"How can I help you?"
"You can fix my foot."
"What's wrong with your foot?"
"I think I have Plantar Fasciitis. It hurts near the heel and when I get up in the morning, my foot hurts a lot when it hits the floor. When I run, it hurts some too but after I finish, I have a lot of foot pain."
"How do you know you have Plantar Fasciitis?"
"Well, that's what I've been told and I kind of came to that conclusion too. From the research I did, it seems like it to me."
"So, tell me what you think it is. Plantar Fasciitis. What is it?"
"I think its when your heel gets inflamed or the tissue or stuff on the bottom of your foot is inflamed. Right?
"How long have you had this?"
"Well, let's see. I guess about two years or so."
"What have you done for your foot pain thus far?"
"I stretch it and do another stretch for my heel cord. I use ice when it's bad and take Advil. Seems to help some. Have had some massage. Tried some acupuncture too."
"Are you getting any better?"
"A little I guess. But, I still hurt a lot when I run."
"Have you tried not running?"
"Yeah. I did. But, really, I didn't notice much difference so I figured I might as well run."
"Beyond the massage and acupuncture, have you seen anyone else? Received any other type of treatment?"
"Nah. What for? Everybody says basically the same thing. Stop running, stretch, ice, try a heel lift, take these pills. I don't know. I feel like I'm just wasting my money really. No one seems to have a solution that makes sense. I've wasted a lot of time and money."
I have had that type of conversation with people, many, many times. Plantar Fasciitis is one of the most difficult foot injuries to beat. And, I believe I know why.
Have you ever been to a movie with someone and walked out saying, "Wow, what a great story!" Great movies always have great stories. The best stories are ones that keep us guessing but at the end, bring everything to a conclusion leaving you feeling good. Satisfied.
When you hear "sprained ankle", what comes to mind? Perhaps turning your foot over, landing funny on your foot, occurs with basketball frequently, swelling, ice, crutches, some type of brace? Something will be tumbling around in your head. That's because we use the phrase "sprained ankle" to define a story. An ankle sprain has a predictable story. In over 85% of ankle sprains, you injure the ligament on the outside (lateral) of your ankle. If you know the story, you will be less anxious about the injury because you know what you injured, how you injured it, what makes the injury worse, what makes it better and anything else that may be associated with it.
But, people with plantar fasciitis rarely know the story and most of what they do know is wrong. The reason Plantar Fasciitis is hard to beat is because they don't know the true story. The story they know goes something like this:
"Well, Jim, you have Plantar Fasciitis. That's inflammation of the tissue on your foot and heel and you hurt because it's inflamed. So, you'll need to stretch your foot and ankle to keep the tissue from tightening up, put ice on your foot to keep the swelling down. I'm going to write you a prescription for some medicine to bring down the inflammation. We'll get you some inserts, too. That usually helps. Now, you'll probably hurt for a while but be patient. Of course, you should stop running. Eventually, you'll get better. "
Jim may decide to get more information on his own perhaps using the Internet but the story is the same: tissue is inflamed, stretch, ice, heel lift, inserts, etc. In fact, read what Emedicine.com has to say about Plantar Fasciitis:
"Considered a chronic inflammatory syndrome rather than a post-traumatic disorder, plantar fasciitis is common in runners and dancers who use repetitive, maximal plantarflexion of the ankle and dorsiflexion of the metatarsophalangeal joints. It is common in those who experience sudden weight gain and in overweight individuals who increase their activity level."
The biggest problem is the name "Plantar Fasciitis". What if I told you, that instead of Plantar Fasciitis, you have a torn ligament in your foot? Yikes. Torn? Are you serious? I have a torn ligament in my foot? Yep. You do because that is what happens in the misnamed and poorly told story of Plantar Fasciitis. You have torn the plantar ligament in your foot. Suddenly, it seems a bit worse somehow. Doesn't it?
