Last summer, I injured my right foot and developed plantarfacsiopathy or more commonly called plantarfasciitis.

By the end of October, many of my symptoms had resolved. I even went on a vacation to Disneyworld and walked and walked and walked with little to no difficulty. I could exercise without difficulty.

So, I was feeling optimistic about things.

But in November, as I gradually increased my exercise loads, in teenytiny amounts, my foot rebelled leaving me with a limping gait, a dread of going to sleep, and a serious dose of Doubt.

General consensus is that plantarfasciopathy gets better, almost regardless of what you do, over a 2 year period (many people feel better within 9 months).

Two years is a long time to not be quite “right”. And since I had seen substantial progress but could not tolerate increases in load, I realized that to resolve this meant doing something different than what I was doing.

And the first step was to get some help.

What to Do?

After my first post about the injury, I received a lot of advice about what I should do:

• stretch the heel cord
• stretch the hamstring
• roll my foot on a tennis ball
• strap the foot with duct tape
• acupuncture
• osteopathic adjustments
• shockwave therapy
• ice
• heat
• various forms of massage and manual therapy
• strengthen my hip on the opposite side
• buy new shoes
• don’t wear shoes

…among other things.

The people who were kind enough to share their ideas did so because what they shared had worked for them. How is that possible? How could it be that so many things in this list, some of which contradict each other, apparently heal or at least resolve the symptoms, of plantarfasciopathy?

The reason is that pain is a symptom; not a problem. You can have heel pain or pain in the bottom of your foot from:

• trigger points in the foot muscles
• ligament sprain – low to moderate grade
• ligament sprain – moderate to severe grade
• calcaneal bursitis
• posterior tibial tendonitis / tendonosis
• fracture / stress fracture / stress reaction
• referred pain from the calf
• referred pain from the hamstring / trigger points
• referred pain from the lumbar spine

Your body has no rule about having only 1 condition. I’ve seen clients with trigger points in the foot and calf along with tendonosis, for example. This combination of conditions is what makes diagnosis and subsequently treatment so challenging.

For example, if you have trigger points, then things like massage, pressure, stretching will help but if you have a ligament tear, none of that will help much.

In my case, I contacted Brad Fullerton, MD whom I had seen for other soft tissue injuries. In this case, I wanted to know if I had torn the ligament (technically, a sprain is a tear but most people think of a tear as in the kind where the ligament comes apart).

My guess was that I had torn it based on how my foot had been reacting. I knew I had trigger points in the foot and calf but treating those didn’t change my function much.

During my appointment, Dr. Fullerton used ultrasound to image my foot. The benefit of the ultrasound is that you can see how your tissue responds to various pressures. When you push on torn tissue, it produces a certain kind of image and motion that intact tissue does not.

Well, the ligament was torn. A nice, big tear.  The defect wasn’t an end-to-end tear. It looked as if someone had taken the bottom of the ligament and then pulled it apart from top to bottom like shredding corn beef.

What I Did

After I saw the size of the tear on the ultrasound, I knew I had one viable option: platelet rich plasma injections (PRP). I scheduled the injections for January 17, 2014.

Following the injections, I wore a walking boot – which is closer to a cast than it is a boot – and used crutches for the first three days. The new cells are fragile so too much force and activity can disrupt the healing process which is why I used both the boot and crutches.

After three days, I then wore the boot for another three weeks.

At the end of three weeks, I started gradually weaning myself off the boot and wore a pair of CROCS whenever I wasn’t in the boot.

For my rehab, I used my Total Trainer so I could perform sub-gravity exercise (exercise with less than full body weight).

This allowed me to perform squats, heel raises, single leg squats, and eventually hops. I could gradually increase the load until I reached gravity level forces (full body weight) and then eventually progress to super-gravity (above body weight). I also used walking as part of the program starting out with 20 minutes and working my way up to 60 minutes of walking. We had adopted a 3 month old puppy right around the time of the injections so walking was a must – crutches included.

My foot hurt for about six weeks and I had a couple of episodes where the symptoms returned in full force. We call this the “prolocoaster” – the phenomenon of symptoms coming back intermittently over many months. It can be very confusing to suddenly hurt all over again. You start thinking that you somehow re-injured something but rarely is that the case.

Around the two month mark, I noticed that the original symptoms were mostly gone. Walking felt reasonably good although walking barefoot was not yet comfortable.

On April 17, 2014 I had a follow up visit with Dr. Fullerton and repeated the ultrasound. The ligament had healed about 80%. There were still some small areas of the ligament that appeared torn on the ultrasound but the magnitude of the original tear was much, much less.

I can now run short intervals, do all the exercise routines I normally do, walk barefoot, and have had no return of the original symptoms. The ligament will continue to heal over the next 12-16 months so I still have to be smart about the progression of load and volume of activity.

Summary

The term “plantarfasciitis” is a general term for pain in the heel and bottom of the foot. The pain can come from something as mild as a trigger point in the muscle(s) or, as in my case, a torn ligament.

One of the reasons that people struggle with this condition for so long, is that they treat it without knowing whether they’ve torn the tissue. If the tissue is torn, it will take a very long time to heal on it’s own unless you reduce the force on the foot (and even then, it’s a long time). This means using crutches, wearing supportive and force absorbing shoes, and avoiding aggravating the injury for many months. Most people can’t manage to stay on crutches that long or refuse to use them. The result is a chronic pain in the foot and a nearly endless chase to do something about the symptoms.

The combination of the PRP injections with the sub-gravity exercise was very effective in my case and has also worked for a number of clients I’ve worked with.

If you or someone you know is struggling with plantarfasciitis, consider having your foot assessed with ultrasound imaging by a practitioner who is skilled in the technique. Once you know if your ligament is torn or not, you can then get on the best path for healing the injury.