Hidradenitis Suppurativa: A Disease Underdiagnosed and Undertreated
February 1, 2018
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Plantar Fasciitis, A Real Pain in the…Foot

by Larry Collins, PA-C, ATC

Do you ever notice that when you see a condition that you possibly haven’t seen in a while, all of a sudden it seems that everyone is presenting with it?  A few weeks ago I started having a dull ache in my foot, being a (somewhat retired) runner, I have experienced plantar fasciitis in the past, and I am acutely aware if it seems to be rearing its ugly head again. I am not running a great deal now, but the symptoms were unmistakable – pain (localized to the bottom of my foot) that occurs first thing in the morning and after sitting for a while when I get up to walk and point tenderness near the plantar fascia insertion on my calcaneus.

The next afternoon I get a call from my elderly mom “son, I have this stabbing pain in my heel every time I get up to walk”.  Within the next few days at least a half dozen patients (and one or two co-workers) also expressed symptoms consistent with plantar fasciitis! Coincidence?!?

Time to make certain I am still making the right recommendations.  Recall that the plantar fascia is a thick, fibrous structure that originates from the medial process on the plantar aspect of the calcaneus and extends distally, dividing into a section extending to each toe.

The pathophysiology of plantar fasciitis is poorly understood and may involve some component of degeneration and proliferative changes with or without inflammation. Symptoms usually include pain in the plantar region of the foot that is worse when first getting up to walk. It is probably one of the most common causes of foot pain in adults and it often occurs bilaterally.

Fortunately, plantar fasciitis usually resolves with conservative treatment (and often spontaneously), but unfortunately it often takes weeks or even months to completely resolve. There is no one proven treatment that is universally accepted to cure or shorten the course, but most experts agree that stretching the bottom of the foot and the Achilles, along with supportive shoe wear and avoidance of excessive activities will usually help shorten the course of symptoms.  Many also advocate dorsiflexion stretching of the great toe and rolling over a ball or frozen water bottle to help control symptoms.

Occasionally more aggressive interventions are required. Night splints are sometimes helpful as are corticosteroid injections. More invasive extracorporeal shock wave therapy, autologous whole blood or platelet-rich plasma injections are also being used with some limited success. My foot has stopped hurting and I hope that my mom’s will soon follow, although she says it still hurts when she first gets up in the morning.

See Larry Collins, PA-C, ATC speak in 2018 at a Skin, Bones, Hearts & Private Parts event in Destin, Orlando, or Pensacola Beach.

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