Sore feet - Plantar fasciitis

[Marty63]

had sore heels and feet for months,
read a post on here and other sites,
went to docs,
he confirmed Plantar Fasciitis = goosed tendons in foot(ish),
will heal in time he said if rested,
cant rest to much as have to work still,
he did mention about a steroid injection into sole of foot & into sore bit,
(curls toes thinking about it)
months later still sore - good days and bad days - worse after resting as you break them all when you start walking again.

question is;
has anyone suffered same, have you had injection, did it have a + effect.
I am starting to walk like a car park attendant to get around, not good.

thanks in advance.

[E21_Ross]

the injection can help but does have its risk factors and almost always offers temporary relief, but temporary relief only, and not permanent. get to a local physio/chiropractor etc and they should sort you some exercises, and provide soft tissue work, help to see any possible incorrect biomechanics of your gait/walking (or running etc, which may have brought the condition on).

during flare ups icing it for 20-30mins followed by an hour or so off, then another 20-30mins on. 4-5x a day if you have time. you're doing the right thing in trying to at least keep some sort of activity going, but, as already said, rest will ultimately help it. just really cut down on the activities which aggravate it and try to exercise in other forms which do not (e.g. swimming, cycling)

the length of time the condition lasts for varies greatly between people. my advice is get it seen to if you can afford it. it will help, though how much depends on what clinician you can see.

all the best.

Ross.

Edited by E21_Ross on Friday 17th June 22:47

[Zad]

My mum has this (and unfortunately has had for some time). Orthotic insoles help quite a bit.

[Marty63]

Cheers gents,
appreciate the comments/advice

did try heel supports - they where good for a while, then no effect,
meant to try arch supports but work and time limits has eliminated this at mo.

will seek out a physio/chiro

Thank You

[staceyb]

See a physio, ask him/her to teach you to do this

http://www.heel-that-pain.com/plantar_fasciitis/ta...

[Dav37D]

If the pain is only in the heel the first thing to try is a silicone heel cup. It is also helpful if you wear trainers first thing in the morning, and dont walk barefoot. This supports your arch and reduces the tension on the plantar facia. The fascia repairs during the night when at rest and then tears when you start walking (tear and repair process).

Having a tight calf muscle can also be a cause of plantar fasciitis. Stretching the calf muscle can also help. Orthotics may also help as these stop the foot rolling inward (pronation) which is also a possible cause of plantar fasciitis.

Hope this helps.

[sawman]

you need to address and posterior muscle group tightness - this means calf muscles and hamstrings. so stretches for this are hugely important. Might be worth seeing a physio' to look at your core muscle groups too. You need to look at your footwear, avoid flat fashion trainers and get some decent trainers - the sort designed for high mileage, or light trail shoes. they need to be stable. Ideally there will be a reasonable height differential between heel and forefoot.

Once you have increased your flexibility and dealt with footwear issues you might get more help from orthotics - I would start with superfeet green over the counter orthotics. You could also consider custom devices, but you would need to seek professional advice to pursue

Short bursts of over the counter anti inflammatories can be helpful - say 14 days. but only if you can take them safely - ie not asthmatic or have history of stomach issues etc - they don't cure anything but can sometimes make things feel better and aid recovery.

[E21_Ross]

sawman said:

you need to address and posterior muscle group tightness - this means calf muscles and hamstrings. so stretches for this are hugely important. Might be worth seeing a physio' to look at your core muscle groups too. You need to look at your footwear, avoid flat fashion trainers and get some decent trainers - the sort designed for high mileage, or light trail shoes. they need to be stable. Ideally there will be a reasonable height differential between heel and forefoot.

Once you have increased your flexibility and dealt with footwear issues you might get more help from orthotics - I would start with superfeet green over the counter orthotics. You could also consider custom devices, but you would need to seek professional advice to pursue

Short bursts of over the counter anti inflammatories can be helpful - say 14 days. but only if you can take them safely - ie not asthmatic or have history of stomach issues etc - they don't cure anything but can sometimes make things feel better and aid recovery.

but it's also worth noting that the patient may have fasical tightness/adhesions, in which case stretching himself isn't going to help; he'll need someone else for some PNF, cross friction therapy etc.

[sawman]

E21_Ross said:

sawman said:

you need to address and posterior muscle group tightness - this means calf muscles and hamstrings. so stretches for this are hugely important. Might be worth seeing a physio' to look at your core muscle groups too. You need to look at your footwear, avoid flat fashion trainers and get some decent trainers - the sort designed for high mileage, or light trail shoes. they need to be stable. Ideally there will be a reasonable height differential between heel and forefoot.

