Advice for a Non-Surgical Approach

This week I received a comment from Lynette with some very helpful advice for dealing with AVN without surgery. I have copied and re-posted her comment below. Thanks, Lynette, and good luck!

Thank you for your blog. A year ago this was really helpful and I feel compelled to share with everyone my strategy over the past year of a conservative, non-surgical approach. Here are the things I believe to have worked:

-Exogen 4000+ Bone Stimulator (2x/day) bought on ebay because of my high insurance deductible. I've also replaced the battery 3x because of the high volume of uses (over 475+ uses). 
- Inferno Wrap 20 minutes per day
-Custom Orthotics with a First Ray Cut out. Stiff shoes with lots of cushion to absorb the foot strike. I couldn't wear flip flops for almost 6 months, and bought incredibly nice house slippers (Haflinger) with a stiff cork sole to limit the big toe extension. If you are a female NO cute flats! not allowed. 
-Activity Modification: absolutely no running. Cycling, open water swimming, gym workouts with NO jumping. NO yoga stretches in which the big toe is fully extended. 
-Occasional Massage: a good massage therapist will do cross friction massage and dig into the flexor hallucis brevis/longus. Mine were described as 'crunchy'. It's really hard to do to yourself becuase a lot of pressure is needed to break down the adhesions. 
-Calf Stretching! Like a lot. I have limited dorsiflexion on both ankles, which according to the literature may or may not contribute to the amount of impact on the forefoot and there by the sesamoids. 

Things I tried but can't say they really helped:
-Calcium Supplements (why not? but can't prove it helped)
-Accupuncture for 4 months (needles in the bottom of the foot are INCREDIBLY painful). However, I do believe the application of heat the accupuncturist emphasized is important. Also, topical analgeisc (zheng gu shui) helped during the acute inflammation.
- If you live in California: I went to 3 doctors. The best regarded is Dr. Chou at UCSF. Her advice "Wait 3 years". literally, she is not an advocate of surgery for this overuse type of injury. She said I would be able to accomplish all my athletic goals "just not right now."
-Physical Therapy: They provided education, massage, ultrasound, and taping techniques before I purchased the orthotics. Lodi taping is the best method to limit the extension and provide stability for the healing foot. 

I hope this helps. I can provide external links to any of those methods if needed! Good luck. 

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