Even though its cold outside and people are exercising less due the temperature and illness, the incidence of Plantar Fasciitis is still high. In fact, we are seeing more and more patients with Plantar Fascial tears. Otherwise known as deep surface tears, laminar tears or partial thickness tears. These patients are in agony and describe excruciating pain which causes them to limp and compensate for the injured foot. Some of these patients have no choice but to wear an immobilisation boot.
As discussed in our previous articles about Plantar Fasciitis, and its causes, the aggressive cases and the incidence of torn Plantar Fascia often come on due to a sudden increase in exercise over a short period of time. The change is too much for the foot to cope with and the strength in the foot just isn’t there. This overloads the Plantar Fascia and leads to torn fascia or aggressive Plantar Fasciitis. Heel pain comes out of nowhere, overnight, and patient’s wake up in agony and can barely walk when they get out of bed. Patient’s visit their doctor and have an X-ray taken of their foot which doesn’t help as it often comes back clear. Even with a Heel Spur on the X-ray, this doesn’t help as there is no treatment plan that follows. Remember, Heel Spurs don’t cause pain, Plantar Fasciitis does.
We are still seeing patients who have tried a cortisone injection as a first line of treatment. The cortisone can kill the pain and draw you into a false sense of security, meaning a return to exercise, which further aggravates the Plantar Fascia. Once the injection wears off, the heel pain is back with a vengeance. I saw a patient yesterday at the Parramatta clinic who was perhaps in the most pain I had ever seen. She had been given an ultra sound guided injection of cortisone in November which reduced the pain, but she was told to do foot stretches. 100 reps per day! This excessive load on the Plantar Fascia has more than likely caused it to tear. Her Heel Pain was extremely high. The very slightest of finger pressure, without me even pushing against the heel, caused this lady to withdraw her foot and jump as she lay on the bed. This situation supports the theory that the Plantar Fascia can not be stretched. Muscles and tendons can be, but not fascia. Fascia is like gristle. The stretch just causes strain, and the plantar fascia pulls away from the heel and gets more inflamed. Hence Plantar Fasciitis gets worse. This particular lady responded beautifully to the immobilisation boot and walked out smiling, as she was pain free. I will review her in 4 weeks and talk about how to wean her off the boot. When she is able to walk normally without hobbling, I will be able to assess her foot function and find out what caused her Plantar Fasciitis.
Of course, we are still seeing regular Plantar Fasciitis, which is less painful although still very sore, and usually more chronic. The heel pain has come on more gradually over a longer period of time and is not quite as aggressive as torn fascia. Treatment for regular Plantar Fasciitis is different to the above approach and patients will make a full recovery with the alternative therapies that we have.
Wrap up warm and maintain your usual exercise regime. Taking a break from your usual programme might cause problems if you jump straight back in, without taking it slowly. Wear proper sports shoes and always stretch your calves.
Written by Karl Lockett