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Plantar Fascia... will it ever heal?

Posted by Mike on 12/27/00 at 21:27 (035477)

Hello, about a year ago I tore/ripped my plantar fascia. I thought it was fully healed, with the exception of some scarring(lump in my arch), however, I have recently started running (about 2 months now) and it appears the same pain I encountered after the tare is resurfacing. Granted the pain is not as severe, nor long lasting, but it is worrisome that I could possible tare it again. What's up with my foot? WIll it ever fully heal? SHould I see a doctor or do I just need to buy some inserts to support my arch?

Re: Plantar Fascia... will it ever heal?

Dr. Zuckerman on 12/27/00 at 23:30 (035486)

If the pain is still there then you need to have an mri to determine if you torn the posterior tibial tendon and or any other ligaments in the foot and ankle.

Re: Plantar Fascia... will it ever heal?

Dr. Biehler on 12/28/00 at 16:18 (035513)

How much dorsal range of motion do you have in your big toe? If you can not get 90% to your metatarsal, this might be causing the over tightening of the fasica. Dr. B

Re: Plantar Fascia... will it ever heal?

Hank C. on 1/02/01 at 08:50 (035793)

Dr. B,
Could you please explain in laymen's terms about the dorsal range of motion with the big toe? I have had
pf now for over 2 years. It did go way for about 5 months last year and I was able to resume triathlons. I
believe I reaggravated the pf by playing tennis, however. My fascia in my left foot is extremely tight -
could this be due to lack of big toe flexibility?
Thanks, Hank C

Re: Plantar Fascia... will it ever heal?

Barbara TX on 1/02/01 at 10:53 (035795)

Hank - I too had this problem with the range of motion of my big toe - I belive that it is called hallux rigidis (or hallux limitis if it is less severe). A good chiropractor who was experienced with extremities was able to stretch it out and restore all the motion in that joint. He did trigger-point releases. Good luck! B.

Re: Plantar Fascia... will it ever heal?

Dr. Biehler on 1/02/01 at 12:00 (035800)

In a normal gait, in order for your body to pass over your foot, your big toe has to be able dorey flex ( bend up ) to a 90% angle to your first metatarsal ( this is the bone that leads to your big toe ). If your toe does not have this range of motion your body has to compensate somewhere for this. Normaly, as the big toe goes into this 90% angle it pulls the fasica forward ( the call this a windless mechanisism ) and this helps tighten the fasia and support the arch. It your big toe doesn't have the full motion it causes a retrograde pressuse back to the metatarsal and forces it ( the metatarsal ) into a plantarflextion which has the result of overtightening the fasia. There are other ways your body can compensate,ie.. turning the foot outward and rolling off the side of the big toe, shortening your stride lenght, bending the knee which also effects the pelvis and back. Dr. B

Re: Plantar Fascia... will it ever heal?

hankc on 1/02/01 at 15:31 (035805)

Dr. B,
Thanks for the explanation. A few more question and then I'll quit bugging you. Assuming my first metatarsal
is parallel to the floor when I am standing straight (i.e feet flat to the ground) , should I then be able to reach
down and pull my big toe up to a 90% angle with the floor? Is that an accurate measurement of this flexibility?
My feet (toes) have always pointed outward - ever since I was a child. You can clearly distinguish my footprints
on a beach. Perhaps this somewhat unnatural position has contributed to the pf (first sustained at age 42).
Like many of the posters here I am trying to ascertain the root cause - biomechanical, poor flexibility, or
otherwise. I have worked on flexibility to try to eliminate pf but not specifically big toe flexibility. If there is
something to be gained from trying to improve my big toe's range of motion I will surely do it. Thanks again
for taking your time to assist...
best regards, Hank C

Re: Plantar Fascia... will it ever heal?

wendyn on 1/02/01 at 18:29 (035814)

Hi Hank - I'm not a doctor - just a person with foot problems.

I have the little duck foot prints like you on the beach. You could pick mine out in the snow out back too!

I would suspect that if you have biomechanical problems with your feet, it probably would have surfaced before now. My problems started at 11, I'd be suprised if you could go 42 years without a problem if there was something structuarally really wrong. If there's an underlying/contributing problem - it could have been aggravated by an increase in activity or extra weight. Or - even just a change in foot wear.

Re: Plantar Fascia... will it ever heal?

