(The Trainer’s Room is a regular column at Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy, the pain and rehabilitation experts at the Mountain View Pain Center in Denver, CO.

All treatment options provided in this article should not be taken as specific advice, but rather as a general guide regarding what is typically done to treat the injury being described.

You should always consult your doctor before beginning any pain management or rehab program.)

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Plantar Fasciitis

After the recent foot injury suffered by Carlos Quentin, the White Sox’s left fielder, we have come to the topic of plantar fasciitis. Last year’s homerun leader for the White Sox was placed on the 15 day DL on May 29th for pain in the sole of the foot. Plantar fasciitis, one of the most common causes of heel pain, can keep a player sidelined for weeks, and if not properly treated will become a chronic issue. This injury is common in football, basketball, soccer, and running. This type of injury will inhibit a player’s ability to sprint.

Plantar Fasciitis Symptoms and Mechanism of Injury

Someone who suffers from plantar fasciitis usually experiences pain localized to the bottom of the foot on the inside of the heel. In an acute injury the patient may be unable to place weight on the foot due to the intense pain. With chronic plantar fasciitis the first few steps every morning will be painful, as well as any pushing off with the foot, including jumping.

Plantar Fasciitis Symptoms (image courtesy of Medline Plus)

The injury is usually a tear of the plantar fascia closest to the heel that causes an area of irritation or a lump to form on the inside of the heel. The plantar fascia is there to help attach the muscles to the bottom of the foot, provide protection to the plantar nerves and vessels, provide shock absorption, and create equal transmission to the biomechanical forces placed upon the foot. With an injury or inflammation to this area any movement that requires a push off of the toes will cause pain.

The injury itself comes from a muscular imbalance in the lower leg, ankle, and foot. The imbalance comes from a weak tibialis anterior (the muscle on the front of your shin) and plantar fascia, as well as a spastic or tight solues and gastrocnemius (the muscles of the calf). This imbalance causes increased tension on the Achilles tendon, which pulls on the plantar fascia causing the stretching and tearing of the muscle. As the micro tears set into the muscle, the pain will develop in the area. If the tears and chronic stretching of the plantar fascia are not treated then the area will become increasingly weakened. In many cases, an athlete will hear or feel a pop in the bottom of the foot followed by intense pain and swelling. This is from the tearing of the fascia.

Plantar Fasciitis Diagnosis

Here are some self tests you can do to determine if you might have plantar fasciitis:

1. Pain on the inside (medial) portion of the calcaneus.
2. Pain during the first few steps in the morning.
3. Localized swelling on the bottom of the foot, or along the plantar fascia.
4. Standing on the toes causes either a band like pain on the bottom of the foot, or increases the pain symptoms near the calcaneus.
5. Pain on the bottom of the foot when pushing of with the toe. Ex. sprinting or jumping

If you are experiencing one or more of these symptoms, it is a good indication that you might have plantar fasciitis. In order to prevent further injury and pain, this would be a good time to consult your physician and discuss your potential plantar fasciitis diagnosis.

Your doctor may take is an X-ray to rule out any underlying fracture, dislocation, or other abnormality. In about 50% of cases where there is a plantar fasciitis diagnosis, a heel spur can be seen on the X-ray. The spur is the body’s way of trying to protect itself. Over time with the chronic strain and stress on the area the body will begin to lay down calcium in the area for stabilization. Once the spur forms it is common to have pain directly over that area.

Plantar Fasciitis Treatment

The most commonly misapplied treatment of plantar fasciitis is to stretch and massage the area. As mentioned above the plantar fascia is already stretched and torn, which causes the pain.

Treatment for Plantar Fasciitis (image courtesy of Spectrum Wellness)

Common sense would tell us that if the fascia is already stretched and torn, that further stretching the area as part of a plantar fasciitis treatment plan would in fact cause more damage than good. When the injury first occurs, applying pressure to the area may actually cause some relief. The reason for this is the pressure on the inflamed, injured area will release endorphins, the body’s natural pain killers. The down side to the unfortunately common plantar fasciitis treatment approach of stretching and massaging is further damage to the injury and a higher probability of recurrent injuries. The stretched fascia is already depleted in oxygen. The increased pressure will further deprive the injured area of essential oxygen.

Plantar fasciitis responds very well to conservative care. If you notice any of these symptoms the best thing you can do is get plantar fasciitis treatment quickly. This condition can easily be resolved with the appropriate care. Many with plantar fasciitis think that they have to live with it, or they are one of the few that plantar fasciitis treatment will not help. This is simply not true. If you get on top of your plantar fasciitis treatment quickly, the pain will generally subside, and the incidence of chronic problems will greatly decrease.

There are several successful treatments for plantar fasciitis. We will now describe the treatments we have success with at Mountain View Pain Center.

