stiff feet

by LH

I am finally coming to an end with a severe episode of Plantar fasciitis but it is still lingering after 10 months!! I am going to physical therapy twice a week which involves deep tissue massage in my arches which is so painful at first but the therapist says he has to break up the scar tissue for it to heal and to be less stiff! I do stretches and ultrasound with the heat and ice etc etc. It all helps a lot. After the therapy I feel great and can walk without that stiff and pulled feeling in the bottom of my feet. But it comes back a couple days later and I do it all over again. My question doctor is this pf ever going to completely go away or do I have to deal with this ailment for the rest of my life. The feedback from your website and others have said people have this for sometimes YEARS!!!I have also read it is self-limiting which means it will eventually go away on its own. I find that very hard to believe considering all the horrific things I had to go through because it would not just go away on its own. I have been through all the conservative ways to treat it and mine was just chronic and bad!. I am at the very end of this pf and getting better every day but I experience the very tight and very stiff pulling of the fascia ligament and my Achilles' tendon every 3 or 4 days -- is this normal or is this telling me that surgery is in my future? I am female 45 yrs and very active and on my feet all day with no weight issues. I have been in therapy for one and half months so far. I wear your superstep orthotics.

Hi,
Before I would consent to surgery there are other options to consider. Based on your story it sounds like the plantarfasciitis is more in the arch then towards the heel.

If your pain is in the mid-arch it may be more difficult to eradicate due to less options available. Do you wear orthotics all the time? By that I mean do you wear them during the evening or do you walk around barefoot when you get home? That is a mistake a lot of people make.
Are you able to wear orthotics every day? Supporting the arch in an effort to "rest" the ligament is very important.
If your pain is more at the attachment of the plantarfascial ligament into the heel bone, there are options out there. These include cryosurgery or radiotherapy where in both instances the nerves around the painful heel are deadened. Additionally there is shockwave therapy (see my section on ESWT) and lastly there is an area that I am getting involved in known as prolotherapy.
The argument that most experts make about chronic plantarfasciitis is that basically the ligament where it attaches into bone is become stretched and worn out. Since ligaments have a very poor blood supply they have difficulty healing themselves.
The idea behind shock wave therapy and prolotherapy is to create a new pocket of inflammation in the painful area so that the body can send blood to the area to heal the area.
Another new innovation is also known as dry-needling which was discovered in Europe. By injecting the heel and actually jabbing the plantarfascial ligament an inflammatory response is created and again, the body can heal the area.
All that I have just mentioned are basically minimally invasive procedures done in the office.
Ask your doctor if he or she is aware of these procedures or can refer you out.

I would certainly look into these procedures before consenting to surgery. Remember surgery is not without its own potential risks.

Marc Mitnick DPM