Once you have increased your flexibility and dealt with footwear issues you might get more help from orthotics - I would start with superfeet green over the counter orthotics. You could also consider custom devices, but you would need to seek professional advice to pursue

Short bursts of over the counter anti inflammatories can be helpful - say 14 days. but only if you can take them safely - ie not asthmatic or have history of stomach issues etc - they don't cure anything but can sometimes make things feel better and aid recovery.

but it's also worth noting that the patient may have fasical tightness/adhesions, in which case stretching himself isn't going to help; he'll need someone else for some PNF, cross friction therapy etc.

You may well have a valid point, what is the mechanism for adhesions in PF, and what is adhering to what - just out of interest?

to answer the OP's original question (as I forgot earlier) I would do all the physical stuff outlined above before contemplating injection, There is precious little, solid, evidence that supports wholly the use of injections for plantarfasciitis, they remain useful but not a cure. You need to be addressing the reasons the ligaments got stressed in the first place.

[E21_Ross]

sawman said:

You may well have a valid point, what is the mechanism for adhesions in PF, and what is adhering to what - just out of interest?

to answer the OP's original question (as I forgot earlier) I would do all the physical stuff outlined above before contemplating injection, There is precious little, solid, evidence that supports wholly the use of injections for plantarfasciitis, they remain useful but not a cure. You need to be addressing the reasons the ligaments got stressed in the first place.

there is a continuous "line" of fascia/connective tissue which starts with the plantar fascia, the achilles tendon, surrounds the calves, hamstrings, lumbar fascia etc and ends up at the front of the skull. thus, adhesions in one place (though usually many places) will likely cause tightness elsewhere. quick test to show it.....sit up straight and raise a leg so it's at 90 degrees out in front of you. now relax the leg, then slump forward, bend your neck and now try to raise your leg, is it harder/feel more of a stretch in the hamstrings? you can even try it with just flexing your neck/tucking your chin to your chest, then try and raise your leg (for extra effect point your toes up towards you as best you can!).

fascial adhesions occur mostly due to trauma, be it macro (major) or micro/repeated trauma (eg repeated exercise. the layers of fascia should be smooth and not "stuck together". they "adhere" to either muscle or other layers of fascia. when this occurs movement can't occur as freely. it's very common, particularly in athletes.

stretching can help prevent it occuring (but not totally), but once it's set in, no amount of self static stretching is really going to remove adhesions (though it will stretch the muscles/fascia so you'll feel more loose) but ultimately you need physical treatment to help it (as said, PNF, cross friction as well as active/passive release).

depending on the location and your knowledge on muscles, you can do active release yourself, but it can be quite tricky and can only be done in certain places without the aid of someone else!

edit - realised i didn't strictly answer your question

the mechanism of adhesion formation depends on the cause really. however, with plantar fasciitis (as the -itis implies) there is an inflammatory response, this alone will cause fascial adhesions. if the condition has been brought about by running for instance, then repeated microtrauma and inflammatory responses (muscle damage due to activity etc), chronically tight muscles etc will all cause fascial adhesions. where they are varies from patient to patient, naturally, though i've found working with people that everyone has some tightness in common locations! plantar fascia tightness is common in many runners/walkers and so on, but it rarely causes pain. though releasing it does do remarkable things!

Ross.

Edited by E21_Ross on Sunday 19th June 14:08

[sawman]

Cheers Ross, saves me looking it up. Certainly tissue stress is a major issue

with regards Plantar fascia I don't fully buy into the inflammatory stuff. I am sure there is some present at some stage - probably initially, but I rarely see any inflammatory markers on ultrasound scan of established heel pain more often fasciosis is noted- This is probably why steroids fail often in their anti inflammatory action. and why prolotherapy and platelet rich plasma injections show promise

Sorry to the OP for slight diversion!

Edited by sawman on Sunday 19th June 14:35

[E21_Ross]

sawman said:

Cheers Ross, saves me looking it up. Certainly tissue stress is a major issue

with regards Plantar fascia I don't fully buy into the inflammatory stuff. I am sure there is some present at some stage - probably initially, but I rarely see any inflammatory markers on ultrasound scan of established heel pain more often fasciosis is noted- This is probably why steroids fail often in their anti inflammatory action. and why prolotherapy and platelet rich plasma injections show promise

Sorry to the OP for slight diversion!

