Scar Tissue

Discussion in 'Ask the Docs' started by Barefoot TJ, Mar 19, 2012.

  1. Barefoot TJ Administrator
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    After the surgeries on both of my feet to remove the neuromas (two in each) and the previous attempts to kill said neuromas (cortisone, alcohol sclerosing, electroshockwave therapy with numbing injections, and cryosurgery--37 injections before the final sugeries), I have developed a lot of scar tissue. The balls of my feet feel hard, packed, and painful.

    Wouldn't running barefoot on asphalt and concrete help break up the scar tissue?

    Other than massage, how else do you recommend your patients get rid of or reduce the scar tissue in the balls of their feet and toes?

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  2. Dirty Toes Joe Barefooters

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    I'm interested in what pops up in this thread, TJ. I accidentally shot my mom in the top of the foot with a framing nailer. She's got a ball of scar tissue in the bottom of her foot now. She says it feels like a marble in her sock. Most times it doesn't bother her, but once in a while it really hurts. She said her doctor told her that they could do surgery to get it out, but the surgery would just create its own scar tissue.......

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  3. SaraLord Administrator

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    Hey TJ,

    I think massage is your best bet. You might look into the graston technique, which is a type of massage with metal instruments that get deep into tissue, not unlike the golf ball or foam roller. Maybe someone else has more to add on this? I think the quicker you work on it the better chance you have of breaking the scar tissue up.

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  4. Haselsmasher Barefooters

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    I was thinking Graston as well - or ASTYM or Gua Sha. They all seem to me to be very similar. There's even a YouTube vid out there that shows someone doing Gua Sha on themselves using a plastic spatula. :)

    Jim

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  5. Barefoot TJ Administrator
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    On the feet? A video of someone beating the hell out of their feet with a spatula? Haven't I already done that? I mean the beating part? Although my spatula was wrapped in cushioning! Ha. Wait, not so funny.

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  6. Haselsmasher Barefooters

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    :)

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  7. Barefoot TJ Administrator
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    I just came back from my second appointment with a deep tissue/accu-pressure point massage therapist (she's from Thailand). She's very talented and paints wonderful portraits. The first time, I went, it was slightly painful, not much. Tonight, it was rather painful, and I could feel some of the tissue was moving around as she did her work, like maybe it has loosened up from the first visit. She then pulled out this weird tool and dug into the balls and toes of my feet. OUCHIE! I hope this works.

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  8. Barefoot TJ Administrator
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    That guy there in the video, Hasel, has some boney feet. I can't see the fascia when I bend my toes back, but you can clearly see his. Interesting to see his branch out that way, as it should be, just interesting to see it though.

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  9. Dr. Gangemi_SockDoc Barefooters

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    I am almost always against any therapist using anything other than their hands/fingers (okay I guess elbows too) for fascia and muscle work. If you use devices like a spoon/spatula or whatever is laying around your house or office (or you paid a crazy amount for at a seminar) you cannot feel the tissue you are manipulating - so you end up just beating the hell out of it, often causing more inflammation, a lot of pain, and maybe even more scar tissue. A lot of therapists lack the necessary palpation and muscle manipulation skills because they are trying to feel thru some metal or plastic; good luck. Now of course this means you sometimes need to have strong hands, and many people don't (and they're therapists) then they need to be very careful. Now for someone doing therapy on themselves using a device may be okay, especially in areas you cannot reach (such as your back - and you want to lie or roll around on a ball), but don't think more is always better. Hands are always better!

    There are basically three things I look at when it comes to scar tissue. 1) you guys have already discussed here - breaking it up with manipulation 2) This one is addressing the biomechanics of the body so the stress is removed from the scar tissue. What happens when someone has surgery, such as this neuroma surgery or say, back surgery is two things have happened (or not happened) - first is that the reason for the problem has never been addressed. In this case, the muscle imbalances and gait mechanics that led up to neuromans are still present and these imbalances will now affect the scar tissue, rather than the neuromas. The second is that any surgery - the act of cutting into the body - is a big deal! It's a major stress on the nervous system and the musculoskeletal system so now, post-surgery, other imbalances have been created. 3) Is the nutritional component. A diet low or absent in refined carbs, refined vegetable oils (canola, sunflower, safflower, etc), and trans fats is a must. Increasing good fats in your diet - coconut, egg yolk avocado, butter, fish oil, and some raw nuts/seeds can help a whole lot with inflammation and therefore the scar tissue, as can making sure your protein intake is adequate (1.5 grams protein per kg bodyweight).

