Home The Book Dr Articles Products Message Boards Journal Articles Search Our Surveys Surgery ESWT Dr Messages Find Good Drs video

PF and Fibromyalgia or CFS....?

Posted by Sherri K. on 8/05/01 at hrmin (055578)

I am curious if anyone here has been dealing with plantar fasciitis as part or in conjuction with a larger problem such as Fibromyalgia or Chronic Fatigue Syndrome. I would be interested in hearing a little bit about how they relate in other folks' experiences.

In my case, I got FM and then HS's in BOTH feet that never went away after months of treatment. My docs told me it was my fault because it was supposed to be a temporary problem. Well then I started getting other problems in joints and such and I have been diagnosed (unofficially pendning more tests) Fibromyalgia.

Re: PF and Fibromyalgia or CFS....?

Carmel M on 8/05/01 at hrmin (055585)

I also have Fibromyalgia. I was diagnosed in 1998, but have had it for a lot longer than 3 years.

I looked up heel pain in a book about FMS and MPS (Myofascial Pain Syndrome) and what I found was this: 'Do your first steps in the morning feel as if you are walking on nails? This can also happen after a meal or at other times when you stand up after sitting for a while. In Travell and Simons' Trigger Point Manual, Volume II, this condition is listed as commonly occurring with flat feet, but it also occurs with cases of the wedge-shaped FMS/MPS foot, which is characterized by high arches as well. The condition occurs as the foot first flattens during the stride, due to the weight of body. When the plantar fascia (fascial tissue on the bottom of the feet) stretches more than it should, it starts to contract whenever you are off your feet for any length of time. It sometimes shortens to the point that walking can become very painful. This condition is usually caused by trigger points in the long flexor muscles of the toes. The trigger points are to be found in the calf area, not the foot itself. Morton's foot or any other foot deformity that causes hyperpronation can become perpetuation factors for these trigger points.'

I also wanted to let you know the definition of fibromyalgia as quoted from the book. 'A painful, but not articular (not present in the joints), condition predominantly involving muscles, and as the most common cause of chronic, widespread musculoskeletal pain. And some symptoms that are often overlooked...the presence of unexplained widespread pain or aching, presistent fatigue, generalized morning stiffness, non-refreshing sleep, and multiple tender points. Most patients with these symptoms have 11 or more tender points.'

I went in to see the doctor for chronic headaches and muscle pain and was sent to a specialist who checked me for tender points and I was diagnosed with FMS.

I don't know that I believe that plantar fasciitis is a problem related to FMS because I don't have 'trigger points' which are a symptom of Myofascial Pain Syndrome more than they are of FMS. I have the 'tender points' that are associated with Fibromyalgia Syndrome.

I hope this has helped...sorry to overload you with information, but when you said you had joint pain, I just wanted you to have some more information on Fibromyalgia because it's not associated with joint pain. The author of the book also has a web site. She is also a doctor! the address is http://www.sover.net/~devstar/

Take care,
Carmel

Re: PF and Fibromyalgia or CFS....?

Dr. Chris Reynolds on 8/06/01 at hrmin (055607)

I find your comments very interesting and will copy them to my archive on PF and auto-immunity. Fibromyalgia and CFS are conditions that are almost certainly related to altered immunity and many patients with auto-immune conditions develop plantar fasciitis. Although I tend to get laughed off this site every time I mention it by those who obviously know better, I firmly believe that PF has an auto-immune etiology, possibly in genetically predisposed individuals. In your case, I believe this is what we are dealing with. The following example, an anecdote I received from a young and previously very fit and healthy married male from the US, illustrates my point.

