Can This Be Plantar Fasciitis?
By Dr. Melva L. Baker, DPM
One of the more common overuse injuries that patients come in for during the fall months when marathon training is in full swing is plantar fasciitis. If you’ve had that nagging pain in your heel that seems to never go away – and is especially painful when you wake up in the morning – then you know what I’m talking about.
Plantar fasciitis occurs when the long thick band of tissue (fascia) connecting the heel bone to the toes becomes inflamed, irritated and painful. There is a degenerative process that occurs within this band of tissue due to excessive stretching and overuse. The pain may be substantial, resulting in the alteration of daily activities.
Usually when someone comes into my office with plantar fasciitis, they answer YES to the following questions:
- Are you having pain that affects the bottom of the foot, especially closest to the heel?
- Are you having foot pain when taking the first few steps after getting out of bed?
- Are you having foot pain after being off your feet for an extended period of time?
- Are you having foot pain that improves by walking for a few minutes?
- Are you having foot pain that develops after exercise, not during?
Plantar fasciitis can be a difficult problem to treat – and if you don’t address it, the condition can become chronic. Fortunately, most patients with this condition eventually have satisfactory outcomes with nonsurgical treatment. About 85% of plantar fasciitis cases resolve spontaneously by or before 12 months; 5% of patients end up undergoing surgery for plantar fascia release, because all conservative measures have failed.
For athletes in particular, the slow resolution of plantar fasciitis can be a highly frustrating problem, and it’s one that doesn’t go away overnight. Particularly for people who have more chronic pain or who continue their regular activities, improvements can often take many weeks or months and require considerable effort to maintain a heel-cord stretching program.
Generally the pain resolves with conservative treatment. For more severe cases in which conservative methods do not work, I usually recommend injection therapy of a steroid anti-inflammatory medication and/or an orthotic device. An injection to the foot can help decrease the inflammation and pain resulting from plantar fasciitis.
In conjunction to these treatments, I refer patients to a physical therapist that is trained to evaluate and treat plantar fasciitis, and who will work with you to develop a program to decrease your symptoms:
- Manual work to the plantar fascia, calves and even up into the hip to improve the flexibility of your ankle and plantar fascia. This work restores foot arch muscle control as well as restores normal calf and leg muscle control.
- Kinesio taping of the foot/ankle/leg to provide short-term relief
- Identifying stiff joints within the foot and ankle complex that can be loosened to help avoid plantar fascia overstress
- Strengthening and stretching exercises to assist joint mobilization/manipulation during the painful phase and prevent a recurrence and improve sporting performance
- Icing the foot to reduce pain and swelling, or adding heat before stretching to increase mobility
Treatment with your podiatrist and physical therapist generally reduces pain and restores the patient’s ability to put weight on their foot again. Make sure to address plantar fasciitis sooner rather than later to avoid changes in weigh-bearing patterns resulting from the foot pain – which in turn may lead to associated secondary injury to the hip and knee joins.
Dr. Melva L. Baker graduated from the New York College of Podiatric Medicine and completed residencies in Podiatric Orthopedics and Podiatric Medicine and Surgery. Dr. Baker has extensive experience in treating a wide variety of podiatric concerns including common skin and nail disorders, sports-related injuries, diabetic and vascular wound care and biomechanical issues.