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The response to the question below was authored by Marc Mitnick DPM

plantar fasciitis

by Betina

I have been struggling with plantar fasciitis for the past 5 months and had it both feet. It started in my right foot and progressed in my good foot due to me limping and putting all the pressure on the left. So I got cortisone shot/one in each foot. It lasted 4-5 days and most of the pain came back but not as bad as it was before the shot. Still, I was in a lot of pain and had to go for a MRI and found I had a partial tear of the Achilles tendon. I go to physical therapy which helps a lot. My doctor said no to any more cortisone because it did not work for me 6 weeks ago and probably would do more harm then good. He is right or I just did not get enough the first time. I cannot take any more ibuprofen it is just ripping up my stomach and I have been taken it for the last 6 weeks since I finally found out I had plantar fasciitis. In the beginning of all this choas I waited for the pain to go away and it did not. I first went to a podiatrist who said I was fine and to stay off my feet. Two more doctors said pretty much the same until I went to an orthopaedic doctor/surgeon who has been helping me to this day. I am still in pain, it more like stiffness and achy, sore feeling and hard to walk a full stride. My arches are sore and stiff-the insides. I am getting orthotics and are not ready yet. My doctor said the first day he saw me that is was abnormal to see plantar fasciitis in both feet and there may be another factor involved ? I am a waitress 44 yrs old and in great shape 5'4 and 109lbs and try to eat a lot of organic foods not a lot of junk food. I never had foot/ankle problems and no major health issues untl now. I can't understand any of this-why me? Any thoughts?

Hi Betina,
First of all it is ridiculous to think that if one cortisone injection did not work, additional ones won't be helpful. Most doctors I know give three as each subsequent injection builds on the progress of the previous one.
However, even tho you are in great shape, you do have an occupation that may make you prone to this type of condition and I think orthotics may ultimately be your best bet.
Start in with the orthotics, if they do not initially give you the type of relief you are looking for, I would supplement them with a second or even third cortisone injection. If that does not fully do the trick, I would then suggest physical therapy which over the years has greatly helped many of my patients when orthotics alone did not.
Marc Mitnick DPM

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Jul 17, 2015
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Question For Doc re Bunion, Hammertoe, Maybe Plantar Fascitis?
by: Anonymous

Have a bunion (not large maybe medium sized), the 1st toe is a hammertoe (caused by RA?). Last evening I used a bunion splint for 2 hr at night and this AM (actually all day) the foot is experiencing great arch pain. Could this be plantar fasciitis caused by the bunion and bunion splint? Can a moderate bunion cause arch pain? Never had this before but certainly super uncomfortable. The hammertoe causes me pain in the metatarsal area. All of this is on right foot. Have been wearing soft footbed Birkenstock sandals which seemed at the time (up until now) to help with my high arch and need for metatarsal support. Maybe I should have orthodics?

RESPONSE

Certainly would be a lot easier to answer your question if I could actually examine you, but I can offer you a little insight nonetheless.

Yes, it is possible that the bunion splint aggravated your plantar fascial ligament because when you apply the splint and move the big toe away from the second toe that could actually change the tension on the medial slip of the plantar fascial ligament (there are three slips to the ligament). It may have also aggravated the abductor hallucis muscle which is the muscle that moves the big toe away from the second toe and this could feel like plantar fasciitis as it would be causing pain on the bottom of the foot on the inside portion of the arch.

You mention you have a high arched foot. I would guess that you actually have a flexible cavus foot deformity, meaning when off weight bearing, you have a high arch, but when you put weight on the foot, the foot actually flattens out. That mechanism might be what actually caused your bunion.

How you go about addressing your foot problem would be predicated on how much pain you generally have with your foot. If you have a flexible cavus foot, then wearing an orthotic might be very beneficial for a couple of reasons. It would help prevent your arch from hurting (assuming you stop wearing the splint) and perhaps more important, it might slow down the progressive worsening of your bunion, as excessive flattening of the foot is what causes bunion formation in most people.

I would also need to see an x-ray to determine how much your rheumatoid arthritis plays in this equation.

If you really want more accurate advice, why not make an appointment with a local podiatrist and see what your options are. If your hammertoe is also a problem, that can be addressed as well.

