Foot Fasciitis: Symptoms, Diagnosis, and Treatment Options

Plantar fasciitis?

Hello Dr.
Pan,
About a month ago, I consulted you regarding a sensation in my feet that feels like electric shocks when walking, to the point where it becomes nearly impossible to walk.
Although I have stopped wearing shoes, I still frequently experience soreness in my feet.
Recently, I have noticed that the joints of my big toes sometimes hurt abnormally.
During these painful episodes, my body shivers, and I experience tingling in my scalp (specifically at the big toe joints).
Afterward, I start to feel the electric shock sensation again while walking, followed by tingling and pain that radiates from my big toe to my ankle, and then other toes begin to hurt as well (the pain seems to move around).
My ankles often feel as if they are sprained.
I have seen several orthopedic specialists, and they all said it was just tendonitis, providing me with injections and medication.
However, the problem remains unresolved; my feet are almost always either sore or painful, and the tendons frequently feel inflamed.

Last year, when I first started wearing leather shoes, I experienced this same type of pain in my big toe joints, accompanied by episodes of urinary incontinence (sudden urgency, feeling as if my bladder is about to burst, but the actual urine volume is less than a third of what I usually produce).

My questions are: Is there a specific name for this condition? Also, are there any instruments available to examine the condition of the big toe joints or the foot fascia? (I have had X-rays and an electromyogram done.) What other tests should I consider?
Thank you.
I am approximately 167 cm tall and weigh about 63 kg.
I used to drink alcohol frequently, and recent tests have indicated signs of rheumatoid issues, which are currently being monitored.
I consider myself an active person, walking several kilometers daily and climbing stairs (even if I don’t exercise for a few days, my feet still hurt).

Mr. Zhang, 50~59 year old female. Ask Date: 2008/06/08

Dr. Pan Yingda reply Rehabilitation

I'm sorry, but I may not be able to solve your problem! Is there a specific name for this condition? I believe the focus should be on what to do and how to treat it, rather than what disease I have.
It's a strange phenomenon that in outpatient settings, when patients are unaware of the name of their problem, they feel anxious.
However, once we provide them with a diagnosis, you can see them relax; perhaps they think that having a name for their condition means it can be treated! Therefore, sometimes doctors, to satisfy patients, will give them a diagnosis, but terms like tendonitis, periostitis, degeneration, bone spurs, rheumatism, poor circulation, and circulatory issues are essentially the same whether stated or not, yet saying them provides reassurance to the patient! I cannot categorize your issue; we can only use the process of elimination: Is it gout? Is it inflammation? (Is there redness, swelling, or heat? Is the pain localized or does it move around?) Is it neuropathic pain? (What kind of sensation is it? Is it a deep ache or does it feel like pins and needles on the skin?) What are the triggers for the pain? My suggestion is: do not take any medication for now; return to your pre-pain lifestyle.
If you don't need to wear shoes, then don't; if you should exercise, then exercise; if you enjoy drinking, then go ahead and drink! Let things return to the starting point; it may be easier to identify the root cause.
P.S.
Have you practiced Qigong or engaged in religious activities? We have encountered some unusual cases related to energy, but these are rare exceptions.
If you are not involved in such activities, you can disregard this!

Reply Date: 2008/06/08

More Info

Understanding foot fasciitis, particularly in the context of your symptoms, involves a comprehensive approach to diagnosis and treatment. Foot fasciitis, commonly referred to as plantar fasciitis, is a condition characterized by inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes. This condition often results in heel pain and discomfort, especially with the first steps in the morning or after prolonged periods of sitting.

Symptoms
The symptoms you describe, including the sensation of electric shocks while walking, persistent pain in the toes and ankles, and the feeling of tightness or discomfort, can be indicative of several underlying issues. The fact that you experience pain that seems to "move around" can suggest nerve involvement, possibly due to compression or irritation of the nerves in the foot or lower back. Additionally, the cold sweats and tingling sensations in your scalp during episodes of pain could indicate a more systemic issue, potentially related to nerve function or circulation.

Diagnosis
Diagnosing foot fasciitis and related conditions typically involves a thorough clinical evaluation, including a physical examination and a review of your medical history. While X-rays can help rule out fractures or bone spurs, they may not provide sufficient information about soft tissue conditions like fasciitis. Electromyography (EMG) can assess nerve function, but it may not directly diagnose fasciitis.
For a more comprehensive evaluation, consider the following diagnostic tools:
1. Ultrasound: This imaging technique can visualize the plantar fascia and assess for inflammation or tears.

2. MRI: Magnetic resonance imaging can provide detailed images of both soft tissues and bones, helping to identify any abnormalities in the fascia or surrounding structures.

3. Nerve Conduction Studies: These tests can help determine if there is nerve damage or compression contributing to your symptoms.

Treatment Options
Treatment for plantar fasciitis and related conditions often begins conservatively. Here are some common approaches:
1. Rest and Activity Modification: Reducing activities that exacerbate the pain can help alleviate symptoms. Avoiding high-impact exercises and opting for low-impact alternatives may be beneficial.

2. Footwear: Wearing supportive shoes with adequate arch support is crucial. Custom orthotics may also be recommended to provide additional support and alleviate pressure on the plantar fascia.

3. Physical Therapy: Engaging in physical therapy can help strengthen the muscles in your feet and legs, improve flexibility, and reduce pain. Stretching exercises for the calf muscles and plantar fascia are particularly effective.

4. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation. In some cases, corticosteroid injections may be considered for more severe inflammation.

5. Alternative Therapies: Techniques such as acupuncture, massage, or the use of ultrasound therapy may provide relief for some individuals.

6. Surgery: If conservative treatments fail after several months, surgical options may be considered to release the plantar fascia or address any structural issues.

Conclusion
Given your symptoms and the complexity of your condition, it is advisable to seek a second opinion from a specialist, such as a podiatrist or an orthopedic surgeon with expertise in foot and ankle disorders. They can provide a more tailored diagnosis and treatment plan based on a comprehensive evaluation of your condition. Additionally, addressing any underlying issues, such as potential rheumatoid factors or other systemic conditions, is crucial for effective management. Remember, early intervention often leads to better outcomes, so don’t hesitate to pursue further evaluation and treatment options.

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