Planting the Pain in Your Foot

What Causes Plantar Fasciitis and How to Deal with It

Non-steroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen or aspirin and cortisone injections can very effectively reduce inflammation but should be used judiciously. Long term use of NSAIDs can lead to a stomach ulceration, although the newer class of these drugs known as Cox II inhibitors are reportedly safer in this regard. One cortisone injection in the plantar fascial area is typically very safe, but more than one injection in the same area over a short period of time may lead to weakening of the tissue. Ray Pugsley received one injection into his plantar fascial area, but it is doubtful in my opinion that this led to his rupture. He competes at a very high level and was doing his track workouts in spikes, in addition to racing in them, and that was probably the main factor leading to his rupture.

In chronic cases, physical therapy to reduce the inflammation with modalities and exercises to strengthen the foot muscles can help cure the injury. Massage to the area to break up scar tissue and restore the suppleness of the fascia can also be added to the treatment in chronic non-healing cases. Self-massage can effectively be accomplished by rolling your foot over a tennis ball. When the pain level is lower you can progress to rolling over a golf ball. I advise my patients to put the golf ball in the freezer next to the water bottle between treatments.

Taping the foot to support the fascia and reduce the traction forces that are causing the inflammation is another excellent treatment tool. If the foot feels better when it is taped then this helps to confirm the diagnosis of plantar fasciitis. Click here for a series of photographs and step-by-step instructions of this taping technique. Over the counter arch supports can also help to reduce the stress on the fascia.

Custom orthotic devices can be a very effective treatment if there is a biomechanical abnormality or with an extreme foot type. Your local sports medicine Podiatrist can perform a complete examination including a gait exam to determine if these inserts are necessary. (For a referral you can call the American Academy of Podiatric Sports Medicine at (800) 438-3355 or visit their website at www.aapsm.org). Custom devices can be made out of all different materials and combinations including plastic, graphite, cork, EVA and Spenco, with equal effectiveness. The most reliable method for fabricating the devices is through the use of plaster casting while the patient is sitting or lying down.

A new treatment that has received mixed reviews is the use of a device called an Ossatron. It delivers a treatment called extra-corporeal shock wave therapy. The treatment has been used in Europe with a reported 60% improvement after one treatment. The drawbacks of this treatment are limited availability and lack of insurance coverage for a procedure that may cost up to $1,000. It should be noted that there are no long term follow up studies on the use of the Ossatron.

If It Doesn’t Go Away

Over 95% of the time plantar fasciitis improves or resolves with conservative therapy. If the symptoms are not improving then there may be something else causing the pain such as a stress fracture, nerve pain, or bursitis. In these cases further testing including an MRI, bone scan, or CT scan should be considered. In the event that plantar fasciitis is a confirmed diagnosis and pain is still present after a year or so of conservative treatment only then should surgery be considered.

Surgery involves cutting the inside half or two-thirds of the fascia away from the attachment into the calcaneus. Your surgeon may elect to perform this through a larger open incision or through the use of a scope known as Endoscopic Plantar Fasciotomy or EPF. Either way the success rates appear to be similar. Your plantar fascial symptoms should be relieved but pain may arise in other parts of the foot as a result of the disruption of the main supporting structure of the arch. The good news about rupturing your fascia is that you have performed your own surgery. After his plantar facia rupture, Ray Pugsley was able to return to racing but it was a long road back due to complications.

If you do have to resort to surgery make sure your surgeon is a Podiatrist board certified in foot surgery or an Orthopedist that completed foot surgery fellowship training, and make sure you seek a second opinion.

Dr. Brian W. Fullem is a sports medicine Podiatrist in Newtown, CT. He is captain of the Bucknell Alumni Distance team that won three of the last four Hood to Coast Relays. He can be reached at bfullem1@aol.com.