Patient: 24 year old female college student complaining of bilateral sharp, stabbing foot pain increasing in severity in the last three weeks. The patient recently took a trip to Paris where she walked the city for one week. Upon her return, she began experiencing occasional sharp pain on the soles of her feet. The symptoms have progressed in intensity and frequency. She currently has the most severe symptoms upon waking, and in the shower in the morning. The pain is severe enough that it causes her to “try to walk without putting my feet on the ground”. Relief position is lying on her back with a pillow under her Achilles tendons, allowing her feet to hang in plantar flexion.
Examination: Plantar fascia of both feet is tight and very tender to the touch. Tight and tender bilateral calf muscles (gastrocnemius and soleus). Tender calcaneous on lateral margins. No significant tenderness at the medial tubercle of the calcaneous. Joint dysfunction of the metatarsophalangeal joints and the calcaenocuneiform joints. The tibialis anterior was weak bilaterally. Orthopedic testing for a sprain or strain, nerve irritation or circulatory problem was negative. Muscle testing of the calf was within normal limits.
Discussion: This case is a fairly common presentation for plantar fasciitis. The patient is female, relatively inactive and recently had and increase in physical activity. In addition, she has weak tibilalis anterior muscles and tight calf muscles. The action of the tibialis anterior is to bring the foot up to a 90 degree angle, allowing us to walk without our toes dragging on the ground. The calf muscles do to opposite, helping to point the toes. It is important that these muscles have equal strength and pull on the ankle. If, as in this case, they are unbalanced, joints are unstable and problems ensue.
In plantar fasciitis, the calf muscles pull on the Achilles tendon, which pulls across the calcaneous on the plantar fascia. The fascia becomes very tight, pulling the ball of the foot closer to the heel. When this tight fascia is suddenly stretched, as in the case of our patient standing in the concave basin of her shower, the patient experiences a sharp pain.
Outcome: In a case of acute plantar fasciitis, the key is to remove the tension on the plantar fascia and then focus on correcting the imbalance. In this case, the patient wore a small heel lift which slackened the fascia. During her treatment, she received massage on the tight fascia and calf muscles, as well as adjusting to ensure proper motion of the feet and knees. At home, she was trained to stretch the calves and strengthen the tibialis anterior muscles. In chronic cases of plantar fasciitis, recovery is a longer process and may even require specialized footwear or custom orthotics. Night splints are also a common treatment method.
For more in-depth information into plantar fasciitis, especially in athletes, visit www.coachr.org/planfasc.htm. This is an article written by a chiropractor who is also a track coach. He goes into much more depth on all the complicated factors that predispose someone to plantar fasciitis.
Suggestion: Ice bottle
During a flare-up of plantar fasciitis, or any time your feet have been over-worked, try using an ice bottle to reduce pain and inflammation. Keep a plastic water bottle (like Arrowhead or Evian) in the freezer. When you foot is bothering you, place the bottle on the floor and roll your foot on the bottle. The ice will help decrease pain and inflammation, and the pressure of your foot on the bottle will help to stretch tight tissues. Just remember that water expands as it freezes, so make sure there is some extra room in the top of your water bottle before you freeze it.
Exercise: Calf and toe stretches
One of the best ways to prevent plantar fasciitis is to maintain muscle balance across the ankle. Try adding stretching of the calves and toe flexors to your daily routine. For the calves, stand in a lunge with your hands bracing you on the wall. The back leg calf is being stretched. Now bend the back knee to bring the stretch down toward the ankle. For the toes, sit and hold your foot in your lap. Pull the toes back in a gentle stretch. Hold each of these positions for 10 seconds on each leg for a great stretching series.