The Plantar Fasciitis Book

The Plantar Fasciitis Book

Dr. Donald Pelto

Copyright © 2019 Donald Pelto

All rights reserved.  No part of this book shall be reproduced or transmitted in any form or by any means, electronic, mechanical, magnetic, photographic, including photocopying, recording or by any information storage and retrieval system, without prior written permission of the publisher.  No patent is assumed with respect to the use of the information contained herein.  Although every precaution has been taken in the preparation of this book, the publisher and author assume no responsibility for errors or omissions.  Neither is any liability assumed for damages resulting from the use of the information contained herein.

Requests for permission to make copies of any part of the work should be mailed to: Permissions, Donald E. Pelto, DPM, Central Massachusetts Podiatry, 299 Lincoln Street, Suite 202, Worcester, MA 01605, USA.


Introduction

Thank you for your interest in the “The Plantar Fasciitis Book”  This book is intended to help provide further education to you about plantar fasciitis.  

By no means do we believe that this book takes the place of visiting the office; however, it can be used as a good reference source for information about treatments than can begin at home and what treatments are used in the office setting.  

This book is set up with different sections and online resources and videos that can be helpful to your recovery from plantar fasciitis. You can view each of these resources  by clicking the accompanying link.  These are the same resources that I give to my patients in the office.  If you are a visual learner, I would recommend starting by watching this video explanation of plantar fasciitis.  This will help you better understand this book.  The video is 27 minutes long.  Click HERE to watch the video.

 

To your health,

Dr. Donald Pelto


Introduction        2

Plantar Fasciitis        4

What is Plantar Fasciitis        4

Symptoms of Plantar Fasciitis        4

The Plantar Fasciitis Score CardⓇ        4

Causes of Plantar Fasciitis        5

Diagnosis        6

Plantar Fasciitis Treatment Evaluator®        8

Treatment Categories        9

Reduce Inflammation        10

Reduce Tightness        14

Stabilizing Foot & Reduce Pressure        19

Surgical Options        24

Preventing Plantar Fasciitis        25

Video Explanation        25

Plantar Fasciitis Treatment Checklist        26

Frequently Asked Questions        26

Additional Resources        27


Plantar Fasciitis

What is Plantar Fasciitis

Heel pain is most often caused by a problem called plantar fasciitis.  This can also be termed heel spur syndrome, where a spur is present on x-ray evaluation.  Heel pain can also be due to other causes such as a stress fracture, tendonitis, arthritis, nerve irritation or even a bone cyst.  Since there are many probable causes, it is essential to have the heel pain properly diagnosed.  

Symptoms of Plantar Fasciitis

The most common symptoms of plantar fasciitis are:

People with plantar fasciitis often describe the pain as severe upon rising in the morning and then improving as they become more active during the day.  After they sit down and relax, their pain is lessened until they begin moving again.  After walking for a few minutes, the pain decreases because they are stretching the plantar fascia.  For other people the pain is worse when they are on their feet for long periods of time.

The Plantar Fasciitis Score CardⓇ

To help you better understand your symptoms I have put together a Plantar Fasciitis Score CardⓇ.  To use this scorecard read each of the items on the column on the left and rank your symptoms and give it a score.  Add the scores you have on the right column and read the information below.  

Scoring System

0-24 - You probably don’t have a problem with plantar fasciitis at this time but you may have had a problem in the past.  You don’t need any treatment but would benefit from wearing supportive shoes as well foam rolling on your own.  

25-48 - You have mild symptoms of plantar fasciitis.  You may be able to treat this on your own with some of the home therapies or treatments recommended below.  If the pain becomes worse or more bothersome you should probably get help from a podiatrist to help with this condition.

49-72 - You have severe symptoms and are probably already getting treatment. If you are not receiving treatment you would benefit from treatment to help resolve your symptoms more quickly.  The information below will help you start your own treatment before seeking professional advice.  

73-96 - You have very severe plantar fasciitis and you need help urgently. You may have other conditions along with plantar fasciitis as well and should be seeking out help from a professional.  You may be a candidate for advanced treatments or surgery.

