Do I Have Plantar Fascitis?

Here’s a scenario:  You are healthy, active, mobile and going about your daily life with your normal routines.  You have been walking daily, doing some sort of aerobic fitness and you’re feeling good.  You go to bed and when you get up your first step yields excruciating pain at the bottom of your foot.

This pain stays with you with each and every step causing you to limp and you make an appointment with your primary care physician (PCP) or even a Doctor of Podiatric Medicine (DPM) because of the pain. You then leave with a diagnosis of Plantar Fascitis.  

What does this mean?

 Most of the time as health providers we will ask where does it hurt? How long has it been going on? How is your first step in the morning? Does your pain last?  As a healthcare provider just these questions prove to be a slam dunk and we don’t even have to touch or feel your foot to tell you that it is Plantar Fascitis.  It is also “confirmed” with a Windlass Test (see below).  The problem is that this test is often performed poorly and there is a high rate of a positive test that is actually not true.

Let’s take a dive into what it is to actually have this pathology.  It is when we understand what the tissue is that is “damaged” that we can understand the treatment. The Plantar Fascia is a bundle of connective fibrous tissue (made of mostly collagen fibers) that run from the heel (calcaneal tubercle) to the small bones of the toes (metatarsal head).  The purpose of this tissue is to provide stabilization to the arch of the foot.  It has no muscle and very little blood supply which means a very slow healing (turnover) rate.  In fact, the average turnover rate for collagen tissue is about 365 days.

The Plantar Fascia is also a very strong tissue so I do have an issue with the wording of the diagnosis Plantar Fascitis.  It may be nit picking, but because of the previous fact, I do not believe that you can have, or have I ever seen a “fascitis”.  This would have to mean acute swelling at the tissue and since the tissue has poor blood supply, this cannot be clinically relevant.  I do think that you can get an inflammatory response around the tissue, but if the tissue is truly damaged then it is usually a case of prolonged micro trauma(stress) on the tissue.  For this reason, it should be considered more of a plantar fasciopathy (meaning chronic in nature). 

I believe that this can happen due to several reasons. First, and most common, is poor foot mechanics.  The foot is an amazing part of the body due to the fact that it has 26 bones, 33 joints and over 100 muscles that control it at any given time.  The foot also has to go from a supple load bearing cushion during landing, to a hard, rigid spring-like mechanism during push off of gait in a moments notice.  To me, this is amazing physics and engineering but it also means that there is a lot of stress in the foot.  For this reason we can break down the foot to see where those stress points are, where the joints are not moving, or moving too much and assess what can be done to normalize the stress and forces in the foot. 

The second reason that we can get breakdown at the plantar fascia is lack of strength and foot control.  This refers to the dynamic movements of the foot, and our ability to control them through all those movements.  Most of the time this has to do with lack of strength in regards to toe grip strength.  Simply put, our foot strength should be just as strong as our hands, and to be honest, in most of the clinical testing I do, we are better off walking on our hands than our feet due to the lack of strength.  

Lastly, the pain can be generated from a nerve that travels down into the foot.  This is one of the most common structures that is misdiagnosed as Plantar Fasciopathy.  The reason for this is due to the close proximity of the nerve to the heel bone.  If not treated according to the structure that is irritated, then the symptoms will continue to persist.  

So back to the real question at hand. Do I have Plantar Fascitis?  The answer is, if you do, and it is diagnosed appropriately, then you are looking at about a year of healing.  This time table is also dependent upon doing the proper treatment to see if and where the stress came from in order to properly determine the course of treatment. 

The good news?  You can get better, you can improve the mechanics, strength, control as well as the nerve irritability if there is any present.  It is all about finding the tissue that is involved, and getting the proper treatment. 

We will be putting out a couple videos to try and help you get some relief from home. If these do not help please give us a call at (817) 923-9000. We will be more than happy to answer any questions you might have and even get you into the clinic for a FREE 15-minute screen!