The correct term or name for the story, to be consistent with other body areas (have you ever heard of a Lateral Ankle Fasciitis for an ankle sprain or a Medial Collateral Fasciitis for a Medial Collateral Ligament Sprain?), is a Plantar Ligament Sprain. A sprain is a tear in a ligament. And, as with all sprains, it is either a Grade I, II, or III. Grade I is mild, Grade II moderate and Grade III severe.
Now that we know it is a sprain, what should you do? Well, what do you do with an ankle sprain? Do you stretch an ankle sprain? Never. Do you use crutches? Yes, if you cannot walk without a limp. Do you wrap the ankle creating a graduated compression from toes to calf? Yes. Do you consult a professional for advice and rehab to prevent further injury? Yes. Do you run on a sprained ankle? Not if you're smart. Do you gradually put more weight on your foot and ankle respecting what you feel and how your foot and ankle responds? Yes.
A sprained Plantar Ligament story is not much different from an Ankle Sprain story. But, for many reasons, the Plantar Ligament Sprain has managed to become one of the worst stories in health care. Practitioners are taught the story in school or on a clinical rotation (as I was). They're told about the characteristics of Plantar Fasciitis (heel pain, hurts first thing in the morning when the foot hits the floor, starts usually from overuse), and the treatment which is largely symptom based (ice, stretch, NSAIDs, heel lifts, inserts, massage). So, practitioners learn the story, recognize it in their patients and follow the suggestions to bring the story to a conclusion. Unfortunately, just like a bad movie, this story leaves you feeling dissatisfied.
A better, more satisfying Plantar Ligament Sprain story would go something like this:
"Well, Jim, you have a Plantar Ligament Sprain. This is a tough tissue on the bottom of your foot. A sprain is a tear of this tissue and from your history and examination, I suspect it is a Grade II, which is a moderate type of tear. Right now, your ligament is inflamed which means that the tissue is very sensitive to load and motion. Inflammation is a normal healing response and there are some things you can do to help. Ligament sprains heal the best when you keep the tissue at its ideal length, keep the area compressed with a graduated compression garment, and gradually increase the load placed on your foot. When you sleep at night, you may need a special sock or brace to keep your ligament from healing in a shortened position since your foot will tend to fall into a relaxed position allowing the ligament to shorten. You may need some additional padding in your shoes to help absorb the load. And, you will need to use crutches, probably for the next 2-3 weeks or until you feel like you can walk normally and have very little discomfort.
What will make this sprain worse and potentially turn into a chronic problem is if you place too much load on your foot too fast. This can cause your tissue to stay inflamed and become gradually weaker and weaker. So, for now, use the crutches, the special sock at night, wear the compression garment. As your tissue heals, you will have less pain and stiffness. We have other exercises for you later, but for now, we need to help your body work its way through the inflammation. Control the load, move your foot a little, and use the crutches."
This story makes sense and, it is consistent with other "Sprain" stories. If you have an ankle sprain, the first phase of recovery will sound very similar to the above. Can you see how something simple, like a Plantar Ligament Sprain, becomes a complicated and complex problem later? Because it is not viewed as a tear, the tissue is easily and rapidly overloaded leading to a chronic, low grade inflammatory state resulting in weaker and more easily damaged tissue. All because of a bad story.
Success with "Plantar Fasciitis" starts with first understanding the nature of the problem and having the correct story. From this, you will make good choices, help your body heal and go back into an active and fun life.
Get your story straight first.
Make today count.
Author. Teacher. Therapist.
P.S. If you are a clinician who works with injured athletes and would like to learn how we work with disc and joint disease in the spine, join us for our first professional seminar in 2005 entitled "The Spine: Diagnosis and Treatment of Lumbar Degenerative Disc and Joint Disease". Come to our training facility in Austin on April 28th-29th, 2005 for this cutting edge seminar for physical therapists and athletic trainers who want simple, powerful solutions for their active clients. Learn proven examination techniques and specific drills for back pain that you can execute with confidence on Monday morning. Seating is very limited and already filling. Call Angie Francis at 512-206-0433 to sign up today.