Comment: I have been to several orthopaedic surgeons and they only recommend surgery. They never mention stretches, physical therapy, pain medication, lifestyle changes, etc. It’s very frustrating. Surgery is scary and the recovery is long. This is why people are searching for alternatives.
Hi Laura,
Your question/comment is outstanding. Unfortunately your story is all too true. To be honest, most of my colleagues do want to help you in the best way they know how. However, the non-surgical methods that they understand, the same ones they have been taught and tried in the past, fail too often.
Why do these non-operative treatments fail, you ask? I heard you ask that just now BTW. To be blunt, they treat the wrong thing—the obvious problem in the foot (plantar fasciitis, midfoot arthritis, second MTP synovitis, etc.). After all, you just showed them where the problem is that needs to be fixed and they can touch it and reproduce it. The source of your complaint is so obvious, it is right there in your foot. Any fool can diagnose and treat your problem. Certainly it would be nice if you went in and said, “My foot hurts, but the pain in my foot is really coming from my asymptomatic calf that is too tight. So doc, what treatments do you have to fix my calf so that my foot or ankle pain will go away?”
Do my colleagues ascribe to a thing as simple as calf stretching? For the majority, the answer is NO! Even if they believed or knew it was at the problem stretching the calves would be too simple and would take too long to treat, and both you and the surgeon want this resolved now. Almost everyone and I mean everyone, thinks that calf stretching does not work even though the evidence says otherwise. So here you have a SURGEON who finds that these non-operative treatments fail (how convenient)…well the next step is obvious. We pull the old scorpion on the frog in the river thing and do what is in our nature, we cut.
Stick with me here because I am coming to a point.
Orthopaedic surgeons and podiatrists are generally good diagnosticians. Here is the problem, and here is the treatment. Any deeper thought is not usually necessary because the problem is so obvious. So, the thought that the calf is what is boogering up your foot and ankle is just not on the radar or comprehensible to most of us. But we should be better than that.
The idea that your symptoms might not be coming from where you are pointing and originating from a remote location is generally speaking above our pay grade. Having stated that, it is most definitely our duty to connect the dots between cause and effect. We call it clinical correlation and unfortunately it is becoming a lost art. Then and only then can we have any chance of effectively treating the problem effectively.
To further make my point I was going to use a medical illustration here like constipation, but I opted for golf. Both can stink BTW. A reasonably decent intermediate golfer with a pretty good swing has started to slice the ball and of course, tries to fix it themselves along with all their golfing buddies handing out their unsolicited help. They finally go to a pro for real help presenting their own theories as to the cause. The pro smiles and says, “Hit a few 7 irons for me,” knowing there are only so many causes of a slice. The golfer thinks it is very complicated and there are infinite reasons because a slice can be so hard to eradicate. The pro suggests some seemingly minor, totally unrelated change like the stance and voilà, problem fixed. No changes in the swing what so ever. The cause of a problem is not always what it appears. Think outside the box!
This is where I get angry. Here is the problem Laura, my colleagues are mostly closed minded to this concept so I have to reach out here to everyday people like you, to the AO-nation. Using plantar fasciitis as an example, just look at the number of treatments for this problem. There is an old line in medicine, “When there are many treatments for the same problem, none are really working well”. Most often presented with a clinical dilemma we know the underlying cause of the problem, but in some cases it is just difficult to treat or we have not found the right answer yet. Here it comes, wait for it……..
What if the treatments are not working because they are not directed at the cause, but at the end result, the effect, the location where you are pointing? What if the cause is unknown or not accepted? What if most everyone is missing the point completely? In this case we are doomed to endless searching and making the same mistake over and over. What if the simple concept of equinus or calves that are too tight causing the majority of foot and ankle problems was actually correct? What a revelation that would be for so many of us!
Too many of my colleagues fail to make this connection, but some do get it. Here’s a video that makes me think: maybe I’m not all alone.
Original link: Plantar Fasciitis: looking in all the wrong places.
Stay healthy my friends,
AO
Hi,
May I see you in your practice? Not sure where you are located. I am in Los Angeles. Thanks.
Hi Nina,
How flattering, really. And I would definitely see you and do my best to help you thru what you are experiencing. But I will tell you a little secret. I have retired from active practice and I have moved on to another gig. While my new adventure is medically related it is not patient related. I am having a blast doing something different, but rest assured I have not lost one bit of my medical mojo. So, I will still be here for all of you, angry as ever. Nina, one of my best buds in the business is right there in your neck of the woods, Ventura, CA. Please go see one of the nicest and best, Ray Nickel, MD.