Dr. Biehler on 1/02/01 at 19:37 (035821)

Hankc, The metatarsals are usually at a 15% angle to the ground. If you pulled your toe up 90% to the metatarsals you would be at an 85% angle. You can not do this test while standing, as the big toe/metatarsal joint has an axis that actually changes to at least four positions durring gait and the big toe rides up on the top/front of the metatarsal. Your metatarsal might be parrallel to the ground if you have a collapsed arch. As we become older alot of the compensations our bodies have made while we were growing up all of a sudden start to bother us. Dr. B.

Re: Plantar Fascia... will it ever heal?

Dr. Zuckerman on 12/27/00 at 23:30 (035486)

If the pain is still there then you need to have an mri to determine if you torn the posterior tibial tendon and or any other ligaments in the foot and ankle.

Re: Plantar Fascia... will it ever heal?

Dr. Biehler on 12/28/00 at 16:18 (035513)

How much dorsal range of motion do you have in your big toe? If you can not get 90% to your metatarsal, this might be causing the over tightening of the fasica. Dr. B

Re: Plantar Fascia... will it ever heal?

Hank C. on 1/02/01 at 08:50 (035793)

Dr. B,
Could you please explain in laymen's terms about the dorsal range of motion with the big toe? I have had
pf now for over 2 years. It did go way for about 5 months last year and I was able to resume triathlons. I
believe I reaggravated the pf by playing tennis, however. My fascia in my left foot is extremely tight -
could this be due to lack of big toe flexibility?
Thanks, Hank C

Re: Plantar Fascia... will it ever heal?

Barbara TX on 1/02/01 at 10:53 (035795)

Hank - I too had this problem with the range of motion of my big toe - I belive that it is called hallux rigidis (or hallux limitis if it is less severe). A good chiropractor who was experienced with extremities was able to stretch it out and restore all the motion in that joint. He did trigger-point releases. Good luck! B.

Re: Plantar Fascia... will it ever heal?

Dr. Biehler on 1/02/01 at 12:00 (035800)

In a normal gait, in order for your body to pass over your foot, your big toe has to be able dorey flex ( bend up ) to a 90% angle to your first metatarsal ( this is the bone that leads to your big toe ). If your toe does not have this range of motion your body has to compensate somewhere for this. Normaly, as the big toe goes into this 90% angle it pulls the fasica forward ( the call this a windless mechanisism ) and this helps tighten the fasia and support the arch. It your big toe doesn't have the full motion it causes a retrograde pressuse back to the metatarsal and forces it ( the metatarsal ) into a plantarflextion which has the result of overtightening the fasia. There are other ways your body can compensate,ie.. turning the foot outward and rolling off the side of the big toe, shortening your stride lenght, bending the knee which also effects the pelvis and back. Dr. B

Re: Plantar Fascia... will it ever heal?

hankc on 1/02/01 at 15:31 (035805)

Dr. B,
Thanks for the explanation. A few more question and then I'll quit bugging you. Assuming my first metatarsal
is parallel to the floor when I am standing straight (i.e feet flat to the ground) , should I then be able to reach
down and pull my big toe up to a 90% angle with the floor? Is that an accurate measurement of this flexibility?
My feet (toes) have always pointed outward - ever since I was a child. You can clearly distinguish my footprints
on a beach. Perhaps this somewhat unnatural position has contributed to the pf (first sustained at age 42).
Like many of the posters here I am trying to ascertain the root cause - biomechanical, poor flexibility, or
otherwise. I have worked on flexibility to try to eliminate pf but not specifically big toe flexibility. If there is
something to be gained from trying to improve my big toe's range of motion I will surely do it. Thanks again
for taking your time to assist...
best regards, Hank C

Re: Plantar Fascia... will it ever heal?

wendyn on 1/02/01 at 18:29 (035814)

Hi Hank - I'm not a doctor - just a person with foot problems.

I have the little duck foot prints like you on the beach. You could pick mine out in the snow out back too!

I would suspect that if you have biomechanical problems with your feet, it probably would have surfaced before now. My problems started at 11, I'd be suprised if you could go 42 years without a problem if there was something structuarally really wrong. If there's an underlying/contributing problem - it could have been aggravated by an increase in activity or extra weight. Or - even just a change in foot wear.

Re: Plantar Fascia... will it ever heal?

Dr. Biehler on 1/02/01 at 19:37 (035821)

Hankc, The metatarsals are usually at a 15% angle to the ground. If you pulled your toe up 90% to the metatarsals you would be at an 85% angle. You can not do this test while standing, as the big toe/metatarsal joint has an axis that actually changes to at least four positions durring gait and the big toe rides up on the top/front of the metatarsal. Your metatarsal might be parrallel to the ground if you have a collapsed arch. As we become older alot of the compensations our bodies have made while we were growing up all of a sudden start to bother us. Dr. B.