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want to make sure it is PF

Posted by Kelsey J on 8/01/01 at 12:36 (055084)

I was diagnosed with PF in January, 3 weeks before I was to run my 1st marathon. I ran it anyway (stupid, I know), and haven't run at all since. My pain is equally bad in both feet, and is primarily in the arches. I do, at times, feel pain on the outside of my feet and in the heels a bit. I have never had severe heel pain and do not have a spur. My pain is worse after I've walked, as opposed to first thing in the morning. I can feel small bumps on the plantar fascia where the pain is worst. My PT referred to these bumps as areas of 'tension.' I have custom orthotics, which I have worn almost exclusively for 3 months. I have tried ultrasound, PT, icing, stretching, deep tissue massage, night splints, and steroids. I have completely stopped running, hiking, etc. My feet have not improved at all, and in fact, seem to be getting worse. I guess I am just wondering if it is possible that I have something other than PF, or if anyone has any innovative advice. Thanks.

Re: want to make sure it is PF

ellen w on 8/01/01 at 13:15 (055089)

You might try doing a search on this website for info on ART (active release therapy). One of our posters says it has helped her significantly.

Re: want to make sure it is PF

D.Thomas on 8/01/01 at 14:00 (055097)

Kelsey,

You sound like you got the exact same pain as I do. I also have it in the arches of both feet. Most people with PF have it around the heel. Sometimes it can feel like the whole foot when the infammation is bad. But once my inflammation goes down the pain is mainly in the arches on the medial side of both feet. I have high arches and my PF started over 7 years ago. They really got bad about 3 months ago. I had bumps on mine after I went to the PT and they did deep tissue massage. I love how they tell you they have to break up the scar tissue. God was that painful! They also had me doing weight bearing stretching. I stopped those after the third week, because my feet were totally worse and I could feel the bumps. The PT actually said that it would hurt before it would get better. But I could'nt take it anymore and quit. They did get a little better after I stopped those and rested as much as I could.

There are only a couple of things I do. I do non-weight bearing stretching that has been talked about on this board. I make sure that I don't over do it. I rest whenever possible. I was actaully getting a little better three weeks ago but had to move and do other stuff. That stuff put me back to square one.

Here are the important things for me -

(1) REST - and patience and more REST. I really believe every time you push your feet when they hurt, you re-injure them. You need to REST as much as possible until the pain is gone and then start back slowly. My goal is to lose the pain and then start strengthing excercises. I believe I can only do non-weight bearing excersises until I lose the pain then I will work on making them stronger slowly once the pain is gone.
(2) ICE - with water bottles. Less chance of getting frost bite becuse I am rolling my feet on them. Less chance of the ice sitting in one spot.
(3) STRETCHING - non-weight bearing only. EVERY morning and night. As well as when I have sat down for a while. Some othe people here apply heat before they stretch.
(4) GOOD ORTHOTICS and SHOES - Still working on these. Finding a good pair of orthotics can be fun and expensive. Every doctor says they have the best. BUT NEVER GO WITHOUT SHOES AND SUPPORT!!!!!!!!!!!!!!
(5) I want to try taping next

Things that won't work with people who have the pain in their arches instead of the heel: (A couple of the doctors I saw and talked to told me these)

night splintS
ESWT
SHOTS

Hope some of these help.

Re: want to make sure it is PF

Ed Davis, DPM on 8/01/01 at hrmin (055110)

Are the bumps in the fascia? Are the bumps tender? Plantar fibromatosis is a possibility--a cousin to plantar fasciitis. Do you have high arch feet with tight fasciae? If so, the orthotic needs to hug the arch very closely and possibly have a plantar fascial groove to avoid direct pressure.
Ed

Re: Re:Dr. Ed :)

D.Thomas on 8/01/01 at 17:23 (055129)

Hey Doc,

Are the bumps bad? Will they go away in time? Mine has gone down quite a bit from stopping the PT but I can still feel it when I push in on the fascia. And exactly what do you mean by a cousin to plantar fascitis?

Thanks.

Re: want to make sure it is PF

Kelsey J. on 8/01/01 at 18:27 (055138)

Thanks to all for responses thus far. Yes, the bumps are in the fascia and are tender. What exactly is plantar fibromatosis? I do not have high arches or flat feet, but I do pronate. My orthotics do seem to hug the arches closely, but feel as though the are putting pressure on them. Any further thoughts?

