Can Plantar Fasciitis Really Be Cured?
In the fall of 2013, I pronounced myself cured of plantar fasciitis. I’m still cured, doing plenty of hiking and walking and running, but what does “cured” mean? It means functional, to me. If I fail to do the right stretches and wear the right footgear, I very quickly find my walking limited. But I don’t fail to do those things, and now there is no limit.
The question is: The tissues of the plantar fascia, once deranged by age and/or trauma, can they ever go back? Or can they not, and it’s a matter of having your PF “managed?” With the right combination of “self-cure” regimens, the docs tell us, 90% of us can cure. I did it.
But will the cure mean regaining that perfect alignment that the plantar fascia had when they were sound? You can see it in the microscope and the arthroscope, the docs tell me, when you see what were once tightly woven, perfect threads of smooth parallel tissue, and now the tight weave is ruptured and threads are torn, and now it’s not perfect. SO it’s not perfect. That doesn’t mean you can’t get it back to functional.
Cured, in my opinion, means getting back to the point where you can live a normal life without pain or even discomfort.
Nowadays I’m back hiking up mountains with impunity, so that’s cured as far as I’m concerned. Sure I can still feel that place, feel that my plantar fascia (right foot) is not the virgin tissue it was. I even imagine I can feel that if I were to stop wearing the right shoes and orthotics, and doing the proper stretches, it could come back. So I wear the right stuff and do the right stuff.
OK, NOW the Experts!
For that estimated 90 percent of people who can self-cure, without surgery, we hear a variety of estimates on how long it takes, ranging from 9 months to 24 months. Some (with plantar fasciitis that is not too bad, assumably) even speak of curing within weeks. But … a plantar fasciitis cure? What does that mean?
Plantar fasciitis typically afflicts people in middle age or later in life. Before that, who ever worried about that apparently most solid piece of the body, the heel? So when we talk about a plantar fasciitis cure, does that mean that the heel will return to whatever unspoiled condition it was in youth, never to fail again? Or is it just a matter of reducing or eliminating the chronic inflammation, while something has changed permanently and will always have to be managed?
“People with plantar fasciitis have a partial tear,” says Dr. W. Hodges Davis, a Charlotte, North Carolina Foot & Ankle Surgeon, and 2012-2013 President of the Outreach and Education Fund of the American Orthopaedic Foot & Ankle Society. “If you look at the MRI, it shows there’s a weakness in the plantar fascia itself.”
“The underlying condition is chronic degenerative wear and tear of the plantar fascia,” says Dr. John Wilson, a faculty member in the University of Wisconsin School of Medicine and Public Health, and a team physician for the University of Wisconsin Athletic Department. “When you see them on an MRI or ultrasound, the tissue looks thickened, disorganized. The patient may experience pain relief or resolution, and even though the tissue is not different at the cellular level, the ultimate goal is to get them to that point or to doing the things they want to do. As long as the patient is happy and doesn’t have pain, we’re satisfied.”
“The tissue probably remains abnormal forever,” he adds. “And when you have that you’re probably prone to recurrence. Some people CAN get back to normal, but it’s difficult to predict who that patient will be.”
When plantar fasciitis suffers are exchanging talk of experiences and treatments, they often find themselves wondering where in the heck the other person is coming from.
Keith R. runs marathons. He has plantar fasciitis, he says, but what he does is roll a golf ball under his foot and that really helps, and he keeps on running marathons. Barb L. says, oh yes, she has plantar fasciitis. But all she has to do is hold an Achilles stretch one time, for 90 seconds, once a day in the morning, and she’s good to go hiking.
“What?” you may think disbelievingly when you hear people like this. “I can’t go hiking without limping home. And marathons? I have discomfort walking a mile, let alone 26 miles, let alone running it. These people don’t have real plantar fasciitis,” you may suspect. “They’re talking nonsense.”
“The problem is, there are all levels of severity,” says Dr. Davis. “For some people it’s just an irritant. After they wake up in the morning, they don’t think about it all day. For some folks, it’s disabling. They can’t get through the day without significantly changing their activities.”
That’s why such broad statements as saying self-cure can happen within 10 months, a year or 24 months are fairly misleading, he says.
“If you have the disabling type, 24 months is a lifetime,” Dr. Davis says. “But if you just have irritation, then 24 months to keep stretching and avoid surgery is not much at all. The variety of presentations is dramatic. I’ve had patients come in and say, ‘My life is a sham of what it used to be.’ And then I have patients who say, ‘I had it real bad this summer and stretched through it. Now I have it, but I stretch, and it has no effect on my life.”
But these patients have the same diagnosis: plantar fasciitis.