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  10. Barefoot TJ Administrator
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    Thanks so much for that lengthy explanation, Dr. G. I think because she had already spent about an hour on the balls of my feet, working to break up the scar tissue, she had pretty much learned where the scars had built up, so she knew where to apply pressure with the tool, as she would go back to her hands to continue to "read" where the bulkiness was needing more work. Let's hope that's the case, right? If she had only used the tool and never her hands, I would definitely wonder if she knew what she was doing. I'll keep you informed and let you all know how I am doing as I go through this "process."

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  11. Barefoot Scott Barefooters

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    I have a neuroma or scar tissue on the bottom/ball of my foot, between the big and second toe, closer to the big toe. I have had it since 2002, when I first ran barefoot. A sharp rock hit the same spot twice that year. The bruising wrapped all the way around from bottom to top of the big toe joint. It's like a small marble or hard pea embedded under my big toe/ball of foot. When I step on something on that spot while running, it really hurts. Quite honestly, it makes barefoot running not fun. And now I am getting swelling and pain on the top of the foot, at the base of toes 2, 3 and 4. Never had that before. Bone scan was negative for stress fracture, so it must come from the neuroma/scar tissue near the big toe ball?
    I am thinking about a cortisone shot. My doctor thinks it might help.
  12. Barefoot TJ Administrator
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    You say neuroma OR scar tissue. You're not sure which it is? You were diagnosed with a neuroma next to your big toe, between toes #1 and #2? That's not normally where they are, but if you got it from an injury, that would make sense. You actually recall this new pain on your first barefoot run back in 2002? Do you recall a certain step you took that triggered it? Or did it just show up during or after the run and you not know how it happened?

    You can try to cortisone shot, but know that you may have to keep repeating that injection every three or so months.

    Have you tried to have the scar tissue broken up?

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  13. Barefoot TJ Administrator
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    Here's the latest on me (copied from another thread):

    I have seen a massage therapist three times now to break up the scar tissue in the balls of my feet from the surgeries to remove the neuromas. sigh. The first time didn't hurt much at all. The second time, I could tell she was moving tissue around pretty good, most likely loosened up from the first visit. She used her hands then a tool on the right foot to break up the tissue there. All of it, hands and tool, hurt a little at first; the more she did it with her hands, the easier it got - the more she did it with her tool, it never got easier. No problems afterwards for either of the first two visits. I didn't have throbbing, burning pain in my feet or toes at night when I'm trying to sleep as I often do. Then I saw her again yesterday morning, the third visit. She worked the tissues on both feet pretty hard, and I could feel the tissue loosening and moving around. (I could even feel a lumpy-sensation afterwards walking around for a little while at first.) But! My feet haven't settled down since. They hurt and throb and burn, both of them, and she only used the tool on the left one this time, meaning the right one and the left one are hurting just the same, with or without the tool being used. Why? What is happening in there? Is this normal? To be expected? Will it get better with more visits? Will it get better without more visits?

    On a side note, but very important one to me, she found a neuroma on my left foot with her tool. It's very tiny. I can feel it when she runs the tool over it. It "pops" (not really, but that's what it feels like) which is common for a neuroma to do when it has pressure applied to it. Wonderful me. sigh.

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  14. Barefoot TJ Administrator
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    Update: My feets still hurt. This is the longest I've gone without at least some calming of the pain. I even took a couple of Ultram, and I rarely ever need to do that for this problem, and they don't seem to be taking the edge off this time.

    So my question, does breaking up the scar tissue cause this kind of pain? Is this normal and to be expected? I mean I have this pain whether I am active on my feet even a little or a lot or sitting on my hiney all day, but normally it settles down and gives me a break for a day or so. With this last visit, it just hasn't stopped.

