Why not really give someone a scare this Halloween? Instead of yelling "boo" step into a crowded room of mixed gender, age, body type, etc and shout "recent plantar fasciitis diagnosis!!!" at the top of your lungs. You are likely to get a few individuals to break out into a cold sweat.
Plantar fasciitis affect approximately 2 million Americans each year, or an estimated 10-30% over the course of a lifetime. It is the single most common foot condition treated by health care practitioners. A comprehensive review of literature performed by The Journal of Orthopaedic & Sports Physical Therapy in 2014 indicates that running, a high arch type, decreased ankle flexibility, increased body mass, and employment which involves long hours standing or walking are all positive risk factors for developing plantar fasciitis. A full text of this review can be found here.
If you are suffering from true plantar fasciitis, studies show that joint mobilization, trigger point manual therapy, taping techniques, and specific stretching exercises can powerfully reduce plantar fasciitis related pain in the short and long run. Night splints and custom or prefabricated orthotics were also shown to benefit. Do you know who can help you implement these treatments in a way that is right for you? You guessed it- your friendly neighborhood PT!
What I want to caution you against doing is assuming you have plantar fasciitis simply because you have pain at or near the bottom of your foot. An improper diagnosis will hinder your chances of a swift and long lasting recovery. Knowledge is power, empower yourself!
So what else can be going on down there? Let's consider a list of differential diagnoses (ie. medical speak for "what else can be going on down there")
1. Calcaneal Fat Pad Irritation
We all have cushy pads of fat on the bottom of our heel bones to protect from weight bearing forces. These pads are highly innervated, and can become inflamed or thinned from repetitive and/or excessive impact. OUCH! Pain is reproduced with deep palpation of the fat pad and often feels like a deep bruise or like you are walking on a pebble. Stretching does not aggravate symptoms, unless you have both fat pad irritation AND plantar fascia pain, which is possible.
2. Bone Issues such as a Heel Spur, Calcaneal Stress Fracture, or Haglund's Deformity
Bone is a living tissue, meaning that is changes and adapts to the pressure we put on it. Sometimes it changes in a maladaptive way, or it cannot change fast enough to accommodate the stress it is receiving. Abnormal gait patterns and/or tight calf musculature will cause excessive pulling of the achilles tendon on the calcaneus, where it attaches. As a result your body will deposit additional bone to re-enforce the area. This is when a heel spur develops, which can in turn aggravate the achilles tendon. It's a bad cycle!
Stress fractures of the calcaneus are less common, but still possible. Symptoms may mimic those of calcaneal fat pad irritation, but will typically differ in intensity and severity of pain. If you have calcaneal stress fracture, it is likely that you received it from a traumatic event such as a fall or epic ankle sprain.
Haglund's deformities, also called a "pump bump", frequently exist without showing any symptoms at all. They form for the same reason that heel spurs do, only in a different location. If a Haglund's deformity does become painful, it is because the enlarged bony area leads to bursitis of the retrocalcaneal bursa sack. In this case, the bump will be red, inflamed, and tender to the touch.
3. Posterior Ankle Impingement
When this occurs, there is literally a pinching of soft tissues between the tibia and talus as the foot goes into a pointed-toe position (plantar flexion). Patients complain of "jamming" and pain when kicking, swimming, walking on tip-toes, or any position that requires the foot to be plantar flexed. Posterior impingement most often occurs in dancers or individuals who have not fully rehabilitated a previous ankle injury.
4. Tendinopathy- Achilles Tendinopathy, Posterior Tibial Tendinopathy, etc
There are MANY muscles, and thus tendons, that support the foot. All of these muscle-tendon units are capable of becoming painful due to poor movement patterns or overuse. Insertional achilles tendonitis will present as pinpoint pain at the back of the heel. Posterior Tibialis tendinopathy will give broad pain at the inside of the ankle with activity and weight bearing. Tendinopathy of the small muscles which flex the toes can contribute to arch pain and symptoms similar to plantar fasciitis. Pain caused by tendinopathy is NOT the same as pain caused by plantar fasciitis, and thus should be treated differently. Stay tuned for my future blog post on "What is the difference between tendonitis, tendonosis and tendonopathy? And how can i get rid of it?"
5. Nerve Entrapment- Tarsal Tunnel Syndrome, Medial Plantar Nerve Entrapment, Lateral Plantar Nerve Entrapment, Medial Calcaneal Nerve Entrapment
Regardless of the specific entrapment, any nerve issue causing pain in the foot will usually be accompanied by numbness, tingling, burning, stabbing, and/or electric sensations. There may be swelling and pinpoint tenderness in the area of entrapment although this does not alway occur. Specific symptoms will depend on where the entrapment exists and which specific nerves are effected. Regardless, treatment should focus on addressing WHY the nerve became compromised by fully analyzing biomechanics, soft tissue restriction, and joint mobility. Seeking surgery without addressing these deficits will not end well!
As always, if you feel that you have exhausted your self-treatment options, or simply have questions, contact a physical therapist for guidance. You do not need a doctor's referral to make an appointment.
Stay informed, my friends.