Member Case Study: Plantar Fasciosis

author : AMSSM

comments : 3

I have had Plantar Fasciitis in both feet for 5 years, orthotics have finally helped where I can run again. Are there recommendations beyond ice and stretching?

Member Question from hrliles

I have had Plantar Fasciitis in both feet for 5 years, orthotics have finally helped where I can run again. Is it more of a weight issue since I should weight 170 vs 207 that I am now, or is it an issue even normal sized runners suffer? If so, are there recommendations beyond ice and stretching?

Answer Craig Burnworth, M.D.

Member AMSSM
 

Thank-you for your interesting and common question.
There is Plantar Fasciitis, which is the acute inflammation of the plantar fascia, and Plantar Fasciosis, which is the chronic degeneration of the tissue. What you describe is more of the later with symptoms lasting 5 years. It usually has an insidious onset. It can occur more in long distance running or people who have to stand for prolonged periods on hard surfaces.

The causes of plantar fasciosis can be multifactorial. Being overweight, having leg length discrepancies, running on sloped surfaces, and overtraining have all been implicated as causes. “Normal weight” runners can also be affected.

Treatment includes acute modification of your training program. You likely will have to decrease mileage and hard surface running, and cross train. Making sure your shoes are relatively new with less than 300-500 miles use, depending on your weight, can be helpful. If you have tight calf muscles you will want to work on calf flexibility of both the gastrocnemius and soleus muscles. Oral pain medications or topical medications can be used, but are more for symptom relief than helping the underlying condition. Off the shelf or custom orthotics can be helpful as well as a soft gel heel lift. At 8 weeks, symptoms were much improved in individuals using a prefabricated orthotic along with Achilles stretches compared to people who did Achilles stretches only. The plantar fascia stretch has been found to be most helpful for improvement in people with symptoms lasting longer than 10 months (1,2).

If failure of these methods occurs, it is common practice to try an injection of corticosteroid. This can improve pain, but the pain can return. Extracorporal shock wave therapy, injections of platelet rich plasma, or botulism toxin have also been shown to be beneficial in the right hands. Surgical release would be an option of last resort, and can lead to persistent pain and prolonged recovery times.

I would recommend the plantar fascia stretches, ice, appropriates shoes, and soft surface running. If that doesn’t help, ask a sports or foot specialist to help with an orthotic with a soft heel cup.

Good Luck!
Craig Burnworth, M.D.
Primary Care Sports Medicine
Moore Orthopaedics

1. DiGiovanni BF, et al: Plantar fascia specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two year follow-up, J Bone Joint Surg Am 88:1771, 2006

2. DiGiovanni BF, et al: Tissue-specific plantar fascia stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized control study, J Bone Joint Surg Am 85:1270, 2003

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date: December 28, 2009