Early Signs of Plantar Fasciitis?

author : AMSSM

comments : 6

Over the past couple of months I've been waking up with a sore heel. Right in the center, it feels like I stepped on a pebble and bruised it. The pain, fairly minor, goes away as the day progresses.

Member Question

Over the past couple of months I've been waking up with a sore heel.  Right in the center, it feels like I stepped on a pebble and bruised it.  The pain, fairly minor, goes away as the day progresses.  

Right now I'm being cautious (week two after my A race), but summer means running to me and I'm ready to get back into training for 1/2 mary in September.  Here's what I've done so far:

Ice

Advil before bed (sporadically - don't like to take it unless I really need it)

More supportive running shoes - back into my Mizunos (a stability shoe) rather than my Zoots, which are more minimalist.  

Last night I gave myself a foot massage, concentrating on my heel, achilles and arch.  This seemed to work because this morning I had no twinge when I got up, but there seems to be a little leftover ache from yesterday. 

Yesterday was the worst day because it hurt almost all day.  I figured I didn't have anything to lose with the massage.

I don't want to get derailed from running this summer.  Is there anything I've missed that would help?  I'm considering acupuncture.

I have a podiatrist, but he is not an athlete and doesn't "get it."  Unfortunately, we don't have any good sports docs here on Maui.  I thought about going to him to confirm my suspicions then get a referral to PT - I know of a good PT guy at least.  But is it too early for treatment?

Thanks for any input!

Answer from Tracey Hamblin, MD
Member AMSSM 

This certainly sounds like plantar fasciitis based off your symptoms of center heel pain and mild resolution after massage.  Plantar fasciitis is one of the most common causes of heel pain in adults.  The plantar fascia is tissue distributed along the bottom of your foot that provides support as you walk and extend your toes.  The exact cause of plantar fasciitis is not entirely known, but is speculated to be caused by degenerative tears of part of the fascial origin at the heel which is then followed by a tendinosis-type (chronic irritation) reaction.  Plantar fasciitis is more predominant in women and is not associated with a particular foot type.

Those with plantar faciitis often exhibit tenderness directly over the calcaneal tuberosity (heel) in the center and 1-2 cm along the fascia.  Other associated symptoms include tightness of the Achilles tendon and increased pain when the toes are flexed.  Plantar fasciitis is often diagnosed based off these symptoms on clinical exam and do not require imaging such as x-ray or MRI. 

More than 95% of those with plantar fasciitis can be managed satisfactorily with nonsurgical treatment.  This does require some patience as it may take up to 6-12 months for complete resolution.  Being an avid runner, alternative exercises such as biking or swimming can help support your aerobic needs while you provide time for your plantar fasciitis to heal.  Ice, Advil, more supportive running shoes; these are all good options for treatment.  Some other treatments that should be initiated include an over-the-counter orthotic device, such as a silicone, rubber, or felt heel pad along with stretching exercises that can be done at home.  Two exercises include a heel cord stretch and a plantar fascia massage (both explained below).  Some studies have suggested wearing a night splint while you sleep.  A night splint holds the ankle and foot in a flexed position maintaining the Achilles tendon and plantar fascia in a stretched position.  

If none of these modalities improve your symptoms, a corticosteroid injection into the heel may be indicated.  Other treatment options for persistent symptoms include a non-removable cast or custom orthotic device.  Surgical treatment typically involves a partial release of the plantar fascia.  These should be determined by a sports medicine doctor in your area.

As you mentioned, early treatment or physical therapy is not a bad idea.  The above treatments and exercises can certainly be done at home, but if you are not getting any relief, more formal physical therapy may be beneficial.  Such physical therapy should focus on evaluating your foot and ankle mechanics while walking to assess for overpronation.

Heel Cord Stretch:

Stand facing a wall with the knee of the unaffected limb bent and foot forward; the affected limb straight; toes pointed in slightly

Keep the heels of both feet flat on the floor; lower your hips toward the wall

Hold this stretch for 30 seconds, then relax for 30 seconds

Repeat 4 times

Perform this 2-3 times daily for 3-4 weeks

Plantar Fascia Massage:

Sit on a chair with your feet touching the floor

Place a tennis ball under the affected foot

Roll the foot back and forth and side to side over the tennis ball, applying pressure for 60-90 seconds

Perform 2-3 times daily for 3-4 weeks

Good Luck!

Tracey Hamblin, MD

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date: October 15, 2012