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  15. Barefoot Scott Barefooters

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    No, it wasn't my first run. It was during my first year of barefoot running - 2002. I remember both incidents clearly, the original injury and a few months later, the second insult on the same spot. The first was an embedded rock on an offroad path at a much faster pace than i can run today, got me right between the big toe and second toe. I remember a good deal of discoloration. It healed. A few months later, dusk masked a sharp 1 inch or so piece of gravel at the end of group run (ironically put on by the local running shoe store), when I was trying to reel in someone in. So I was, for me, flying, when I got hit again, in the exact same spot. That spot, the ball from the second toe to the big toe, has been hypersensitive ever since and there is more mass there than there was and is in the other foot. I don't know what you call it - my doctor called it scar tissue. I can usually tolerate it running on flat clean surfaces (to the tune of two half marathons in 2010), but when i step on anything on that spot, it hurts for the rest of the run and beyone, until i ice and advil it. My concern lately is the ball of foot pain seems to have now spawen top of foot pain and swelling at the base of the littler toes, unless that is unrelated?

    Hope you feel better.
  16. Barefoot TJ Administrator
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    Thank you. I hope you get better as well.

    What do you Docs say to Scott?

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  17. Barefoot TJ Administrator
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    She found a second one today. I feel them too. Other than the scar tissue pain I'm dealing with, burning and throbbing, the neuromas feel like tiny little knots I'm walking around on. She swears she can work the scar tissue off the nerve (neuroma), so I won't have to have surgery again. They do seem smallish at this point. She said she has done this for countless others. My doctor actually referred me to her to have her break up the scar tissue, so let's hope she can make all this better. Otherwise... sigh.

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  18. Dr. Nirenberg Barefooters

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    Scar tissue is often a catch all term that doctors throw out. But, with neuroma surgery you can have more than ONLY scar tissue. You can STILL have nerve pain because you are essentially cutting/injuring a nerve. Nerve pain is about the worst pain there is. So you may need to get a medication that "calms" the nerves in a sense, such as Neurontin, Gabapentin etc.... And likely, TENS therapy.... And you also DO have scar tissue, and need warm moist heat (compresses and soaks) and DEEP massage, and even ultrasound. It can take a long, long time to recover. I do not know of anything that shows running barefoot will help scar tissue, though. But you never know.

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  19. Barefoot TJ Administrator
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    Thanks, Doc. I'm scared. I don't know if what she is doing is helping or hurting. I mean she's doing what she's supposed to do, that is breaking up the scar tissue, and I do feel the balls of my feet don't feel as "hard" as they used to, but at the same time, it's aggravating the nerves, or what's left of them. I feel like I'm walking on knots in my toes after a session, even in the middle toe where the nerve branch was completely removed. I will say that I haven't had any burning and throbbing at night when I am trying to sleep for a few days now, as I had in the past almost every other day or so. I won't get to see her for a whole month now, since she's going back to Thailand on vacation to visit family. Should I see someone else in the meantime? At least once a week until she gets back?

    She said not to run until she gets back and has had a chance to work on my feet some more, since she believes the scar tissue will have tightened up more in her absence, and she doesn't want me undoing her work. (Not like I can really run anyway right now. :()

    I do have a TENS unit my buddy Matt recommended. I guess I should just place the electrodes over the balls of my feet?

    Will a home ultrasound unit work for me or do I have to see a professional for ultrasound treatments? I'll buy one if I have to. Do you have a recommendation for a certain model?

    I tried soaking my feet to relieve the PF in ice water the other day, and although that did help the PF to settle down a bit, it really ticked off my neuromas! Ouch! I won't do that again. The PF acts up when I walk too much on the back of my feet than on the middle or front of my feet. I don't like putting weight on the balls of my feet yet. Or maybe I'm developing bad habits from being in pain for too long and am having trouble breaking them.

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  20. Dr. Nirenberg Barefooters

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    TENS is worth trying. I would have a physical therapist apply it and do if for a while. If it works well, they can arrange to get you one for at home.

    As far as seeing someone else.... that is really up to you. I do not believe you should need massage forever... so it should improve to a point and you should be able to go on your way.... It sounds like you have multiple issues. Are you certain you do not have something systemic going on that is contributory to all these problems? If not, I would talk with your doctors about investigating a bit for connective tissue issues, arthritis, thyroid, diabetes etc....... I hope this helps.

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