Plantar Fasciitis
by hazel on Aug 26, 2009 2:59 AM EDT
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PrintBefore I jump into this, I'm going to do a bit of vocab.
Inflammation is a word that gets thrown around quite a bit in medicine. It's an extremely common symptom, and it shows up in nearly every type of pathology. Inflammation is basically your body's first immune response to anything that bothers or threatens it. It's a complex reaction, but it basically begins and is mostly characterized by swelling caused by a rushing of plasma and white blood cells to the affected area. Swelling alone is not inflammation- it's also characterized by redness, tenderness and pain, an inflamed area sometimes feels hot (hence the name inflameation), and sometimes it becomes unusable.
Any medical term ending in -itis refers to inflammation. Thus, gingivitis is inflammation of the gums, arthritis is inflammation in the joints. Plantar fasciitis is inflammation around the plantar fascia.
The Plantar Fascia is a band of connective tissue that runs from the bottom of the heel to the beginnings of the toes. There is a thin layer of fascia that occurs throughout the body. This layer lies below the skin and on top of the muscles.
The plantar fascia is thickened and adapted for weight-bearing. By stretching tightly across the underside of the foot, the plantar fascia helps to support the arch in the foot. When people are born, the plantar fascia runs under the heel and connects to the achilles tendon. Over time this connection deteriorates, and most adults have little to no connective tissue between the achilles and the plantar fascia. When calcifications begin to occur near the area of the attachment of the plantar fascia to the heel, they're called heel spurs.
In this image you can see the calcification stretching out into the region where the plantar fascia lies. You've probably heard of heel spurs as being painful or problematic, but the problem isn't the spur itself (which is sometimes asymptomatic and is a soft calcification, not hard and sharp like an actual spur), but the cause of the spur- tension and inflammation.
Plantar fasciitis itself usually presents as a sharp pain in the heel, sometimes after standing for a long period or (in older people) resting or sleeping, and sometimes extending along the instep or rarely along the middle or outside of the foot to the toes. Because the condition is often associated with incidental heel spurs, it used to be called heel spurs, but as I said earlier, it's now known that the spurs are not the source of the pain (and their removal does not confer any benefit to the patient).
It's caused by small tears in the connective tissue which result in inflammation. The sharp pain is a result of the tension of the structures and the anatomically confined nature of the area where inflammation occurs. Standing on the affected foot, pulling up on the toes, and athletic activities can be painful for a person with plantar fasciitis. Other than pain that ranges from barely-noticeable aches to intense stabbing, there are few symptoms. It sometimes gets worse with use, but it also sometimes responds well to calf and other stretches.
There's little that can be done to fix the problem in the short term, because it's caused by an underlying injury to a connective tissue structure. The quickest fix is anti-inflammatory drugs followed by rest, however, an athlete can work around fasciitis if the pain is bearable. This is what we witnessed in 2004 when Albert Pujols played through the pain and was still able to turn in a stellar season. Usually the problem simply takes time to improve as the connective tissue heals and the body accommodates the increased pressure in the area.
"Calf muscle and/or plantar fascia specific stretching can provide short-term pain relief."
via www.nypost.com
Also, there's been a bit of speculation about PF on Colby-wan's heel injury. I'll admit that if he did have a plantar injury that he was trying to play through, this is sort of what it would look like (off every few days for pain or inflammatory drugs), but I have a few issues with this explanation:
1. No one from the FO has breathed a word of it.
2. TLR cannot resist this face:
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Again, Nice job on the medical stuff Hazel!
"Come test me every day if you want," says Pujols, "Everything I ever made in this game I would give back to the Cardinals if I got caught."
Personal experience
I’ve suffered on and off for the past three years from this. Terrible pain in the morning, or after resting for about 15 minutes. I have to limp around until it works itself out. Once the pain is gone, I’m fine until I take stress off my foot again. Then it comes back. I don’t think it would interfere with physical activity, but I’m not a highly tuned athlete who needs to be 100% all the time.
I got anti inflammatory shots into my heel, and I felt better in about 2 days. Symptoms returned about 6 months later, and it’s been off and on since then.
I have periodic (losing) battles with PF. Quick fixes include medication - celebrix and continually rubbing my heel over a tennis ball. Then drinking some good single malt Scotch. But PF is dreadful.
An optimist is a man who upon discovering that a rose smells better than a cabbage concludes it will make better soup.
HL Mencken
shoe insert helps
“orthotic” and “properly fitted,” whatever that means besides more expensive than off-the-shelf. Helped me more than stretching, but is not as fun as Scotch or Singha.
you could get a custom made
orthotic. PT’s are certified to make them. I’d love to help, but I’ve only made one, and it was over a year ago for class.