Stay healthy my friends,
AO
Who can you suggest now in NY? I am on Long Island. I have pain on top of foot right below and going thru the 3rd and 4th toe. (not on bottom of foot) since 2015. Tried cortisone and alcohol injections back in 2015 after confirming on 2015 MRI a 8 x 3mm third interspace neuroma. Shoot ahead to 2020 and I just had RFA (unguided) Dec 10th. 2019 and it did not work.
Dec. 2019 MRI showed: “small 2nd & 3rd webspace neuromas/scarring with 1st-3rd intermetatarsal bursitis.
Subcutaneous tissues: very mild subcutaneous edema. Will your stretching help this?? I am contemplating cryosurgery fot the neuromas. Help!!
Yo Holly,
In the NYC/Long Island area, I would see Martin O’Malley. Good guy and not knife-happy. However, he is unlikely to support calf stretching just like most of my colleagues. I guess it is bad for business. Is it possible that I am right and they are wrong?
My first answer is to do as Andrew (another comment) says, “what could it hurt to stretch my calves” and it is FREEEE!!! I mean it! I would give it high odds (> 65%) that calf stretching will solve your problem no matter the diagnosis. How is that for beautiful.
Okay, now for your answer. The MRI is not remotely definitive for a Morton’s neuroma. The evidence does not support it and neither do I. I am not buying it one bit. Good ole’ history and a little bit of exam are all that is required. Unfortunately, we live in a world where the MRI is king and for some strange reason trumps all. Actually it is not strange as the surgeon can be computably lazy and the radiologist gets rich.
Cryotherapy is not an option in my book and the evidence is weak, especially if the dx of Morton’s neuroma is likely not even present.
Start stretching!
Stay healthy my friends,
AO
Hello – just came across your blog (and saw your comment that you are retired from practice). Do you know of anyone in the Bay Area that might be able to help me? I developed pain while in my third trimester so I assumed it was pregnancy related! Baby is 3 months old now and I finally saw a podiatrist last week. He quickly diagnosed me with a neuroma in my foot and gave me a steroid injection. It was a whirlwind visit that maybe lasted 5 minutes. I am hoping to find someone else who can spend more time looking at my problem and coming up with a game plan to fix it. I had to rely on google to even figure out what it was he diagnosed me with (and came across your site). In line with your post, massaging and stretching has helped alleviate the pain (but the clicking is still there). Thanks in advance.
Hi Teresa,
Let me be so bold as to state that virtually every (>70%) foot problem acquired during pregnancy is due to equinus or calves that are too tight. I have published on this very topic. My colleagues either don’t know this (this is the most likely scenario folks) or business will suffer if it is known, so, cover it up, right I know several docs in the Bay Area, but none could do this, period unless you are just itching to have surgery. Pregnancy-related equinus issues, like plantar fasciitis, are wildly common. Just look at any of the sites devoted to pregnancy or new moms and behold, there is a common thread to foot problems, but no-one can see the connection like your not-so-friendly AO can. So, as far as fixing your problem, fix it by calf stretching.
Here is my really, really BIG message. The default for any human with a non-traumatic acquired foot and ankle issue, especially a pregnant woman or recently having given birth, is stretch your calves and avoid docs!
Stay healthy my friends,
AO
Hello There! I have greatly enjoyed reading your blog. It is so difficult to find straightforward medical information. Do you have any recommendations for podiatrists in the Chicago area? Thank you!
Sincerely,
Lauren
Hi Lauren,
My apologies for the tardiness. There is a blog coming out to explain. Unfortunately, I do not have a recommendation for anyone in Chicago. If you are still seeking you could look at the AOFAS. Best of luck to you.
Stay healthy my friends,
AO
Hello There!
Just wanted to let you know that without your info while searching for years for answers I don’t know what my fate would be. I want to thank you, thank you! I have been in pain for many years and it has changed my life. I haven’t taken long walks, worked out, pilates and yoga stopped. I always felt like I had a rock or rolled sock in my foot, pain in the 3rd and 2nd toes, numbness, cramping, and ball of foot pain. It’s been awful. Orthotics didn’t work, fascia work, chiropractic work, energy healing, extra wide shoes (did make it bearable) acupuncture I have seen several podiatrists, and foot surgeons. One wanted to give me cortisone shots but I didn’t do it because I have a torn labrum in my left hip and a shot gave me thrush so I won’t do it again. I was told I have Morton’s Neuroma. However, the new foot doctor I am seeing says I have an MN in the left foot but peripheral neuropathy so I started taking Neuremedy and it’s helped but the ball of foot pain didn’t go away. I decided to try the calf stretching two weeks ago and I think I am beginning to see a difference. I was supposed to get RFA on left foot MN since nothing was helping and decided to hold off and give the calf stretches a chance first. I am glad I did. Going to revisit this option after 3 or 4 months and see what changes occur. I also have a Taylor’s Bunion and not sure that is playing a part in this also. I just wanted you to know I am not giving up and your advice has been instrumental in helping me. If you have any colleagues in North Carolina please let me know it would be greatly appreciated.
