Plantar Fasciitis

If you're unsure of your doctors diagnosis question him, and get another opinion. All it's going to cost you is another co-pay.

 

I would get a second opinion. Your investigation is correct. Symptoms as you describe are not typical of PF.

 

Albert Pujols had it. He had something called an "OssaTron" treatment (?)

http://cardinals.mlb.com/news/article.jsp?ymd=20050204&content_id=939570&vkey=news_stl&fext=.jsp&c_id=stl

my dad also has this problem, he just stretches his feet when it flares up and that helps.

however I agree with slm, your pain seems to be in the "wrong" location for that diagnosis.

 

If it is on the back of your heel where the achilles tendon attaches it could be tendonitis or bursitis. The plantar fascia runs from the calcaneal tuberosity ( bottom of heel ) to the ends of the metatarsals. Normally plantar fasciitis is more bothersome in the morning when you take the first few steps out of bed due to the shortening of the tissue overnght. Most people have degrees of pronation of the foot ( flattening of the foot ) when weight bearing. This pronation can pull on the plantar fascia and over time leads to inflammation. Custom inserts are the way to prevent pronation. The best over the counter orthotics are called Superfeet and are sold at REI for about $40. Also using a very rigid show with little flex is recommended for heavy pronators.

Based on your post I am leaning to inflexibility/tightness of the calf musculature ( gastroc/soleus ) Tight calf musculature can lead to the symptoms you are describing. When you are he treadmill you are "warming" up the muscles. I use the term warming up loosely as the musculature does not get any warmer it just has an increase in blood flow allowing ease of extensibility of the tissue. When you sit for a period of time these tissues shorten. Try getting up and moving around multiple times per day to decrease this effect.

To stretch these muscles try the following:

Gastroc- Stand on a stair/step, on your toes and let your heels drop towards the floor with your knees straight. Hold a minimum of 20 seconds.

Soleus- Again stand on a stair/step on your toes and while letting your heels drop towards the floor slightly bend your knees. Hold a minimum of 20 seconds.

You can also try icing for 15 minutes a few times per day to decrease the inflammatory response.

See if this link describes your location of pain and symptoms.

http://www.sportsinjuryclinic.net/cybertherapist/back/achilles/achillesbursitis.htm

Dan

 

I just read my post and noticed the errors. "show" should be shoe.

"When you are he treadmill" should be when you are on the treadmill.

I hate errors, especially when they are mine.

Good luck anunakki, if I can help in any other way let me know.

 

I had PF and the Doc gave me a pair of $400 custom inserts that I could have purchased at some store for a 1/10 that price and it would have done the same thing.

My pain was in the back of my heal and the front middle of my shins. For the first month of wearing the inserts I literally couldn't even run because the insert had to stretch out my tendon first. It sucked majorly until I got my groove back.

No pain since.

 

I would agree. I have had PF and your symptoms are not that of PF. You may want to see a Physiatrist (rehab specialist). They are pretty good with these types of issues.

 

Thanks for the info - oh, what fun it isn't to walk like an idiot in the morning. Sure, I walk like an idiot the rest of the time, but, that's beside the point. Superfeet to the rescue!

 

Custom orthotics are only custom if your foot is casted in a non weight bearing position. There are many companies that claim they are giving you custom orthotics by having you stand on a computerized platform. It is mostly BS and a scam where you are overcharged for the product you receive. True it is better than nothing but you are not getting what you think. We cast clients with them lying on their stomach or back with their feet hanging off the end of the table. While the casting material is drying we hold the foot in subtalar neutral ( your ideal foot/arch position ). Once the casting has hardened we remove it and wait a day for complete drying to take place. The orthotic is then made from the casts.

Some, not all, people require a break in period when first using orthotics. When using orthotics you are changing the biomechanics of the foot,ankle,knee,hips and spine. I tell people to wear them and if they have no symptoms keep them in. If they develop discomfort take them out for the same amount of time they had them in. Keep progressing until your body has become used to the orthotics. This can take up to two weeks for some individuals.

Shin splints, patellar tracking problems, recurrent ankle sprains, foot/heel pain, low back and hip pain can all be caused by excessive pronation of the foot.

FYI, I practice physical therapy.

 

You seem to have hit the nail on the head for correct diagnosis and treatment for PF. Last Christmas I could barely get out of bed and hobbled so badly for the first hour or so of the day. Stretching all toes back gave some relief, and boy, could you feel the tightness in lower rear calf muscles when you did that. I went to a proper sports podiatrist who went through the plaster cast procedure you mention. This is very important because you will find a difference between stance and gait left/right. This is very evident when you are videod from the side and rear on a treadmill. With the correct prescribed orthotics I then attended dance physiotherapy specialist (the worst profession for killing your feet) Instead of recreational walking I have taken up serious road cycling which seems to avoid inflamation of the heels. A common misinterpretation from PF sufferers is that the temporary relief you get from exercise is doing you good, it isn't; you only accentuate the underlying inflamation resulting in progressively worse symptoms over time. I'm so glad I went to a prfessional for help instead of opting for the $10 over the counter choice. PF is a seriously painful and depressing ailment if not treated early and properly. I don't think you will ever be 100% again, and its the end of barefeet around the house !!