Re: Re:Calling Dr. Ed :)

Ed Davis, DPM on 8/01/01 at hrmin (055154)

Plantar fibromatosis and plantar fasciitis both involve inflammation of the plantar fascia-- as such they are related. Plantar fibromatosis involves the formation of hard nodules on the fascia. The nodules are actually part of the fascia and are composed of the same type of tissue the fascia is made of except for a lot more scar tissue.

Orthotics which follow the contours of the foot closely often are more effective than those which do not. The problem with close fitting orthotics is that they can place pressure on the nodules, irritating them.
Orthotics may have to be made with poorer conformation in order not to irritate the nodules.

It is thus important to get rid of the nodules--first because they hurt, second, because they are limiting the effectiveness of the orthotics.
Surgical treatment of plantar fibromatosis should be avoided in most cases since the nodules tend to come back when removed. A very effective treatment involves shrinking the nodules by injecting them with triamcinolone acetonide (a type of steroid used to shrink scars) and Wydase (an enzyme used to dissolve scar tissue).
Ed

Re: want to make sure it is PF

Ed Davis, DPM on 8/01/01 at hrmin (055155)

See my prior response. Most of the people I have seen with plantar fibromatosis have high arches, tight plantar fasciae and are overpronated.
Some feel that the nodules represent areas of small tears in the fascia that heal with lumps of scar tissue.
Ed

Re: want to make sure it is PF

Brenda W on 8/02/01 at hrmin (055253)

Why so often does PF affect just one foot? My husband has it in his right foot, and I have just been diagnosed with it in my left foot.

Re: want to make sure it is PF

Ed Davis, DPM on 8/02/01 at hrmin (055263)

All diseases have to start somewhere. We do not always know the reason why something starts in a particular spot. The foot that pronates more is more susceptible to plantar fasciitis. If one leg is longer than the other, the foot on the longer leg is more prone to plantar fasciitis. The dominant foot (the one you lead off with) is more prone to plantar fasciitis.
Ed

Re: want to make sure it is PF

Julie on 8/03/01 at 02:31 (055294)

Brenda, if the PF has a biomechanical cause such as pronation, one foot may pronate more than the other. That is certainly true in my case: both my feet pronate excessively, the right much more so than the left. I have PF in my right foot. The difference in the orthotics that were made for me is noticeable, both in the arch and in the posting.

Have you and your husband had a biomechanical assessment to determine whether you need orthotics?

Re: want to make sure it is PF

ellen w on 8/01/01 at 13:15 (055089)

You might try doing a search on this website for info on ART (active release therapy). One of our posters says it has helped her significantly.

Re: want to make sure it is PF

D.Thomas on 8/01/01 at 14:00 (055097)

Kelsey,

You sound like you got the exact same pain as I do. I also have it in the arches of both feet. Most people with PF have it around the heel. Sometimes it can feel like the whole foot when the infammation is bad. But once my inflammation goes down the pain is mainly in the arches on the medial side of both feet. I have high arches and my PF started over 7 years ago. They really got bad about 3 months ago. I had bumps on mine after I went to the PT and they did deep tissue massage. I love how they tell you they have to break up the scar tissue. God was that painful! They also had me doing weight bearing stretching. I stopped those after the third week, because my feet were totally worse and I could feel the bumps. The PT actually said that it would hurt before it would get better. But I could'nt take it anymore and quit. They did get a little better after I stopped those and rested as much as I could.

There are only a couple of things I do. I do non-weight bearing stretching that has been talked about on this board. I make sure that I don't over do it. I rest whenever possible. I was actaully getting a little better three weeks ago but had to move and do other stuff. That stuff put me back to square one.