"Baseball is like Church, many attend, few understand" - Wes Westrum
re-read your post
and it seems you did get a custom fit orthotic. My bad. Yeah, they are different from off the shelf, in that they are custom fit for your foot and not generic and trying to accommodate a large group.
"Baseball is like Church, many attend, few understand" - Wes Westrum
Thank you, sir for your wisdom and suggestion. Note, the Singha cure is nearly as effectvie as single malt. I have experience wtih both.
Sabadi khrob
An optimist is a man who upon discovering that a rose smells better than a cabbage concludes it will make better soup.
HL Mencken
sub a 20 oz soda bottle
filled about 3/4 of the way with water, then frozen, for your tennis ball. You will get the effects of the stretching of the ball while getting the pain relief of the ice.
You can use a soup can or something like that as well, especially early in the morning to get the fascia stretched out.
I also know an extremely effective taping technique that I wish I could share with you. I’ll attempt to describe it. You can used duct tape (seriously). Before you put any tape on, make sure that you slacken the plantar fascia by curling your toes under a bit. You put one strip down across the met heads (balls of you feet). Then, you take a piece, and starting at the inside edge of the first strip, wrap around your heel all the way around to the other end of the first strip of tape., letting about 1/2 of the strip cover the bottom side of your foot, while the rest of it comes up a little on the side of your foot. Now, you take strips and go across the bottom of your foot until the entire plantar (bottom) surface of your foot is covered.
This taping method is very effective, but, as with all taping, it has its limitations. The tape will stretch out and you will notice that you do not have the support that you need.
"Baseball is like Church, many attend, few understand" - Wes Westrum
MANY THANKS -I've saved this one. If you come to Bangkok, beverage of choice is on me.
An optimist is a man who upon discovering that a rose smells better than a cabbage concludes it will make better soup.
HL Mencken
Yeah,
I have problems with this too. I feel weird limping around after sitting for long periods. Is anyone else’s back-of-foot very sensitive? For example, if something were to bump against the back of my bare foot it would cause immense pain for a few minutes? I’m not sure if that is tied into PF, haven’t really had a doctor give me a good answer.
"The two most important things in life: good friends and a strong bullpen." - Gibson
by davethebutcher on Aug 27, 2009 1:29 AM EDT up reply actions
Your doctor might not be able to give you a good answer because there is very little that can be done about plantar fasciitis.
Stretching (especially calf-stretches), anti-inflammatory medication (either over the counter NSAIDS or prescribed cortisone), icing after very intense exertion or pain. Your doctor might be able to recommend some sort of shoe insert that could help you with your problem.
Also- pain on the back of the foot could be from a different type of heel spurring around the achilles tendon. This is a rarer and sometimes more serious problem. Plantar fasciitis takes a lot of rest and a long time to heal, so your doc might not be able to help right away, but he also should be fine with referring you to another doctor or a specialist who might be able to better diagnose and explain your problems if you’re losing patience or getting frustrated.
"Of course Kolby Rasmus was going deep! That’s what Kolby Rasmus does! You don’t give Kolby Rasmus second chances!" -Kolby Rasmus
I suffer from PF, too.
I don’t have the sensation in the back of the foot you describe, but I have the exact same pain in front, right at the top of the foot. Have had it for a couple of years, and I’ve had the foot X-rayed, but so far no explanation, nothing to be done about it. I forget I have the problem until I bang something into the top of my foot.
I just developed the PF about a month ago, so I’m surprised to see this post and to see that several others here suffer from the same condition.
"I throw him four wide ones then try to pick him off first base." - Preacher Roe on Musial
I've had it on occasion
and it’s NOT fun. A lot like watching Dick swing and miss at every strike that comes his way.
Carp (or Waino) for NL Cy Young!
my problem with colby's injury
Is the reliance on corticosteroids. Long term use of corticosteroids leads to breakdowns in ligamentous/connective tissue. So, if his problem isn’t plantar fasciitis, then he could very well develop it as a side effect of the treatments they are using.
"Baseball is like Church, many attend, few understand" - Wes Westrum
Also, I have to disagree, slightly
with your statement that there is little that can be done in the short term. Taping, iontophoresis, stretching, icing, and fixing the bio-mechanical flaw that is causing the symptoms are all ways to decrease, and eventually eliminate, the symptoms. Well, correcting the bio-mechanical flaw is the long-term key to eliminating the problem. Over-pronation, or having high arches, is often a key factor in developing plantar fasciitis. Purchasing shoes that are designed to support the arch are key for individuals that have high arches.
"Baseball is like Church, many attend, few understand" - Wes Westrum
Iontophoresis-
from my understanding, iontophoresis is a method for administration of anti-inflammatory (or other) medication that isn’t invasive. Is this correct?
Also, how is (if at all) plantar fasciitis related to arch injuries or fallen arches?