'It is interesting when the heel spurs/PF came into my life.
I was bird hunting in Tx. Several days later I had an allergic reaction
to something. I am not allergic to anything . (food,medicine
enviormental stimuli ) . After consulting an allergist here in Dallas ,
extensive blood work, and allergy tests, the results were negative blood
toxins ,and a slight raection to Ragweed. I did not buy the diagnosis,
and by the way it was very expensive. The reaction/hives lasted a week,
and it is impotant to note that on the 3rd/4th day I went to stand up
and collapsed , and the pain in my heels almost brought tears to my
eyes. You must understand that I have a high pain tolerance level but
have not seen anything like this before. The pain has been there going
on two years. My wife and I determined the reaction was to an insect
bite on my buttock. Dr. Reynolds I buy your theory on a autoimmune
response.'

The question remains, why is the heel so often the point of inflammatory predilection? But then, why the elbow in tennis elbow, why the thyroid gland in acute thyroiditis, why the anal fissure, why indeed the whole body in CFS? My point is that these and other conditions are all probably triggered by an auto-immune response and, for some as yet undiscovered reason, different individuals react differently. Quite likely in PF, the individuals who are overweight, who are on their feet all day etc. are unwittingly pre-disposing themselves to the condition. But then, what of the others who do not have these problems? Perhaps this is where the genetic predisposition becomes an important factor. My search of the literature does little to enlighten me on the circumstances surrounding PF sufferers e.g. psychological, physical and emotional stress, illness, allergic reactions etc. around the time of onset of their condition. And what is their family history? If it hasn't already been done, it would be an interesting study.

I have written a bit about auto-immunity and PF on my website at http://www.jadepage.com/pf.htm
I hope this has given you some food for thought.

Re: PF and Fibromyalgia or CFS....?

Terri B. on 8/06/01 at hrmin (055608)

I have an auto-immune disease AND Plantar Fasciitis. I DO believe that the two are related. Even my Podiatrist believes this. He has done a lot of research on my disease and has several patients with Auto-immune Diseases. It would be nice if someone could/would do extensive research and figure out why, where, when etc . . . : ) I'll pray for 'healthy feet', for us all.

Re: PF and Fibromyalgia or CFS....?

nancy s. on 8/06/01 at 07:50 (055610)

dr. reynolds, i agree with you and have thought for a long time that a possible auto-immune reaction should be looked into more thoroughly and studied. i've had pf and other foot tendonitises, now have 'frozen shoulder' that started out as rotator-cuff tendonitis in one shoulder, and have the same tendonitis coming on in the other shoulder. ten years ago i had what was originally thought to be carpal tunnel syndrome, but the end -- and kind of puzzled -- diagnosis was tendonitis in both hands and arms. i was three months in splints, day and night. past and recent blood tests turn up no other condition.
even here on heelspurs.com, how many posters are struggling with tendonitises or other inflammatory conditions elsewhere in their body? i've been here nearly two years and have seen _many_ posts from people with dual or multiple inflammations, sometimes simultaneously, sometimes not; often people casually mention that 'I had carpal tunnel three years ago' or 'i can't swim right now to help my pf because i have tendonitis in my elbow.'
alan k., who used to post here often and was also interested in and knowledgeable about the biomechanics of this condition, repeatedly expressed his interest in the fact that both he and his wife came down with some kind of flu or virus at the same time, and very shortly thereafter both of them developed pf. with all his biomechanical knowledge, he never stopped speculating about that extremely unlikely coincidence. at least one other person after that posted a similar event.
you should not be laughed off the board when you bring up the auto-immune reaction. far from it. i congratulate you for continuing to mention an area that needs a lot more research.
nancy

Re: PF and Fibromyalgia or CFS....?

Dr. Chris Reynolds on 8/06/01 at hrmin (055627)

Nancy, thank you for your support and your very interesting comments. I have already collected a fair bit of material on this subject and I will add your comments to my collection. One day I will collate it all and hopefully come up with a more convincing argument. Thanks again.

Re: PF and Fibromyalgia or CFS....?

Lisa S. on 8/06/01 at 14:36 (055652)

I have had sub-clinical hyperthyroidism since 1994. Is that considered an auto-immune condition? Last November I was diagnosed with heel spurs and plantar fasciitis. Are the two related?