Edited by sawman on Sunday 19th June 14:35

thanks, interesting that. i've always believed it to be a chronic inflammatory condition (which it does seem to say in one of my orthopaedic texts - it also says to ice it regularly etc).

i'm not to "together" with ultrasound imaging to be honest with you, we've done some on it, but mostly we use US for therapy rather than for imaging, and refer patients out if we feel a US scan is needed for whatever reason.

having said that though, surely if there is chronic tissue damage/injury there will be some inflammatory proteins etc present...?

note to self - must read more

cheers

Ross

[shrs2000]

I've had this painful condition for a number of years. Went to see my local Podiatrist & he informed me that I had flat feet & prescribed some insoles. Perservered for twelve months or so with no real improvement. Off to the GP who referred me to a bio mechanics specialist. X rays confirmed my feet were not flat but I had a fleshy pad on the instep which gave the appearance of flat feet! Ultrasound confirmed Plantar fascitis. I was given some Vol insoles & an Aircast foot support.
Some three months later my condition has greatley improved. It is still sore after exercise (one of my hobbies is fell walking) but not as painful as before. 'Sensible' footwear is a must & regular stretching exercises help too.

The o/p needs to make an appointment with his GP.

[sawman]

E21_Ross said:

thanks, interesting that. i've always believed it to be a chronic inflammatory condition (which it does seem to say in one of my orthopaedic texts - it also says to ice it regularly etc).

i'm not to "together" with ultrasound imaging to be honest with you, we've done some on it, but mostly we use US for therapy rather than for imaging, and refer patients out if we feel a US scan is needed for whatever reason.

having said that though, surely if there is chronic tissue damage/injury there will be some inflammatory proteins etc present...?

note to self - must read more

cheers

Ross

I think theres a few issues bundled up together, which probably accounts for the variability of individual responses to the various treatments. When I practiced in canada, at least 75% of my working week was with this condition, I had the luxury of US imaging in my office and so was able to use it routinely. As I said precious little neovascularisation was seen but fascial thickening was a huge predictor of treatment success.

[E21_Ross]

sawman said:

I think theres a few issues bundled up together, which probably accounts for the variability of individual responses to the various treatments. When I practiced in canada, at least 75% of my working week was with this condition, I had the luxury of US imaging in my office and so was able to use it routinely. As I said precious little neovascularisation was seen but fascial thickening was a huge predictor of treatment success.

you mean there was little neovascularisation?? i'd expect to see at least some, but much more so in chronic, long standing cases.

thanks again, really helpful.

Ross.

[sawman]

E21_Ross said:

you mean there was little neovascularisation?? i'd expect to see at least some, but much more so in chronic, long standing cases.

thanks again, really helpful.

Ross.

Thats right little or none most of the time, in chronic cases significant degenerative changes in the fascia and localised thickening. It surprised me too!

Higher chance of seeing some neovascularisation in more acute cases, usually with less thickening.

[E21_Ross]

sawman said:

E21_Ross said:

you mean there was little neovascularisation?? i'd expect to see at least some, but much more so in chronic, long standing cases.

thanks again, really helpful.

Ross.

Thats right little or none most of the time, in chronic cases significant degenerative changes in the fascia and localised thickening. It surprised me too!

Higher chance of seeing some neovascularisation in more acute cases, usually with less thickening.

surprising! thanks for the info

[sawman]

E21_Ross said:

surprising! thanks for the info

Yes, my observations support work done by lemont in 2003. I think it possibily helps to explain how prolotherapy might work - the irritant nature of injected substance stimulates the repair process, platelt rich injections would pep up the process in a different way, as would deep massage etc at a guess. It certainly challenges the historical assertations regarding the nature of the condition.

Not withstanding this the functional elements still remain and need to be addressed. Calming things down is one thing, removing the cause of the problem is another!

[bexVN]

I started getting horrendous pains in my feet after buying a pair of shoes for work that obviously weren't suitable. After looking up symptoms and realising I likely had this (also known as policemans foot I think) I found a lot of people got a great result from wearing Crocs shoes. I took the plunge and bought a pair (I was desperate) and after a couple of months I had considerably less pain. As a Vet Nurse I was lucky that I could get away with wearing Crocs for work. Just thought it was worth a mention.

I think in comparision to some I had a mild case but it didn't feel like it at the time! I still get flare ups if I'm not careful about what footwear I use but can't complain.

[Mutton]

I had Plantar Fascia strain a few years back, tried complete rest and various treatments for a long period of time with no luck at all. Ended up having a cortisone injection into the ligament and this completely cleared it up and have had no soreness ever since.