Causes of Plantar Fasciitis

The most common cause of plantar fasciitis is too much motion in your foot causing excess pulling on the plantar fascia.  The plantar fascia is a ligament-like structure that courses from the heel to the ball of your foot.  When your foot has too much motion there is excess pull on the plantar fascia causing it to become inflamed.  Feet that are overly flat (pronated) or have too much of an arch are more likely to develop plantar fasciitis.

Also, an overly tight Achilles tendon (equinus) in the back of your leg will cause excess tightness on the structures on the bottom of the foot.  If you imagine two ropes pulling on the heel bone, the bottom one is the plantar fascia and the top one is the Achilles tendon.  If the Achilles is pulling up, the plantar fascia will naturally become tighter making it more prone to injury.

Wearing non-supportive footwear on hard, flat surfaces puts an abnormal amount of strain on the plantar fascia and can also lead to plantar fasciitis.  This is especially true for those that wear flip-flops over extended periods of time and for those who have a job that requires long hours on their feet.  Obesity can also contribute to plantar fasciitis.

Diagnosis

To properly evaluate heel pain, a complete medical history and examination of your foot and lower extremity mechanics is necessary.  This will require an evaluation of your walking (gait) and possible video or photography of your feet.  By doing this we are able to rule out all other possible causes of plantar fasciitis.

Also, diagnostic imaging such as x-ray, ultrasound, bone scan, and magnetic resonance imaging (MRI) may be used to distinguish among different types of heel pain.  Sometimes x-rays can reveal heel spurs with people with plantar fasciitis; however, these are rarely a source of pain.  

Image 1 - X-ray of heel spur

Image 2 - Ultrasound of plantar fascia showing thickness increased on the left side

Image 3 - MRI of plantar fascia showing thickening and inflammation

Plantar Fasciitis Treatment Evaluator®

Here is the Plantar Fasciitis Treatment Evaluator® I put together that evaluates the different treatments based on the type of treatment (Reducing Inflammation, Reducing Tightness, Stabilizing Foot and Reducing Pressure) and effectiveness of treatment.  This is essential because many people who read about different treatments think that all have  a similar effectiveness, which is incorrect.  

Obviously, icing is not as effective as a cortisone injection yet they both work at reducing inflammation.  Similarly, supportive shoes is not as effective as a custom orthotics at stabilizing your foot.  However, when wading through the material presented either online or by your physician you  have difficulty determining what treatment to try first.  

I hope you find the Plantar Fasciitis Treatment Evaluator® helpful in determining the best type of treatment for your plantar fascial pain.  The following resources are in order of effectiveness based on the table below.

Plantar Fasciitis Treatment Evaluator®

Effectiveness Scale

(5 is most effective)

Reduce Inflammation

Reduce Tightness

Stabilize Foot and Reduce Pressure

5 - Most Effective

Cortisone Injection

Physical Therapy

Custom Orthotics

4

Shockwave Therapy

Walking Boot

4

Amniotic Membrane Therapy

3 - Moderately Effective

Steroid Anti-Inflammatory Medications (Prednisone)

Home Therapy (Foam Rolling, Stick and TP Tools)

Over-the-counter Arch Support

3

Oral Non-Steroidal Anti-Inflammatory Medications (Motrin, Ibuprofen)

Supportive Shoes

3

Strapping of Foot

2

Icing and Contrast Baths

Stretching

Padding

2

Platelet Rich Plasma

Night Splint

Compression Sleeves

2

Strassburg Sock

1 - Least Effective

Topical Pain Reduction Creams (Voltaren)

Losing Weight

Treatment Categories

There are numerous treatment options for plantar fasciitis.  These are divided into different categories based on the purpose of the treatment.  There are 3 purposes of treatment.