Re: PF and Fibromyalgia or CFS....?

Olga C on 8/06/01 at hrmin (055669)

I too have been diagnosed with hyperthyroidism- Graves disease since May 01. I also have P.F. for 2 years. I too wonder about any possible link between the two. Olga c

Re: PF and Fibromyalgia or CFS....?

Carmel M on 8/05/01 at hrmin (055585)

I also have Fibromyalgia. I was diagnosed in 1998, but have had it for a lot longer than 3 years.

I looked up heel pain in a book about FMS and MPS (Myofascial Pain Syndrome) and what I found was this: 'Do your first steps in the morning feel as if you are walking on nails? This can also happen after a meal or at other times when you stand up after sitting for a while. In Travell and Simons' Trigger Point Manual, Volume II, this condition is listed as commonly occurring with flat feet, but it also occurs with cases of the wedge-shaped FMS/MPS foot, which is characterized by high arches as well. The condition occurs as the foot first flattens during the stride, due to the weight of body. When the plantar fascia (fascial tissue on the bottom of the feet) stretches more than it should, it starts to contract whenever you are off your feet for any length of time. It sometimes shortens to the point that walking can become very painful. This condition is usually caused by trigger points in the long flexor muscles of the toes. The trigger points are to be found in the calf area, not the foot itself. Morton's foot or any other foot deformity that causes hyperpronation can become perpetuation factors for these trigger points.'

I also wanted to let you know the definition of fibromyalgia as quoted from the book. 'A painful, but not articular (not present in the joints), condition predominantly involving muscles, and as the most common cause of chronic, widespread musculoskeletal pain. And some symptoms that are often overlooked...the presence of unexplained widespread pain or aching, presistent fatigue, generalized morning stiffness, non-refreshing sleep, and multiple tender points. Most patients with these symptoms have 11 or more tender points.'

I went in to see the doctor for chronic headaches and muscle pain and was sent to a specialist who checked me for tender points and I was diagnosed with FMS.

I don't know that I believe that plantar fasciitis is a problem related to FMS because I don't have 'trigger points' which are a symptom of Myofascial Pain Syndrome more than they are of FMS. I have the 'tender points' that are associated with Fibromyalgia Syndrome.

I hope this has helped...sorry to overload you with information, but when you said you had joint pain, I just wanted you to have some more information on Fibromyalgia because it's not associated with joint pain. The author of the book also has a web site. She is also a doctor! the address is http://www.sover.net/~devstar/

Take care,
Carmel

Re: PF and Fibromyalgia or CFS....?

Dr. Chris Reynolds on 8/06/01 at hrmin (055607)

I find your comments very interesting and will copy them to my archive on PF and auto-immunity. Fibromyalgia and CFS are conditions that are almost certainly related to altered immunity and many patients with auto-immune conditions develop plantar fasciitis. Although I tend to get laughed off this site every time I mention it by those who obviously know better, I firmly believe that PF has an auto-immune etiology, possibly in genetically predisposed individuals. In your case, I believe this is what we are dealing with. The following example, an anecdote I received from a young and previously very fit and healthy married male from the US, illustrates my point.

'It is interesting when the heel spurs/PF came into my life.
I was bird hunting in Tx. Several days later I had an allergic reaction
to something. I am not allergic to anything . (food,medicine
enviormental stimuli ) . After consulting an allergist here in Dallas ,
extensive blood work, and allergy tests, the results were negative blood
toxins ,and a slight raection to Ragweed. I did not buy the diagnosis,
and by the way it was very expensive. The reaction/hives lasted a week,
and it is impotant to note that on the 3rd/4th day I went to stand up
and collapsed , and the pain in my heels almost brought tears to my
eyes. You must understand that I have a high pain tolerance level but
have not seen anything like this before. The pain has been there going
on two years. My wife and I determined the reaction was to an insect
bite on my buttock. Dr. Reynolds I buy your theory on a autoimmune
response.'

