This can be such a stubborn problem that it is easy to get very frustrated. Very few people need surgery for this since there are so many options for treatment. The treatment options are so numerous that we are normally limited only by our time and imaginations to develop a successful treatment plan. Each week there should be improvement once active treatment begins. If improvement plateaus, make a change. Analyzing what is working and what is not working should be part of the process.
Deal constantly with the 3 areas of treatment---anti-inflammatory, stretching or flexibility, and mechanical support (transference of pressure from the painful areas to non-painful areas). Most cases of plantar fasciitis need simple solutions like daily icing (anti-inflammatory), plantar fascial and Achilles stretching 3 times daily (flexibility)--see links below to various stretching routines, and arch support (either custom orthotics or store-bought arch supports). Some more stubborn cases of plantar fasciitis need the above along with physical therapy to improve flexibility and anti-inflammatory measures, custom-made orthotics if not already manufactured, night splints to gentle stretch out the plantar fascia, cortisone shots if a bursitis under the heel bone is found, and many other options.
In resistant cases, 3 months in a removable cast can help calm down the inflammation. The moral of the story with plantar fasciitis is never give up. Keep trying to find the right combination of anti-inflammatory, flexibility, and mechanical support. Good luck. In later posts, I will discuss each aspect of treatment in greater detail. Also remember that 25 to 30% of all cases I see for plantar fasciitis for a second opinion, have something else. Neuritis, bursitis, stress fractures, all head the list in the differential diagnosis. I hope this helps and gives you encouragement. Dr Rich Blake
http://www.drblakeshealingsole.com/2010/08/plantar-fasciitisachilles-tendinitis.html
Dr. Blake,
ReplyDeleteDo you have an opinion on minimalist running trends? I have read many of the studies and am impressed with the research, but mostly in terms of how running shoes may contribute to some over use injuries. In my case, running with shoes causes sharp pain (immediately) in the low back. Whereas without shoes there is none.
Marc
Marc, since I have spent my entire podiatric life making feet more stable and more protected, this concept is a new paradigm. However, biomechanics is the basis of most problems and solutions in some many activities like running, cycling, swimming, etc, where there is repetitive motion. Running shoes in general have around 1/2" heel height, increasing low back curve (lordosis), and, in some patients, producing low back pain. The high heel effect also can cause many runners whom land on the lateral (outside) border of the running shoe to either excessively supinate (lateral instability), or rapidly pronate (arch collapse). Both of these problems can cause foot/ankle/knee/hip/low back pain. Both of these problems also get worse with as little as 200 miles of shoe wear. I will have a later post dealing with the weakest link in the chain syndrome. Serious, if not all, runners need to link up with a good running shoe store, and/or knowledgeable sports medicine practitioners, whom can evaluate the function of an athlete shoe purchased or possibly causing problems. I will also have a post on generalizations in choosing the right running shoe.
ReplyDeleteSo, yes, shoes can produce problems. I have mentioned only a few. But, does the answer lie in a minimalist approach to foot wear? For some, definitely. For others, a fatal running mistake. Who will help them decide? My best advice with any new device, shoe, technique, is to listen to your body (Golden Rule of Foot). Go gradual, and use common sense on what surfaces to wear them. Avoid pain. Any thing that causes pain weakens the body. Will feet get stronger with this type of shoe? I hope the physical therapist/runners out there will tell us. Is the answer more in prescribing foot strengthening exercises for every pair of stable running shoes and/or foot orthotic devices purchased or prescribed. I hope this helps. Dr Rich Blake
Thanks for the advice...I believe we'll see ever more shoe options which should help those with special biomechanic and musculoskeletal needs...In may case, the elevated heel in running shoes causes a heel strike where forces collide...without running shoes (and I've video taped both) I land on the foot pad with a more reactive strike and quicker turn over...Love the Golden Run of Foot...great advice...
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