It’s true that there are treatments- I didn’t give a very complete listing, but I mentioned ice, stretching and anti-inflammatory drugs. None of these are particularly likely to fix the problem, especially in the short term. Because the underlying issue is a connective tissue injury, it takes a lot of time to heal and may or may not respond to a specific treatment. It’s easy to get frustrated when relief is so slow in coming, so I didn’t want to mislead anyone.
"Of course Kolby Rasmus was going deep! That’s what Kolby Rasmus does! You don’t give Kolby Rasmus second chances!" -Kolby Rasmus
you are correct
Iontophoresis is a method of administering anti-inflammatory drugs, or other substances (NaCl is effective for scar tissue IIRC) that does not require using a needle. Also, the anti-inflammatory that is used, most commonly dexamethasone, is not of the strength of the likes of cortisone. This means there is less chance of negative side effects from the drug.
The mechanism of injury for the arch affecting the plantar fascia is simple. When you over pronate on every step, the plantar fascia is stressed significantly. As we take thousands of steps per day, the plantar fascia is stressed thousands of times. This causes the microtrauma that leads to the pain. Getting high arch support to keep the arch from dropping down and stretching the plantar fascia is a key to eliminating the problem. If you continue to let the arch drop down and stress the fascia, the problem is never going to go away.
I agree that the treatments you listed aren’t going to correct the problem. The reason being that they treat the symptoms, and not the underlying cause of the problem. Ultrasound is another treatment method that many patients like because it makes them feel better, but it doesn’t really fix the problem. Proper footwear and controlling pronation through stance is the key, IMHO.
I believe the key in treating plantar fasciitis is recognizing what works and what doesn’t work for each specific individual. This is not a pathology that can be treated with a cookie-cutter approach. I have seen patients get results in just a few treatments because we found the right treatment for that patient. I’m not saying that Albert could have been pain free in a few days. I assume it would take quite a while due to the stress of playing every day. But, everyday, joe schmo should be pain free in 2-4 weeks. If they aren’t, the treatment isn’t working and a new treatment approach needs to be implemented.
"Baseball is like Church, many attend, few understand" - Wes Westrum
by scoot on Aug 28, 2009 12:43 PM EDT up reply actions 1 recs
thanks
good to see you posting again (even if it is brief). It’s amazing how much you learn in PT school, especially about the things that are interesting to you. Two years ago I wouldv’e read my own post and not had a clue about what I was talking about!
"Baseball is like Church, many attend, few understand" - Wes Westrum
Marginally related - scoot, hazel others with medical insight. . .
Do players who’ve taken PEDs incur an increased likelihood of physical breakdowns? On the Cards thinking of Glaus and Ank this year and legions of others on other teams – A-rod to lots of lesser lights on the DLs around the leagues.
An optimist is a man who upon discovering that a rose smells better than a cabbage concludes it will make better soup.
HL Mencken
PEDs can refer to a few different things,
from Amphetamines to painkillers to HGH or anabolic steroids. In baseball, however, it generally refers to the last two.
I’m not an expert, but this is my understanding of the effects of steroids and HGH:
The very reason anabolic steroids are so popular and lucrative, is because they increase the height and longevity of an athlete’s peak. There’s little doubt that sluggers like Bonds, McGwire, and Sosa, as well as pitchers like Clemens were able to play so long was because they were aided by PEDs in their training. There is some evidence that anabolic steroids can cause muscle growth to be accelerated to the point that the connective tissues cannot keep up and are injured much more easily, however there isn’t that much of an increased risk as long as the training done is regimented and safe.
The primary risks of steroids are after the athletic peak, during the 40s and 50s, when an athlete who used is likely to suffer the effects of liver damage, high blood pressure, and heart damage. The connective tissue damage that most people (especially professional athletes) suffer in their backs and knees is likely to be worse in users, and they’ll spend these years dealing with lots of pain and chronic illness from the use of steroids.
HGH is a different story- I’m not well apprised on its effects (which are extremely varied and occur in many different areas of the body), but I’ve read that it’s either substantially less useful for athletes or not even useful at all. It’s being used right now on all sorts of problems from arthritis to aging to athletic enhancement, but as far as I know its utility for any of these is dubious and unresearched at best. The side effects are even less so, but I’ve read a bit of research that speculates that it could increase or cause tumor growth.
"Of course Kolby Rasmus was going deep! That’s what Kolby Rasmus does! You don’t give Kolby Rasmus second chances!" -Kolby Rasmus
Thanks, hazel, very informative. I coached high school athletes and always asked medical people to talk to the kids. Wish that I had had your voce.
Best
akaitori
An optimist is a man who upon discovering that a rose smells better than a cabbage concludes it will make better soup.
HL Mencken
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