Dealing with Persistent Plantar Fasciitis

author : AMSSM
comments : 3

Five years later, I'm still fighting it. Plantar fasciitis. It's back again in both feet. Running is out. I have been swimming and cycling only the last five years. How do I deal with this?

Member question

Five years later, I'm still fighting it.  Plantar fasciitis.  It's back again in both feet. 

I have heard that some people just have a sore heel, others have more pain. In my case, my feet feel almost 100% and then in one step it feels as though I stepped on a razor blade. Amazingly sharp and intense it'll make you shout, but it's usually a brief pain. I'll sit down, move my foot around, and it feels better as long as I don't touch the painful area Sometimes I can continue walking almost pain free again, other times I'll have to take a break for an hour or so. (I have been in Brooks Glycerins with orthotics or insoles the entire time.

Running is out. I have been swimming and cycling only the last five years. I'm finally considering elective release surgery, although I have not tried "art" therapy.   (Calf needling to release plantar tension was a painful nightmare, causing spasms and locked up the muscles for a very long time.

I'm just having trouble with the "art" concept. Manipulating the plantar tendon's fascia in the very spot that's separated and inflamed at or near the heel bone? Aren't we supposed to be protecting this week point with orthotics, anti-inflammatory medicine, reducing swelling and trauma using frozen peas etc.,? 

Cortisone injections?  I haven't tried it as I'm concerned about the possible tendon damage, and the loss of fat padding at the heel. Maybe it is time to give cortisone a go? I just don't see how a shot can correct the problem, couldn't it mask the pain, allowing greater fascia separation?  

What is the best way to deal with this? 

Answer by Rebecca Gurney, MD
Member AMSSM

Unfortunately plantar fasciitis is a very stubborn problem. Your symptoms do not sound classic for plantar fasciitis, so if you have not been able to see a doctor, it would be worth seeing someone to confirm the diagnosis.

That being said, plantar fasciitis can last a long time and can come back once healed even. It sounds like you have tried most of the conservative treatment options which include looking at shoes, orthotics, activity modification, ice, physical therapy, and anti-inflammatories. Other things to consider are night splints, ice massage, ultrasound treatments and graston which are done at physical therapy. If there is no relief with these modalities, sometimes we will place you in a walking boot to give the foot a true rest for a couple of weeks.

Looking into more interventional treatments, the next thing to consider would be a cortisone injection. You are correct that cortisone injections for plantar fasciitis do have a risk of tendon injury or rupture, however the risk is low. It helps calm the inflammation down, but does not fix the original problem that caused the symptoms in the first place. The benefit to an injection is pain relief and sometimes that allows you to better perform your physical therapy exercises which can help in long term symptom management.

There are additional treatments that may be helpful in patients who don’t respond to initial treatment measures. However, these approaches are generally more costly and are of uncertain benefit. These include things like shockwave therapy and platelet rich plasma or whole blood injections.

The last resort for treatment is surgery. While numerous surgical procedures have been described, none have been assessed in controlled trials. Favorable outcomes are reported in more than 75 percent of published case series. However, recovery time may be prolonged and persistent pain is not unheard of.

Dr. Rebecca Gurney, MD

Sports Medicine Physician

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date: January 29, 2015

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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