Warning Signs for Plantar Fasciitis

author : AMSSM

comments : 0

I ended up in the ER in the middle of the night due to unbearable foot pain which they think is PF since the x-rays came back negative. I'm wondering if I missed some warning signs?

Member Question

I realize plantar fasciitis gets chatted about a lot here but I can't find anything on the precursors to it.  I ended up in the ER in the middle of the night due to unbearable foot pain which they think is PF since the x-rays came back negative.  I have a good sports doctor to go back to who coincidentally diagnosed my achilles tendonitis. 

I couldn't move my leg or really body in any fashion without severe pain in my foot before the ER visit. They gave me pain killers which are helping. I don't know very much about PF, just what I occasionally read here. It started early Saturday morning then went away with Tylenol by Saturday day. By 10 pm it was unbearable. I can kind of put weight on it now with moderate pain. It was like going 0-to-60 pain-wise. The last run was Thursday night and the bike on Friday morning. They were both in middle distance and not the hardest effort for either.  

I'm wondering if I missed some warning signs since this seems out of the blue?  I just finished physical training for my achilles and have been following their advice and I thought I was feeling good.  The achilles stuff I could kind of track to the beginning and see what went wrong.  From what I've read so far a lot of the stretching I've been doing should've helped prevent this.  Hobbling around on crutches I keep asking myself what I missed?

Answer from Dr. Sara Brown
Member AMSSM

Based on the description of your pain, it sounds like you had a lot of inflammation or something more serious, such as a stress fracture in the calcaneus (the heel bone) or a tear of the plantar fascia. It is hard to say for sure without examining you. With stress fractures, Xrays can be normal too. An MRI might help to clarify which diagnosis you have.

In these situations, I usually recommend a walking boot to immobilize the foot and ankle in order to decrease inflammation and pain. The walking boot would also support a tear in the plantar fascia and/or the bone if there is a stress fracture. The boot can help you get around easier than if you are using crutches as well.

If there is no bone injury, I recommend a course of anti-inflammatories, which means you take the anti-inflammatories around the clock for one to two weeks. If there is a bone injury, I do not recommend anti-inflammatories because they can slightly slow down bone healing. Also, if there is a bone injury, I recommend rest from weightbearing exercise for six weeks and until you are pain-free. So, an MRI of your foot would help choose which direction to go with treatment.

If the diagnosis is plantar fasciitis, it is due to the tightening of the band of tissue in your arch. This can be a result of overuse and muscle imbalances. For instance, if the muscles in your feet are weak, than your arch is less supported and more pressure is applied to the plantar fascia. Stretching can help mitigate these effects for awhile, but it doesn't always work long-term. Part of the treatment for plantar fasciitis involves working on strengthening the intrinsic foot muscles in order to support the plantar fascia and that can also help prevent it from coming back. Core and hip strengthening can also help prevent running injuries.

If you have a stress fracture, that can occur due to too much impact on normal bone or a normal amount of impact in someone who has decreased bone density. So, I typically recommend a bone density scan in order to determine bone health. The bone density scan may not be necessary if there is another obvious reason for the stress fracture, such as increasing mileage too quickly or changing to a minimalist shoe too quickly.

Running form can effect these injuries as well. If you are a heel striker, that can increase your risk of a calcaneal stress fracture. If you are a forefoot striker, that can increase the tension placed on the plantar fascia and the achilles tendon. Mid-foot striking is considered the happy medium.

Part of the treatment and prevention for both injuries involves physical therapy to work on areas of weaknesses, correcting muscle imbalances and evaluating running form with a video gait analysis.

Dr. Sara Brown

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date: April 16, 2014