 

PT 328 can hopefully refine these thoughts. I've had about 10-12 bouts of PF. What saved me was "anti-tension taping". Using standard athletic tape, you create and "arch support" that takes the stress off of the plantar fascia so that the inflammation can subside. You run 3 strips of tape from behind your heel to the base of your toes (tight enough so that it curls your foot a bit). Then you run a number (10-12) of sling pieces of tape side to side, running from near the top of the foot around underneath the arch (pulling the 3 long tape strips up into your arch) and then up around to the top of your foot (don't overlap the pieces of tape at the top of your foot).

Using this, some occasional icing (wow--does icing the bottom of your foot hurt) and some ibuprofen and it helped every time. I was even able to keep running in some cases and it got better.

Cheaper than orthotics, and perhaps worth it if you don't have a huge gait problem and the PF is a one off problem.

Sorry for the thread hijack, and I agree that the OP problem does not sound like PF.

Scott

 

A couple more tips for decreasing pain / prevention. Strengthening the intrinsic foot muscles will help support the arch. To do this take off your shoes and socks, while standing, feet shoulder width apart, slightly curl your toes on both feet as if you are trying to pick a pen off the floor. Now lean forward slightly, not too much that you fall forward off balance but enough to feel the muscles in the foot working. You will feel these intrinsic foot muscles working fairly quickly. Do this a few times per day to build up the strength/endurance of these muscles that help support the arch.

Another muscle group that helps support the arch is the posterior tibialis. More difficult to strengthen, requires theraband/small ankle weights or manual resistance from a partner and even more difficult to describe online. You might try a google search to find ways to strengthen the posterior tibialis.

 

Scotty,

Taping correctly does help some people with plantar fascia issues. On occasion I do tape first to see if there is a reduction in symptoms, especially if the complaint is shin splints. If the taping solves the problem I know I have the correct diagnosis then I can look at more permanent ways of correcting the problem. I have the mindset that if a problem can be corrected by increasing strength and flexibility that is how I want to initially try and solve it. If that helps but there is not a complete resolution of symptoms I then look to outside sources such as orthotics/taping. The problem with taping is that it can be time consuming and has to be done correctly for maximum effect. Some people do not have the skills to do it on their own. Each case is different and there is not one solution fits all.

In our profession you must not put the cart in front of the horse. Foot pain could be caused by many problems. If I gave someone orthotics for foot pain and the root cause of the pain was a lumbar disc herniation I am doing the patient no service. We have to ask NUMEROUS questions to get to the root problem. I never want to just treat symptoms. If you solve the root cause of the dysfunction the symptoms will go away on their own. If you only treat the symptoms you have a patient for life, or at least until they get sick of seeing you.

I have never understood the need to continue treatments with any profession IE physical therapist, chiropractor for years. Would you keep taking your car to the same mechanic for the same problem 2-3 times per week for years. This might be the wrong forum to say that but If I can't remedy your disorder or significantly decrease symptoms with your participation in 5-7 treatments then my specialty is not helping and I refer you to someone else who may have the solution for you. Too many times egos get in the way of patient care.

 

Do you wear flip-flops a lot?

Try wearing some shoes that raise your heel. That is what my podiatrist told me to do when I had a similar thing going on.

 

Is your doc an orhopedic dr? That can make a difference in the diagnosis. If you have PPO go to one, and you wont have to bother with the referral process.

ALso try freezing two cans of fruit or anything round that will freeze. Put them on the floor and roll your feet over them back and forth for 10 mins at a time or so. This was a process told by one of my Physical therapists...worked wonders.

 

That's really informative. Never heard of foot excercises before. Thanks.

 

I have it, saw a really good podiatrist (chino hills), and got fitted with orthodics. after traveling japan (walking alot), i came back to the states and the pain was off-the-hook. got a steroid injection in both heels and the pain was gone in about 40 minutes. never really came back and now wearing orthodics outside and slippers in the home. takes some time....

 

I have had the high dollar orthodics, and the cheapies, but the ones from barefootscience work great for me. They have a graduated insert area where you add more thickness to the arch every few weeks.

 

I have two suggestions for you.

I live in Toronto, but grew up on Southern California Beaches, Newport and Redondo.

I rarely miss workouts, I started in the 1970's, and still work out on a regular basis. Never got into the steriods, just loved to work out. I ride bicycle all over and hit the weights, usually 4-5 times a week.

As for the heel, I had the same thing in my right foot. For me, I was doing calf raises on a seated press, full stack, without warming up, at a gym I'd never been to!! Heh, it was 10 years ago.

I'll skip the things that didn't work, and go right to what not only healed my injury, but I've never had a problem again.

First, if your going to be working out, buy some Extra Strength Asorbine Jr. this one. Just rub it over your injured area, before a workout. What it does, it brings the blood to the surface, thus making the foot more flexible, and less prone to injury.

Second, buy at least two (or more) high end running shoes. And yes they make a huge difference.

click here this shoe is amazing for workouts, running, and this one click here amazing for walking, and general fitness.

The idea is, whenever you have a chance, change from one pair to the next. If your home for a minute change shoes. Each shoe has its own stability, and by changing your shoes constantly (I don't mean every 10 minutes!), it strengthen your entire foot, as each muscle is worked differently by different shoes.

The shoes above, I actually have several pairs of each, if youv'e never owned a pair of these before, you will be shocked how great they feel. Best of all, it'll fix your heel.

PS; after several doctor visits with zero effective results, I actually came across the above info regarding shoes, from Dr. Bob Arnot .