A patient recently came in with pain on the bottom of her right foot. The pain started several days after a night of dancing. She was not doing anything crazy, simply dancing for a few hours with frequent breaks standing at a table.
The pain continued to increase over the next week. It was becoming sharper and stabbing in the morning. At first the pain would last a few steps, and by the end of the week it was lasting for 10-12 steps. It would also occur whenever she sat for longer than an hour. A quick internet search listed several conditions with sharp pain. She was pretty sure she didn't have a stress fracture, and the pain was in the wrong place for sesamoiditis. It was doubtful she ruptured a tendon, but how could she be sure. The most likely diagnosis was called plantar fasciitis.
Plantar Fasciitis was described as a sharp and stabbing pain first thing in the morning. It could occur in the middle of the foot or by the heel. The pain could be a severe, stabbing, ice pick pain that decreases in intensity after walking. The pain always happens in the same place. The article mentioned that it was more common in people who participate in running, jumping or pounding sports. However it does happen in people who stand throughout the day.
She was correct in her diagnosis. She had aggravated the plantar fascia at the calcaneus (heel bone). It was very tender to the touch and a little swollen. It hurt to stretch her foot or walk barefoot.
She was amazed that she could develop plantar fasciitis from dancing. Dancing might have been the final aggravation to her plantar fascia but it was not the entire cause of her injury. Although the recent dancing may have been a little more impactful than she was used to, some injuries occur with time and repetition. During the conversation she remembered being more active the last few months. She was probably walking and standing more than she had in the previous few months.
We have all spent many hours on our feet standing, walking, or running. Every step has provided impact and small traumas to the bottom of the foot. Over time these small micro traumas accumulate and can lead to larger injuries.
Sometimes it is as subtle was walking two miles further a day in worn out shoes. The shoes are not providing cushioning as they did when they were new. That extra force is being absorbed by the plantar fascia in the foot.
The patient was given recommendations to start icing as much as possible; placing an ice pack under her foot for 15 minutes, then removing the ice for 15 minutes. She was told to repeat this process as many times as possible during the day. People who ice three times a day get better. People who ice five times a day get better even faster, and people who ice 10 times a day get better the fastest.
We discussed looking at her shoes and seeing if any are worn out. We talked about the possibility of shoe inserts or orthotics if she didn't see improvement. Mild cases of plantar fasciitis can be treated at home with rest, ice, modified footwear, and shoe inserts.
Moderate and severe cases usually require active treatment in an office. Physical therapy utilizes techniques to decrease pain and inflammation. Many people require exercises to increase foot arch strength. Stretching is beneficial to decrease calf and hamstring spasms that may be contributing to walking with a harder foot strike. People with back problems often have an altered walking gait, which changes how the heel strikes the ground. We often use Graston Technique on plantar fasciitis to decrease the scar tissue that has accumulated with years of wear and tear. Cold Laser also increases blood flow and healing of the plantar fascia.
There are many treatment options for people suffering from plantar fasciitis. More information on plantar fasciitis and treatment can be found at Plantar Fasciitis Treatment , Graston Technique , Cold Laser pages .