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Practical Keys To The Diagnosis And Conservative Care Of Plantar Fasciitis

We are all familiar with the diagnosis of plantar fasciitis. I often describe this to patients as an inflammation of the thick ligament under the arch that runs from the heel to the toes. I ask the patient if the pain is at the attachment at the heel and ascertain if it is palpably sore on examination. If the soreness is somewhere other than at the plantar fascia attachment, then one should question the the diagnosis of plantar fasciitis. 

If you are sure of your diagnosis, then the next diagnostic test will actually be the prescribed treatment. True plantar fasciitis should respond to classically advised treatment modalities as I describe below.

Another telling set of data is in the symptoms. Plantar fasciitis progressively worsens over weeks to months. If the onset of pain is sudden and the pain is under the heel bone, it is likely not plantar fasciitis. (I will address sudden heel pain, which is definitely not plantar fasciitis, in a future blog.)

Plantar fasciitis is also always worst in the morning when one gets out of bed. Even though it is not advisable to use the word “always” in medicine, this is a pretty accurate statement for this condition. If the pain is not worse in the morning, it is probably something else. Again, see how it responds to treatment to be sure.

When it comes to plantar fasciitis, there should be little to no soft tissue swelling. If there is significant swelling between the two sides of the calcaneal body, it is probably not plantar fasciitis. 

In cases of plantar fasciitis, I have found, in my experience, that typical treatments of ice massage, plantar fascial stretching and taping are therapeutically effective. It can take a few months but the patient should feel better and better each month. I encourage patients to continue activities that they can execute while keeping the pain in the zero to two (out of ten) range on the visual analog scale, even if it hurts a little more after. I do not recommend running again until a patient reaches a baseline of pain. For instance, if the patient runs Monday, they cannot run again until the pain feels the same as before their Monday run. And yes, I try to get my athletes to live in zero to two level pain always, so I know to when its time to make treatment changes or get more diagnostic images.

Treatment recommendation #1: I tell patients to freeze a sport water bottle after filling it half-full with water. Then have them roll this bottle over the painful area for five minutes, two to three times per day with a towel on the floor as they sit. 

Treatment recommendation #2: I love the two Achilles stretching and one plantar fascia stretch described in my video (https://youtu.be/0eAqJ4-oKTM). I recommend that patients do these exercises three times a day, especially before and after exercise like running.

Treatment recommendation #3: I tape the arch to immobilize the pull of the plantar fascia. For me, I replace the time-consuming but wonderful low Dye taping with Quick Tape Foot Support Straps from Support the Foot. I typically have patients leave this on for five to seven days at a time. 

Plantar fasciitis should get a lot better with this regimen. If there is little to no improvement, I doubt the patient has plantar fasciitis at all. If the patient improves by about 50 percent or so, but then plateaus, I will typically increase and expand the treatment.

Plantar fascia treatment should allow full but modified activity. In my experience, non-response to treatment for plantar fasciitis typically means there is no plantar fasciitis but it can take a month of treatment to know that. A partial response, in my experience, typically means more specialized treatment, such as inserts or physical therapy, is necessary.

Dr. Blake is in practice at the Center for Sports Medicine, which is affiliated with St. Francis Memorial Hospital in San Francisco. He is a past president of the American Academy of Podiatric Sports Medicine. Dr. Blake is the author of the recently published book, “The Inverted Orthotic Technique: A Process Of Foot Stabilization For Pronated Feet,” which is available at www.bookbaby.com

Editor’s note: This blog originally appeared at www.drblakeshealingsole.com. It is adapted with permission from the author.

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