Treatment for Plantar Fasciitis

First and foremost, after the initial injury you must get ice on the area immediately. If you wait and try to “walk it off”, the foot will swell and become increasingly tender over the next few days, making even the simple task of walking a real problem. After you have followed the steps of PRICE (protection, rest, ice, compression, elevation), get yourself to someone who deals with sports injuries for treatment. Making a trip to the emergency room for this will be an unnecessary and expensive trip. The treatment you receive there will be some sort of pain killer or shot to reduce the pain and swelling, then a referral to either a chiropractor, therapist, or sports medicine doctor.

At Mountain View Pain Center, when a patient first arrives with an acute injury of plantar fasciitis, we apply a therapy called Hi-volt to reduce pain and swelling to the area, and also wrap the foot with an ice pack during the therapy. The next step we take is to apply a taping method called Kinesio-tape across the bottom of the foot. This method we have found to be a integral part of our treatment program. As local doctors we have the opportunity to work with several sports teams and high school programs. When a player goes down from this injury we immediately apply the tape to the area not only for support to shorten the stretched and torn muscle, but to also pump out the edema and in turn decrease pain and increase plantar fasciitis recovery time.

Plantar Fasciitis Treatment (Image courtesy of Mountain View Pain Center – Denver)

We instruct the patient to leave the tape on for 2-3 days to continue the support and reduction of edema while the patient is at home. This tape can get wet, so the patient can still shower or even apply topical ointment over the tape to help with some of the pain.

At Mountain View Pain Center we have found that within a few weeks the patient will be out of pain and can begin the rehabilitation portion of the plantar fasciitis treatment. As we have stated before, the main cause of plantar fasciitis is from a muscle imbalance in the lower leg. Stretching is still important. However, remember not to stretch what is already stretched.

Part of the imbalance is usually a tight gastrocnemius, so we stretch the calf and Achilles tendon. If you stretch the calf only then the real problem still may not be addressed and a re-occurrence of the plantar fasciitis will occur. You must also address the muscle weakness to correct the problem. You can do this by performing simple toe raises while sitting at your desk at work or while watching TV. Toe raises are not the same as calf raises. This does not mean standing on your toes. You keep your heels on the ground and raise the balls of your feet and your toes off the ground.

If there is a heel spur seen on X-ray, then we can apply some ultrasound to the area to break up some of the calcification. For our athletes who continue to train during treatment for plantar fasciitis, or who have some chronic bouts of plantar fasciitis, we apply the tape to support the area during their events.

Many athletes opt for a quick pain relief and go for a corticosteroid shot in the bottom of the foot. You must be careful here as getting the shot will decrease pain temporarily, but it does not repair the torn tissue or fix the problem. The pain you are feeling is your body’s defense mechanism to protect you from further injuring yourself. If you cannot feel the pain and go out running then you risk damaging the area further. Research has shown that repeated corticosteroid shots actually weaken tendons, damage nerves, and decrease the bone density to the area, which is recipe for disaster.

Supplements as Part of Plantar Fasciitis Recovery and Treatment

• Inflammatone is a specific supplement that contains ginger, bosweilla, and other natural herbs that helps to decrease swelling and pain.
• Vitamin C has been shown to help improve the healing process and decrease scar tissue formation.
• Magnesium is another important supplement for plantar fasciitis as the magnesium helps absorb the calcium into the body and decrease the deposits into the heel(and elsewhere).

If you are interested in any of these supplements, please visit our website. Note: we are still updating the website, so the supplements may not be available immediately. If this is case, find our email address below or leave a comment and we’ll let you know how to get them.

This article contains the opinions and examples of treatment plans for plantar fasciitis from Mountain View Pain Center in Denver, CO, and is not intended as a substitute for specific medical advice from a doctor regarding your individual injury or condition. If you have any further questions or concerns feel free to contact our office or leave a comment below.

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The Trainer’s Room is written exclusively for Midwest Sports Fans by Denver chiropractors Dr. Niall McNally and Dr. Ihsan Erhuy of the Mountain View Pain Center in Denver, CO. You can contact them by leaving a comment below or sending an email to info@mountainviewpaincenter.com.

Dr. Niall McNally is certified in chiropractic neurology and has a strong background in sports injuries and in the rehabilitation of common nagging athletic problems. Dr. McNally also is trained in pediatrics, orthopedics, and nutrition.

He graduated from the University of Central Oklahoma and successfully completed his Doctor of Chiropractic degree at the Parker College of Chiropractic in Dallas, TX. A very active athlete, Dr. McNally played hockey up into the junior level. In fact, it was his love for hockey, and the Colorado Avalanche, that originally gave him the idea to one day practice sports medicine and chiropractics in the area.

Dr. Ihsan Erhuy specializes in motor vehicle accident injures, back, neck, and extremity problems, as well as treating pregnant patients and children. He is certified in the Diversified, Gonstead, Thompson, Upper Cervical, Activator, Sacral Occipital, Applied Kinesiology, Soft Tissue techniques.

Originally from Adana, Turkey, Dr. Erhuy graduated from the University of Arizona and also susuccessfully completed his Doctor of Chiropractic degree, along with his bachelor of science in health and wellness, at the Parker College of Chiropractic in Dallas, TX.