Plantar Fasciitis

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I'm pretty sure that I have either plantar fasciitis or achilles tendonitis. My first step in the morning is painful with the pain reducing thereafter, which I know is a classic PF symptom. However, the pain is in my heel - in the area just "up" from the bottom of my foot. It can be on either side of my heel but definitely not on the bottom.

I exercise regularly, but haven't significantly increased my workouts and I'm not doing anything crazy. I play tennis once or twice a week. Similarly once or twice a week, I'll run on a treadmill at the gym for two miles. Other days, I'll use the bike or eliptical machine (today, for instance, I did one mile in 8:00 followed by 30 minutes on a recumbant bike). Once or twice a week, I do weights, half of the time focusing on lower body (squats, lunges, toe lifts, reverse toe lifts seem the most relevant to this question).

How do I determine which issue it is? For the PF, I know that I want to stretch the plantar fascia, calf, and achilles if it's PF. But if it's AT, I want to allow the achilles to rest and repair itself.

Thoughts?

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It's hard to say, I'm not a doctor. My doctor told me that I have more than one related condition. If exercise is aggrivating it, a doctor will tell you to rest it for awhile. I would find a good orthopedic surgeon and get an opinion. They can also start you on some exercises and supports to help with your condition. Don't let it wait too long or the symptoms could get worse and start involving your knees.
In all honesty it's probalby both. but your calf muscles definitely involved. Stretching isn't enough. You must use some form of neuro-muscular re-education to re-train the muscle to the longer length. Night splints and arch supports help, but the biggest issue is typically ankle mobility and mechanics. Get that taken care of and your pain will go away.
the achille tendon attaches to both gastrocnemius and soleus. if you have baby tears in the achilles, it needs to heal. The probelm is, it also needs to be looser. You cannot stretch a tendon by any appreciable amount. What gets stretched is the muscles that attach to the tendon. You do this by using MET. (Muscle Energy Technique) The other thing that needs to happen is that any trigger points of adhesions in your entire lower leg need to come out. Both will artifically shorten the muscle putting extra strain on the tendon.

Here are the instuctions for MET to Gastrocnemius and Soleus.
Soleus
~ Sit in a chair or on the couch with your leg bent, and a long strap ( 5 feet or so) of NON-STRETCHY material. An old tie will work fine.
~ Holding both ends, run the strap across the bottom of your foot at the ball.
~ using the strap, pull upward, to give some stretch to the calf.
~ breathe in and hold your breath
~ GENLTY push down (10% strength) with the ball of the foot. hold the strap tight enough that the foot doesn't actually move.
~ Hold for 7-10 seconds
~ Release the breath and the muscle, and GENTLY pull up a little further on the strap.
~ Repeat 3 times.
~ Gently plantarflex and dorsiflex the foot, (move it all the way pointed and all the way up, like you're workng a gas pedal) (no strap) 4-5 times.

Gastrocnemius.
~ Sit in a chair or on the couch with your leg straight, and a strap of NON-STRETCHY material. An old tie will work fine.
~ holding both ends, run the strap across the bottom of your foot at the ball.
~ breathe in and hold your breath
~ GENLTY push down (10% strength) with the ball of the foot. hold the strap tight enough that the foot doesn't actually move.
~ Hold for 7-10 seconds
~ Release the breath and the muscle, and GENTLY pull up a little further on the strap.
~ Repeat 3 times.
~ Gently plantarflex and dorsiflex the foot, (no strap) 4-5 times.

use MET 2x day. I would not do full load bnearing exercise until the pain has eased up considerably. Then, I'd gradually work my way back up. Whatever you do, do not neglect your stretching!
Sounds similar to my pain. I was running hills to get in shape for a Fall Lacrosse league when I developed the pain in my foot. I have a friend who blew out his achilles playing soccer and spent 6 weeks in a hard cast so I was concerned about possibly doing serious damage to my foot. So I went to see a podiatrist. He said it was PF.

My podiatrist didn't seem concerned about long term issues and when I said I really wanted to play in the Fall league, he said to go ahead and play. He gave me a steroid shot, inserts for my shoes and taped my foot.

I played the first game, even though I had pain. Near the end of the game when I pushed off hard on my hurt foot I felt a stabbing, burning pain --- ouch. I had to stop playing. I could hardly put any weight on it and could barely walk the next morning.

I went back to the podiatrist since it felt like I did sometime acute. He said that while I had plantar fasciitis (sore plantar fascia) when I first came in, I likely torn it when I felt the burning shot of pain. Interestingly one way to treat PF is to surgically cut the tendon. Evidently you don't need it to function properly.

He suggested that I give my foot 3 to 4 weeks to rest. I am wondering if I should heed my doctors recommendation and rest my, or go ahead and play the last 4 Fall League lacrosse. If the only issue is short term pain, I will go ahead and play. Want I don't want to do is to creat a long term issue.

Have you been seen by a doctor?
I had a similar problem. It turns out I over-stretched my achilles tendon. My doctor told me to take care of the achilles tendon first. I stopped stretching, am wearing Dansko's open-backed shoes and they are great. My heel feels much better and the PF is finally starting to heal also.
Thru x rays and an mri, it was determined that I have P.F. and A.T. I got a cortisone shot because the inserts did not help. There is no improvement yet, but I am told it will take time. I bought a night splint today and am going to try it tonite. My Dr. did say NO running or treadmill anymore. (or step aerobics). I can use the eliptical tho. Hope this helps. Pls be careful!
The location is the main way of determining which one it is.

Achilles tendonitis generally occurs ABOVE the calcaneus. (Heel bone) If there is a thickening (compare to other leg) in the Achilles tendon itself then it is absolutely Achilles Tendonitis (Or a tear...)

Plantar Fasciitis can cause pain in a specific spot on the bottom of the foot typically just in front of the Calcaneus. But the inflammation that results can produce sypmtoms over a wider area. Wikipedia has a good picture of this.

Sometimes there can be a combined problem of the two conditions with one developing first, then the other condition developing as a result of compensatory motion due to pain avoidance.

Another condition that can cause confusion is Retro-calcaneal Bursitis. (Look up Images in Google). A small squishy bump develops at the top and back of the calcaneus.

One check you can do is - Rise up on your toes. (Not a definitive diagnosis, but one of the tests I do in my evaluation) Will depend on how progressive the condition is.
Pain in the achilles tendon - Achilles Tendonitis/Retro-calcaneal Bursitis
No pain - Plantar Fasciitis

Hope this helps

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