So, you think you have plantar fasciitis (inflammation of the thick ligament under your arch that runs from your heel to your toes).
It is typically attached at the heel where it is sore on examination. If the soreness is somewhere else than its attachment, then it is probably not plantar fasciitis. Generally plantar fasciitis is self resolving, meaning it should get better with treatment within two to three weeks. Plantar fasciitis will cause pain in the morning when you get out of bed.
If the condition progressively gets sore over weeks and months, pain is sudden, and is under the heel bone, it is not plantar fasciitis. My next “How I Approach Problems” will be on sudden onset heel pain which is definitely not plantar fasciitis.
Plantar fasciitis should have little to no soft tissue swelling. The patient typically can not feel heel swelling, but a doctor or therapist should. If there is significant swelling between the two sides of the body, it is probably not plantar fasciitis. Again, one of my next posts on “How I Approach Problems” will be on heel pain with swelling.
Plantar fasciitis should respond to ice massage, plantar fascial stretching, and taping. It can take a few months. The goal should be to attain a pain level between 0-2.
Treatment #1: Freeze a sports water bottle after filling 1/2 full of water. Roll over the painful area for 5 minutes 2-3 times a day with a towel on the floor as you sit and roll.
Treatment #2: Stretch the plantar fascia by grabbing hold of the foot using a towel with both hands. Stretch and hold for 1 minute. Do another two sets. These are typically done 3 times a day, especially before and after exercise like running.
Treatment #3: Tape the arch to immobilize the pull of the plantar fascia. This could be done with Quick Tape from Amazon. This is typically left on 5-7 days at a time.
Plantar fasciitis always gets a lot better with this regimen. If there is little to no improvement, I doubt the patient (you) have plantar fasciitis at all. If the patient gets 50% or so improvement but plateaus, an increase in the treatment is recommended.
Plantar fascial treatment should allow full, but modified, activities. A non-response to treatment for plantar fasciitis, typically means that there is no plantar fasciitis but it can take a month of treatment to know that. A partial response to plantar fascial treatment typically means more specialized treatment is needed with custom orthotic devices and physical therapy.
Does having a heel spur cause me to have plantar fasciitis?
Having a heel spur by itself does not cause one to have plantar fasciitis. Many asymptomatic patients do not have heel pain but they have a bony spur that is evident on the X-Ray. They do not need surgery to remove the bony prominence if it is not painful.
If the patient is an athlete, when can he or she return to sports?
Weight-Bearing vs. Non-Weight-Bearing Sports. Plantar fasciitis can be aggravated by all weight-bearing sports. Any sport where the foot lands and strikes the ground repeatedly, such as running and jogging, can aggravate the problem. Non-weight-bearing sports, such as swimming and cycling, are adequate temporary replacements and can help the athlete maintain cardiovascular fitness without irritating the plantar fasciitis.
Warming Up. The athlete should move all major joints through their complete range of motion several times before starting play. Stretching and strengthening exercises help prevent injury.
Playing the Game. When resuming the sport of choice, play at a lower intensity. In running, run for shorter periods of time, at a slower speed, and less frequently. The athlete should choose flat, even surfaces on which to run. If the athlete experiences pain either during the run or the following morning, then he is doing too much. Resume competitive running or play once the foot has healed.
Is the surgery necessary for plantar fasciitis?
Sometimes the pain is recalcitrant and the patient does not respond to conservative treatments. This usually consists of surgical release of the plantar fascia at the point of greatest tension and removal of heel spurs if necessary.
Pain in the back of the heel?
Pain in the back of heel may be caused by a bone projection or spur, or by inflammation of the Achilles tendon when it inserts into the back of the heel bone. X-rays or an imaging ultrasound examination are necessary to diagnose these conditions.