Possible Plantar Fasciitis ??
by J.J.
I developed foot pain 1 1/2 years ago. Went to a podiatrist, had custom orthotics made and was told to rest my feet for 2 months, which I did. No relief. Began physical therapy with stretching, exercises, ice, ect. I was told by physical therapist that I may have a ruptured flexor hallucis brevis, but ultrasound was inconclusive. Physical therapist also did ultrasound treatments - no relief. Was seen by a sports medicine dr who did not think it was classic plantar fasciitis -but more of a tendonosis? Recommended cortisone injections, which I refused. I got 2nd opinon on orthodics - had new custom orthodics made. This specialist also felt it was not typical plantar fasciitis - main problem seems to be that the main tendon or fascia that runs from big toe back to heel actually protrudes quite a bit - especially on my left foot, which the pain has always been worse in. As I take a step, this tendon/fascia sticks out and gets irritated with each step, causing inflammation. When I massage the area, it really feels like a big string- very tight and sticks out. I do have pain in my heels when I am standing, but they are not sore to the touch or if palpated. The area that is really sore to touch or manipulation is in front of heal - about in the middle of foot along that fascia. I am told to treat this as plantar fasciitis, even though many symptoms are not really typical for it. I do not have the classic morning pain - never have. My pain worsens the longer I am on my feet. I also have been using a night splint on the worst foot. I am a 42 year old female. I believe the problem began due to poor fitting shoes and extensive walking on pavement. I am perhaps slightly overweight as well - maybe 20 lbs. Is 1 1/2 years a bit long to be dealing with this? My life has been greatly affected by it. I cannot work, and can barely keep up my house. The pain is very significant. Does this sound like plantar fasciitis? Is there a way to make that fascia relax or soften so it isn't like a guitar string??? What should my next step be? Thank you kindly for any advice. Hi J.J. If that "tight guitar string" is the source of your pain, then you have plantar fasciitis. that is the only structure that will protrude like you describe. I am wondering what kind of orthotics do you have. If they are of the hard plastic variety they will probably worsen the situation rather than remedy it. A softer orthotic might be helpful. The fact that the heel hurts after you have been on it, rather than first thing in the morning is highly suggestive of a heel bursitis or heel neuroma. (see my section on heel pain). Since no one seems to be able to come up with a definitive answer, I would consider having an MRI done as I find ultrasounds have limitations in what they can tell you. If ultimately it comes down to the fact that you have a very tight plantar fascial ligament and if you have enough pain, you might have to consider having a fasciotomy, where the ligament is actually cut at the level of the heel. Good luck. Marc Mitnick DPM
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