Plantar Fasciitis

Review of the nature and treatement strategies for plantar fasciitis heel pain.

Category:

Education

Tags:

• plantar
• fasciitis
• fascia
• heel
• pain
• Achilles
• stretch

[KingSolomonUW2004]

Dr Mark Wolgin,

I think I developed this condition plantar fasciitis heal pain right after my dislocated subtalar--foot dislocation. It only hurts when I walk around for long time or stand in non flat surfaces, however pain seems to go away when on a treadmill machine. Does this mean, I'm stuck with this condition for the rest of life of worrying about being about pain on non flat surfaces all the time? Thinking about surgery. It's like having a time bomb ready go off on my foot. Hate meds.

[markwolgin]

I don' t know if you have plantar fasciitis. The subtalar joint does the side to side motion of your foot, and probably there was some injury to the ligaments that stabilize that joint. Your injury would explain having problems with non-level surfaces. A CT scan would show if you have developed arthritis after the trauma of your dislocation. An aircast type brace or stirrup (you can find one on google) might help protect this joint from the side to side stresses.

[KingSolomonUW2004]

@markwolgin It's been almost 7 months now, since the injury and did use a air cast with pumps after getting my original cast off, as well as experienced a CT scan already and passed with all flying colors.

Did some stretching exercises and seems to help from feeling pain form walking around for long time. Hate taking pain medications like Aleve, but this seems to stop me from feeling pain. Maybe my condition is a nerve matter. Miss playing basketball, however at least could walk without a cast

[markwolgin]

hard to say without seeing your foot, but if you have less than the normal inversion and eversion for your subtalar joint (the side to side motion), you could have had some scarring of the ligaments in that area. Pain in that area, if that is what you have, is referred to as subtalar or sinus tarsi syndrome and may be amenable to injection. If you have even temporary relief by injecting that area, at least you'd have a better diagnosis.

[KingSolomonUW2004]

@markwolgin Sinus Tarsi Syndrome seems plausible. I found a link that offers some exercises to improve on this condition. Thank you for introducing this theory. Diagram on the link seems to point out exactly where my pain is located. Still have a little slight swallowing on my injured foot. Think I getting there in full recovery. Can't wait to play basketball again. It's like torture being stuck on a treadmill upstairs at a gym club, while seeing people hoop beneath me.

[markwolgin]

4. good question, but it's like a sword that cuts both ways. Rest would allow it to heal, but it would not get more supple, hence the stretching recommendation. I haven't had long term success with casting.

5. if the tear heels, the pain goes away. In some cases, there is chronic inflammation, and surgery is needed. Approx 1/2 of the fascia is cut, and usually the patient is better. I rarely do surg, however, since most pts get better with stretching and night splint.

hope that helps.

[markwolgin]

1. patients can have pain in the area on the sole of the heel over an area the size of a baseball, so symptoms are variable. Most pts describe their pain as a stone bruise.

2. The fascia tears in most patients because their tissues are tight and normal activities cause these small tears. That is why stretching is an important part of treatment.

3. In the repair process, regenerating tissue grows similar tissue, like when you cut your skin, it grows skin, not eye cells. Sm bit of bone forms.

[markwolgin]

Number 2 also is correct, that there are small tears in the plantar fascia tissue, not bad enough for your to call 911, but irritating. The body sees these tears as injury and starts the inflammatory process to repair the injury.

3. The fascia is stretched beyond it's elasticity (think of stretching your shirt sleeve to the point of tearing) to create the small tears.

[markwolgin]

alright, I'll try to answer what I can in your questions below. Since I have limited characters, I willl start a little here. 1. your statement about the plantar fascia is correct, as it's like the string on a bow with a bow and arrow, and this tissue helps support the arch of the foot. It's not exactly a tendon, as a tendon connects a muscle to a bone, and no muscle connects to the plantar fascia.

[hananfromny]

4. With total rest and absolutely no pressure or impact on the plantar fascia for an X period of time, would the fascia eventually heel? If so, why dont doctors prescribe putting the affected foot in a cast or a hard brace?

5. How would a heeled fascia resolve the pain in the heel bone (the pain from the inflamed tendon)?

thanks very very much. i am sure your posting here is helping many.

Jon