Kind regards.
Donna
Hi Donna,
Keep it going! There is no doubt calf stretching will not fix everything and it is unfortunately not so fast, but it addresses the problem. Treating the symptoms (all the other treatments) can no doubt help mitigate the immediate pain and loss of activities, but please stretch. Eqinous causes so much misery and structural foot and ankle damage, yet it is so undervalued and basically forgotten if not unknown. In my opinion, calf stretching is the most underutilized, yet powerful tool you have never heard of.
Here is the problem. Maybe your surgeon or other health sources, such as WebMD, etc., tell you to stretch, but do they really tell you and mean it? And do they tell you how or the best method? Do they give you a protocol? The answer is a categorical NO. No real heart, not emphasis, no results. The vast majority of my colleagues are not on board, so don’t expect to hear it from them, at least not with any gusto.
Two of the worlds best foot and ankle orthopods and my good friends are right there in Charlotte, NC. Robert Anderson, MD and Hodges Davis, MD get it and are quality individuals. Their foot and ankle partners are equally good just in case they are busy and count on them being busy.
Donna and all the rest, please spread the word out there about what is happening here. You can’t get this in a consultation no matter what it costs.
Stay healthy my friends,
AO
So happy I found this blog—RA patient with foot issues that mimic MN–really don’t want surgery — will putting this information to go use….Murphy Texas
Hi Cathy,
With RA please warm up to the stretching. You might be a challenge, but I can’t imagine you don’t see improvement. I am not sure why you put your location, except only a Texan, could be as brash as I am, at least here on the AO. Don’t tell anyone, but while I don’t live in Texas anymore, I was born in Houston, raised in Richardson and I used to ride bulls in the Wylie buck out. Great time. I plan to come back home in the not so far future.
Stay healthy my friends,
AO
I am so grateful to have found your blog.Ive had PF with heal tear for 8 months now.When I read your blog 4 months ago I began faithfully 3 x3 calf stretching everyday and after doing everything else imaginable before that the calf stretching has given me the most relief to date.
I am still a long way away from walking barefooted or jogging that’s for sure but it is better.My question is at what point do I say Ok perhaps the cortisone shot that’s been recommended to me is now Worth doing.I am scheduled In April /19 to get another ultrasound to see if the tear in my heal has healed .I figure if I’m still having pain after 1 year this is not going away and I have nothing to lose.I will keep up with your 3 x3 stretching forever as I believe this to be very valuable for leg and foot health.Could it just be that I need more time yet?
I appreciate your time
Thank you
Hi Jan,
Thanks for the compliment. I am just here to serve. Your results are not surprising. Isn’t it crazy how stupid simple stretching is, but it does take a bit of effort and a lot of patience.
As for your plantar fascial tear do not despair. I found the percentage of relief obtained from stretching for all plantar fasciitis sufferers virtually the same: ~94%. This includes those who were early or not “chronic” (> 6 months), chronic, post-op plantar fasciectomy failures, and plantar fascial ruptures like you. I am seriously getting angry just writing this.
I think a cortisone shot is always OK, but not for a “cure.” It is for making the patient symptomatically better and more active while the real treatment is allowed time to work. So, go for it, just keep stretching. I think stretching is a problem for two reasons: it can take a while to work, which is discouraging, and it is physically remote or seemingly disconnected.
Finally, you do need more time. I found, even in my own wife, a two-tiered recovery response in about 40% of all comers. The other 60% just resolved all symptoms once the stretching started to work: the lucky ones. Of course, there are those few who do not get a satisfactory recovery using stretching.
The two-tiered recoveries are like yours- I hope. After a period of time, these patients get significantly better, but there was an annoying plateau with an occasional to a constant reminder that some of the original problem is still there. This creates doubt and fear that it could return at any point. This is entirely understandable, but easier to take if there is some reassurance and reasonably sure path as I am describing here. My wife had second MTP synovitis, and after 3 months of dedicated stretching and a few cortisone shots to keep her going, she got much better. She even proclaimed it was over! Then on second thought, she admitted that she still felt it was still there on a small scale. Reducing activities somewhat and continuing to stretch, as she still does today 8 years later, and about 6 months later her problem finally resolved completely.
So Jan, there is still hope. Keep it up!
Stay healthy my friends,
AO
Thank you for your encouraging words and your time