rage.
My opinion is that virtually every Achilles issue has a root cause of equinus (calves too tight). This even goes for complete mid substance traumatic tears. Why would anyone direct treatment away from solving this at the root cause? There is plenty of evidence to support the calf stretching works. There is even more “reverse evidence”, basically meaning, the treatment solves the problem. There are many articles showing that surgical calf or Achilles lengthening helps Achilles issues. Someone, please explain to me how equinus is just a random association as widely assumed and that adequate calf stretching is ineffective? Then there is “eccentric” calf exercises. While they do seem to work, what about them actually works? In each of these studies, calf stretching is involved, yet its presence ignored in every study. What role does static stretching play? I think way more than it is given credit, which is none.
My advice for Achilles issues is to do both exercises, static and eccentric. But, don’t not do the static stretching. For the eccentric method please look to YouTube where many videos can be found.
Let us know how you are doing.
Stay healthy my friends,
AO