  1. Reducing Inflammation - These treatments focus on reducing the inflammation that is the main reason for the pain you are feeling.  If you do not reduce the inflammation you may continue to limp and walk differently which can cause pain to other parts of your foot or your body.
  2. Reducing Tightness - This is focusing on reducing tightness of the fascia on the bottom of the foot but more importantly reducing tightness to the muscles that are on the back of your leg that insert either in the heel region or in the foot.  This is the most misunderstood reason for plantar fasciitis.  
  3. Stabilizing Foot & Reducing Pressure - Stabilizing the foot is essential to allow your foot to work better.  If you have a foot that is flat or pronated it becomes unstable.  As a result, the muscles in the foot and the back of the leg region have to work harder.  The more stable your foot becomes the less work you have to put into walking and being active.  Reducing pressure is the least important aspect of treatment in my opinion.  If you have plantar fasciitis in only one foot and they both have the same pressure on them, why don’t they both hurt the same?  Reducing the pressure can help initially but only if there is inflammation (as mentioned in item number one) but once the inflammation is improved there is less of a need to reduce pressure on the heel region.     

After each treatment you will find an explanation of the treatment as well as the “Pros” and “Cons” of each, to help you better decide what is the best for you.

Reduce Inflammation

 

 

 

 

Reduce Tightness

Click HERE to see a video to teach you how to use the trigger point tools.

Click HERE to see Trigger Point Tools on Amazon.com.  


Click
HERE to see a video to teach you how to Foam Roll properly.

Click HERE to purchase a Foam Roller.


Click
HERE to see a video to teach you how to use a Stick Roller properly.

Click HERE to see the Trigger Point Stick on Amazon.com.

Stabilizing Foot & Reduce Pressure

 


 

 

Surgical Options

Although most patients with plantar fasciitis respond well to non-surgical treatments, a small percentage of patients may require more advanced or surgical treatments.  If after many months of conservative treatment you continue to have pain, these are other options that can be considered:

Preventing Plantar Fasciitis

No matter what type of treatment is used to treat plantar fasciitis, the underlying causes that led to this condition may remain.  Therefore, you will need to continue with preventative measures such as soft tissue works to the back of the calf region, supportive shoes and custom orthotic devices for long-term treatment for plantar fasciitis.  Recurrence is common especially when using cortisone injections if no other treatment is done.  The cortisone injection can reduce the inflammation temporarily but if no other treatment is used the inflammation can quickly return.  

Video Explanation

Here is an overview video that is recorded about plantar fasciitis.  This video will go over the same treatment options as in this book in an organized format.  The video is 27 minutes long.  Click HERE to watch the video.

 

Online Product Recommendations - Amazon

Here is a list of products that I recommend for my patients if they have plantar fasciitis.  You may be unable to come to the office but you will find on this recommendation page the most up to date treatment options for treating your own plantar fasciitis.  Click HERE to see the recommendations.  

Plantar Fasciitis Treatment Checklist

Here is a checklist you can use with your doctor to go over the different treatment options for treating your plantar fasciitis.

Frequently Asked Questions

Q:  Do I need orthotics to get rid of plantar fasciitis?
A:  Each patient is different and even though the pain may subside, the mechanical instability and excess movement of the foot that caused the problem still need to be addressed.  Using supportive shoes and orthotics are very effective at controlling foot motion.

Q:  Will I need surgery for plantar fasciitis?
A:  Most of our patients DO NOT advance to surgery due to plantar fasciitis.  However, if you have been treated for six months to a year, then some surgical options may be considered.

Q:  When should I seek treatment for plantar fasciitis?
A:  Since there are so many home treatment options to try, that is a good place to start.  However, keep in mind that seeing a doctor can help you get better faster than on your own.  If you have it for over a month and it is not improving with the home treatments, it is best to make an appointment.

Q: How do I reduce the pain I have in the morning when getting up?
A: The best way to reduce the pain in the morning when getting up is to either sleep with a night splint on your leg or stretch with a towel for a few minutes before getting up out of bed.  Finally, you can put on a shoe or a sandal first thing out of bed to reduce the pain when getting out of bed.  

Additional Resources

Here are some other resources that are credible and helpful when treatment plantar fascial pain.  

By Dr. Donald Pelto |centralmasspodiatry.com