The question remains, why is the heel so often the point of inflammatory predilection? But then, why the elbow in tennis elbow, why the thyroid gland in acute thyroiditis, why the anal fissure, why indeed the whole body in CFS? My point is that these and other conditions are all probably triggered by an auto-immune response and, for some as yet undiscovered reason, different individuals react differently. Quite likely in PF, the individuals who are overweight, who are on their feet all day etc. are unwittingly pre-disposing themselves to the condition. But then, what of the others who do not have these problems? Perhaps this is where the genetic predisposition becomes an important factor. My search of the literature does little to enlighten me on the circumstances surrounding PF sufferers e.g. psychological, physical and emotional stress, illness, allergic reactions etc. around the time of onset of their condition. And what is their family history? If it hasn't already been done, it would be an interesting study.

I have written a bit about auto-immunity and PF on my website at http://www.jadepage.com/pf.htm
I hope this has given you some food for thought.

Re: PF and Fibromyalgia or CFS....?

Terri B. on 8/06/01 at hrmin (055608)

I have an auto-immune disease AND Plantar Fasciitis. I DO believe that the two are related. Even my Podiatrist believes this. He has done a lot of research on my disease and has several patients with Auto-immune Diseases. It would be nice if someone could/would do extensive research and figure out why, where, when etc . . . : ) I'll pray for 'healthy feet', for us all.

Re: PF and Fibromyalgia or CFS....?

nancy s. on 8/06/01 at 07:50 (055610)

dr. reynolds, i agree with you and have thought for a long time that a possible auto-immune reaction should be looked into more thoroughly and studied. i've had pf and other foot tendonitises, now have 'frozen shoulder' that started out as rotator-cuff tendonitis in one shoulder, and have the same tendonitis coming on in the other shoulder. ten years ago i had what was originally thought to be carpal tunnel syndrome, but the end -- and kind of puzzled -- diagnosis was tendonitis in both hands and arms. i was three months in splints, day and night. past and recent blood tests turn up no other condition.
even here on heelspurs.com, how many posters are struggling with tendonitises or other inflammatory conditions elsewhere in their body? i've been here nearly two years and have seen _many_ posts from people with dual or multiple inflammations, sometimes simultaneously, sometimes not; often people casually mention that 'I had carpal tunnel three years ago' or 'i can't swim right now to help my pf because i have tendonitis in my elbow.'
alan k., who used to post here often and was also interested in and knowledgeable about the biomechanics of this condition, repeatedly expressed his interest in the fact that both he and his wife came down with some kind of flu or virus at the same time, and very shortly thereafter both of them developed pf. with all his biomechanical knowledge, he never stopped speculating about that extremely unlikely coincidence. at least one other person after that posted a similar event.
you should not be laughed off the board when you bring up the auto-immune reaction. far from it. i congratulate you for continuing to mention an area that needs a lot more research.
nancy

Re: PF and Fibromyalgia or CFS....?

Dr. Chris Reynolds on 8/06/01 at hrmin (055627)

Nancy, thank you for your support and your very interesting comments. I have already collected a fair bit of material on this subject and I will add your comments to my collection. One day I will collate it all and hopefully come up with a more convincing argument. Thanks again.

Re: PF and Fibromyalgia or CFS....?

Lisa S. on 8/06/01 at 14:36 (055652)

I have had sub-clinical hyperthyroidism since 1994. Is that considered an auto-immune condition? Last November I was diagnosed with heel spurs and plantar fasciitis. Are the two related?

Re: PF and Fibromyalgia or CFS....?

Olga C on 8/06/01 at hrmin (055669)

I too have been diagnosed with hyperthyroidism- Graves disease since May 01. I also have P.F. for 2 years. I too wonder about any possible link between the two. Olga c