Here are the important things for me -

(1) REST - and patience and more REST. I really believe every time you push your feet when they hurt, you re-injure them. You need to REST as much as possible until the pain is gone and then start back slowly. My goal is to lose the pain and then start strengthing excercises. I believe I can only do non-weight bearing excersises until I lose the pain then I will work on making them stronger slowly once the pain is gone.
(2) ICE - with water bottles. Less chance of getting frost bite becuse I am rolling my feet on them. Less chance of the ice sitting in one spot.
(3) STRETCHING - non-weight bearing only. EVERY morning and night. As well as when I have sat down for a while. Some othe people here apply heat before they stretch.
(4) GOOD ORTHOTICS and SHOES - Still working on these. Finding a good pair of orthotics can be fun and expensive. Every doctor says they have the best. BUT NEVER GO WITHOUT SHOES AND SUPPORT!!!!!!!!!!!!!!
(5) I want to try taping next

Things that won't work with people who have the pain in their arches instead of the heel: (A couple of the doctors I saw and talked to told me these)

night splintS
ESWT
SHOTS

Hope some of these help.

Re: want to make sure it is PF

Ed Davis, DPM on 8/01/01 at hrmin (055110)

Are the bumps in the fascia? Are the bumps tender? Plantar fibromatosis is a possibility--a cousin to plantar fasciitis. Do you have high arch feet with tight fasciae? If so, the orthotic needs to hug the arch very closely and possibly have a plantar fascial groove to avoid direct pressure.
Ed

Re: Re:Dr. Ed :)

D.Thomas on 8/01/01 at 17:23 (055129)

Hey Doc,

Are the bumps bad? Will they go away in time? Mine has gone down quite a bit from stopping the PT but I can still feel it when I push in on the fascia. And exactly what do you mean by a cousin to plantar fascitis?

Thanks.

Re: want to make sure it is PF

Kelsey J. on 8/01/01 at 18:27 (055138)

Thanks to all for responses thus far. Yes, the bumps are in the fascia and are tender. What exactly is plantar fibromatosis? I do not have high arches or flat feet, but I do pronate. My orthotics do seem to hug the arches closely, but feel as though the are putting pressure on them. Any further thoughts?

Re: Re:Calling Dr. Ed :)

Ed Davis, DPM on 8/01/01 at hrmin (055154)

Plantar fibromatosis and plantar fasciitis both involve inflammation of the plantar fascia-- as such they are related. Plantar fibromatosis involves the formation of hard nodules on the fascia. The nodules are actually part of the fascia and are composed of the same type of tissue the fascia is made of except for a lot more scar tissue.

Orthotics which follow the contours of the foot closely often are more effective than those which do not. The problem with close fitting orthotics is that they can place pressure on the nodules, irritating them.
Orthotics may have to be made with poorer conformation in order not to irritate the nodules.

It is thus important to get rid of the nodules--first because they hurt, second, because they are limiting the effectiveness of the orthotics.
Surgical treatment of plantar fibromatosis should be avoided in most cases since the nodules tend to come back when removed. A very effective treatment involves shrinking the nodules by injecting them with triamcinolone acetonide (a type of steroid used to shrink scars) and Wydase (an enzyme used to dissolve scar tissue).
Ed

Re: want to make sure it is PF

Ed Davis, DPM on 8/01/01 at hrmin (055155)

See my prior response. Most of the people I have seen with plantar fibromatosis have high arches, tight plantar fasciae and are overpronated.
Some feel that the nodules represent areas of small tears in the fascia that heal with lumps of scar tissue.
Ed

Re: want to make sure it is PF

Brenda W on 8/02/01 at hrmin (055253)

Why so often does PF affect just one foot? My husband has it in his right foot, and I have just been diagnosed with it in my left foot.

Re: want to make sure it is PF

Ed Davis, DPM on 8/02/01 at hrmin (055263)

All diseases have to start somewhere. We do not always know the reason why something starts in a particular spot. The foot that pronates more is more susceptible to plantar fasciitis. If one leg is longer than the other, the foot on the longer leg is more prone to plantar fasciitis. The dominant foot (the one you lead off with) is more prone to plantar fasciitis.
Ed

Re: want to make sure it is PF

Julie on 8/03/01 at 02:31 (055294)

Brenda, if the PF has a biomechanical cause such as pronation, one foot may pronate more than the other. That is certainly true in my case: both my feet pronate excessively, the right much more so than the left. I have PF in my right foot. The difference in the orthotics that were made for me is noticeable, both in the arch and in the posting.

Have you and your husband had a biomechanical assessment to determine whether you need orthotics?