Marc Mitnick DPM

Mar 31, 2015
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Thanks
by: Bessie Mae

Still room for a doc in sunny Florida. Thanks for your reply. My original diagnosis was Bacter Nerve Entrapment, surgery suggested. Next doc said tarsal tunnel, surgery yet emg and nerve test and Mir ordered for wrong foot. Third doc said metatarsalgia and Good Feet said plantar facilities and third doc agreed. I am starting to think plantar fibroma since wearing the orthotics hurt the bumps in the arch. Waiting for new doc appt. Am hopeful this one is a charm. I think an MRI of the correct foot will help find the culprit just not ready to be cut.

Mar 30, 2015
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Solution?
by: Bessie Mae

So there is a solution doc? After all this time I figured it is just something I have to live around. No one has even brought up options to me.

With all the problems you have encountered and all the doctors you have seen, I do not know how I could be of much help, having never physically examined you.
Choose the doctor you have seen who seems the most knowledgeable and caring and go with his/her advice.
Most experts state that even the worst case of plantar fasciitis will eventually resolve itself (if it is truly plantar fasciitis).

Marc Mitnick DPM

Mar 30, 2015
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Taping
by: Bessie Mae

I spent $20K last year on doctors, injections, creams, meds, xrays, mri's, PT for my plantar faciitis (if that is what it really is). No fix and now another year has started and doc wants me to go to yet another podiatrist and try taping. I am game for anything at this point. What are your thoughts? The first doc last year said Baxter Nerve Entrapment, second doc said Tarsal Tunnel, third doc said Plantar Faciitis and Metatarsalgia. I had more than 40 PT treatments at two locations until Aetna said no more (hence the $$ spent). My heel does not hurt, high arch does. Hurts more when I walk (therapist said I needed to walk slower and shorter strides which helped but now I have knee pain), most painful when I stand in one place for time. Ice feels good, heat not so much.

Taping is a treatment, but usually not a solution.
Marc Mitnick DPM

Dec 07, 2008
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Thank you Marc
by: By Betina

My on-going battle with PF still exists. I am your problem child/atypical patient that stands out and doesn't get better. With all the conservative treatment including ice,rest,elevation,deep tissue therapy,heat ultrasound,massage,stretching,exercise,taping, NSAIDS and cortisone injections all helped in baby steps. The best for me were the taping and cortisone injections which unfortunately I got when the PF was already in its chronic stage, after 4 months of endless pain and limping. I was 95% better and went back to work and it all started again and bought new shoes that the doctor approved. Surprised at the fact of my situation, my doctor put me on oral-steroids and re-taped my feet for 7 days. I have been to several doctors from the beginning and the first four could not diagnose me with anything but chronic strain so that when I was finally diagnosed with classic PF, I was already 12-15 weeks into it with no help. I did get a MRI as well as X-RAYS which did confirm PF and tears to the fascia ligament. My question doctor is why me? a person with no weight problem and did everything to a tee that every doctor asked of me and took off 8 weeks of work to make sure I did not aggravate the situation. Was it the improper care that I was given in the beginning or what? Maybe the doctors? I refuse to have any surgery or Plantar Fascia release of any kind!!

Hi Betina,
It is an impossible question to answer-why you? The problem with foot problems, as I have stated many times on my site is that foot problems can exist longer than other musculo-skeletal problems simply because every time we take a step, we are basically re-aggravating an injured area and so the area never seems to get better.
I understand the concept of not wanting surgery, but you have to weigh the risks of surgery versus the amount of pain that you may be in.
Short of surgery, have you discussed cryosurgery or Extra corporeal shock wave therapy with your doctor. These modalities are reserved for people with recalcitrant heel pain that will not resolve itself with more conservative therapies. The school of thought with this unrelenting heel pain is that the brain is not able to recognize the inflammation causing the pain and particularly ESWT causes a re-inflammation which the brain can then recognize and go about healing. I think it may be worth a look.
Marc Mitnick DPM

Nov 23, 2008
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cortisone
by: by Christine

I can truly relate to your PF pain. I endured 8 long months of heel pain and nothing worked for me until I got the cortisone injections. Many doctors including podiatrists, orthopedists and family doctors will refuse to give them and scare the patients that it will cripple you for life.

Hi Christine,
Cortisone injections for plantar fasciitis is one of the first treatments I offer patients; I am surprised by your experiences. The rule of thumb for cortisone injections is a maximum of three in the same area in a twelve month period.
I would tend to be more concerned by doctors who give too many injections into the same site because that is where you can end up crippling the patient.
Glad to hear you are no longer suffering.
Marc Mitnick DPM

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Wonderful advice

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Florida

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plantar fasciitis

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