Post COVID Plantar Fasciitis
This isn’t your Grandfather’s Heel Pain
Let me first start by reminding my readers that the purpose of my articles is never to paraphrase the same information that is available about any medical topic through a Google search. Rather, I try to bring up-to-date practical knowledge on these topics from the perspective of my experience in clinical practice. So here is one that you wont find anywhere else.
There has been an unusual spike in heel pain secondary to plantar fasciitis since the end of the COVID quarantine period. While there is no concrete explanation of why this is happening, there is a theory of why this may be happening and I’ll tell you in just a little bit.
First, let’s briefly describe what exactly is plantar fasciitis. Plantar fasciitis is an inflammation of a thick ligament that runs from the heel to the ball of the foot. The main function of this ligament is to hold up the muscles and tendons of the bottom of our feet. It also helps shape our arches. It is a very elastic structure, allowing our feet to absorb shock when we walk. The main symptom associated with this condition is acute pain when first stepping out of bed in the morning. This is due to the fact that the “sore” ligament which is contracted, is now forced to stretch when weight bearing. The pain gets a little better after the patient walks on it for a while. It is the most common cause of heel pain in the US, for both men and women.
Treatment consists of treating the acute symptoms first. This usually consists of a targeted steroid and local anesthetic “cocktail” to the inflamed part of the fascia using a musculoskeletal sonogram to aid in the placement. A low dye athletic strapping is applied to the foot and the patient is instructed to keep the strapping dry and on for at least three days. A stretching and icing regimen is provide to the patient for the next 2 weeks.
The goal of this post injection protocol is to promote stretching of the inflamed contracted fascia in order to promote greater elasticity of the plantar fascia.
The patient is then followed up in 2 weeks in order to asses improvement of their symptoms. The goal being an improvement of 80% or better. The majority of patients with acute plantar fasciitis respond to this first treatment. If a patient only has less then 80% relief in symptom, we may consider a second steroid cocktail injection and strapping and possibly physical therapy. If there is no relief what so ever, we may consider a non-contrast MRI in order to make sure there isn’t a tear of the fascia or possible a contusion of the calcaneus. I mention an MRI and not an X-ray because this is a condition that deals primarily with soft tissue. Common radiographs only show us bone and no soft tissues, such as fascia, ligaments etc.
The scenario I just finished describing deals with what we consider to be acute plantar fasciitis, meaning usually new onset of the condition, lasting for no more than four weeks. The cause is usually repetitive trauma to the fascia. This stress could be due to lifestyle choices such a strenuous exercise program, weight gain and most commonly any physically demanding job. It is the most common cause of plantar fasciitis and usually resolves after initial conservative care and usually doesn’t reoccur if the underlying causes are addressed.
Post COVID, I started seeing healthy, fit patients that do not have any of the typical underlying causative factors that cause plantar fasciitis. This isn’t to say that I didn’t see typical cases as well. Furthermore, these patients had what would be considered chronic plantar fasciitis because the condition had gone on for several months and did not respond to conservative care. Interestingly, most of these patients had started having these symptoms while in quarantine. They sought out medical care once everything re-opened and they could seek care and unfortunately they did not respond to treatment.
So what caused Chronic Plantar Fasciitis in these patients?
When we first develop plantar fasciitis, or any musculoskeletal condition for that matter, there is an acute or early inflammatory reaction that although painful, brings with it many healing factors that the body produces in order to heal the damaged tissue. The goal of the initial treatment during this acute phase of fasciitis is to help relieve the symptoms and control the causes of the inflammation. While not getting in the way of the body’s natural ability to heal itself. After approximately, four weeks of plantar fasciitis, without any improvement in the symptoms. The body no longer will produce healing factors and we are left with a constant painful inflammation, which can even worsen depending on a patient’s foot type or condition.
Most of the current research on this spike in these cases after COVID speculate that it deals with the effects of isolation on our musculoskeletal system, primarily our feet. While in quarantine, we were in active and probably not eating a well balanced diet. This led to weight gain and muscular skeletal atrophy. The leading cause of arthritic pain in the US. Furthermore, a lot of these home bound patients were active, but wearing the wrong shoe wear. Therefore, leading to biomechanical injury to their feet, once you are dealing with chronic plantar fasciitis, our treatment algorithm changes significantly.
We must first rehabilitate the lower extremities through physical therapy with the goal of strengthening atrophied tendons, while promoting elasticity of the plantar fascia. It may be necessary to have the affected foot immobilized in a CAM walker during this phase of treatment, so as to not re-injure the fascia. Chronic plantar fasciitis has been linked to a change in a patient’s foot type or step. Therefore one needs to consider a custom molded orthotic for these patients in order to correct the patient’s foot type, or gait, for the purpose making sure the condition doesn’t reoccur.
I use a new orthotic casting system that capture’s these patient’s feet under maximum stress while weight bearing in order to offer correction where needed the most. Thus, far I have treated over one hundred chronic plantar fasciitis patients using this method and have had a 95% success rate.
The take home lesson here is that this condition can be treated successfully if properly diagnosed. However, it is very challenging to treat.
Finally, if this condition isn’t managed it can get progressively debilitating . So seek treatment as soon as possible and don’t be afraid to seek a second or third opinion. If you have any questions regarding this topic. Please feel free to write to me; drop a comment here, email me, or send me a DM through any of my social media pages. I will be more then happy to reply.