I’ve never had PF before. Never have had, or do I have, heel pain.
What is hurting is my PF (I believe that is what it is) where these bumps (about three) are present. The bumps have been there for a couple of years but have rarely cause me discomfort.
Yesterday I did a 16 mile trail run on very hard and uneven surface (it pretty much sucked). After that run these “bumps” really hurt and are even red. I’m looking for help on diagnoising and treating this condition… Thanks!
ktm is likely correct - these usually represent plantar fibromas. Commonly seen in patients with plantar fasciitis (but not necessarily) or from repetitive trauma to the area. Can also be associated with Von Recklinghaus syndrome (esp if you have others like on the palm of your hand) - but this is rare.
Treatment involves supporting the plantar fascia, but orthotics are often uncomfortable since they will obviously “push” on them. A good low dye arch strapping will help. I usually do a corticosteroid injection (sometime with ultrasound guidance although they are usually pretty obvious) or 2 and that usually shrinks them nicely. Newer modalities are being researched (i.e. topical calcium channel blockers with ion transport, etc.). Surgical excision doesn’t work well because of the high rate of recurrence and scarring of the skin/subQ tissues (although some newer bioabsorbably wraps are helping this a lot).
For now, I’d start with as aggressive a massage as you can handle (will be painful) after heating/warming the area, ice after, and tape your foot until you can tolerate an orthotic (OTC is probably fine at first). There is still a very remote chance that these are another soft tissue mass (i.e. fibrosarcoma), so you should probably have it checked out if it doesn’t respond.
Thanks for the reply and your expert advice. When it has hurt in the past I was able to talk my wife into giving me a foot massages and that did seem to help. I’ll continue that course of action, along with your other recommendations. If it continues to bother me I’ll visit a specialist. Thanks again!
hey rroof, I just got this diagnosis as well. Curious, when you say ‘aggressive massage’ are you referring to trying to work it out with a golf ball or perhaps Graston Technique? I guess what I’m really asking is, if this is a collection of fibrotic tissue, can it be broken down or worked out kind of like scar tissue?
The recommended therapies just don’t sound all that good (orthotic-already have them, surgery-high recurrence=crap, and cortisone-I’ll tell you how I feel in a week).
My unscientific diagnosis is that your foot is telling you it does not want to do 16 mile trail runs on a bad surface…but I could be wrong.
to Junior and to you TJ56,
“Aggressive massage” that rroof suggests can include (should include IMO) Graston Technique performed by your local DC, PT or ATC. Go to www.grastontechnique.com and perform a search for a certified provider in your area. Make the appointment knowing full well that this will not be a ONE TIME fix. It will in fact not feel good AT ALL and it will take several visits to even know if the treatment will be of benefit. I actually would not suggest orthotics for what you are presenting with. Any history of previous foot trauma? how about changing shoes recently? Or, have you begun to perform speed work during a build up for a race in the near future? How would you say you run? meaning, hard heal striker or do you have your feet landing under you as it strikes with a higher cadence? Cortizone, from my experience with the athletes I work on has not been beneficial UNLESS they completely stop running for 3-4 weeks, work on running mechanics and how they can improve upon them as well as performing rehab exercises. Still, try to find out WHY this happened rather than just having the symptoms treated. Typical cause that i have seen in my practice is overstriding, pushing back/toeing off to the extreme, muscle imbalances in one hip or the other causing one to overstride, too much too fast too soon with training and orthotics added to a persons shoe where orthotics were not needed. It is a puzzle that the practioner will help you figure out. I wish you both the best and if you have any questions just give me a shout via a PM. ERIK
No, these are not just scar tissue bundles like enderoche suggests - seems to only treat athletes? These occur on the hands as well, in very sedentary people, etc. and histologically have increased fibroblasts and not just collagen as they are true “tumors”. Common in people taking certain drugs, diabetics, alcoholics and with chronic liver disease as well.
While manual therapy is important to lessen some of the superficial adhesions (graston or whatever name/technique you want to associated with it), this is still a neoplasm that can actually enlarge doing this. Same reason they have a high recurrence rate with surgical excision unless a very wide margin of the fascia is taken which one would never recommend in a runner unless severe.
Last severe surgical excision case I did was on a CSI police investigator who had his entire fascia involved, perhaps 30 of them with his skin so adhered that he really couldn’t walk. Had to strip the entire plantar fascia - he wanted to see the histology slides of course 
You can google “transdermal verapamil gel 15%” to learn more about the biology/chemistry of these little guys and a new method of treatment as well.
you wrote:
“For now, I’d start with as aggressive a massage as you can handle (will be painful) after heating/warming the area, ice after, and tape your foot until you can tolerate an orthotic (OTC is probably fine at first). There is still a v**ery remote chance **that these are another soft tissue mass (i.e. fibrosarcoma), so you should probably have it checked out if it doesn’t respond.”
You yourself rroof said that this sort of thing, in the way that it is presenting itself needs AGGRESSIVE MASSAGE… Graston IS aggressive massage. you also mentioned, if you read what you wrote that there is a REMOTE chance that it is in fact a fibrosarcoma… I know what a fibrosarcoma is and in this case without further history or other possible chronic illness and/or medications he is on to treat said illnesses one cannot make an accurate diagnosis. I would ask the original poster if he has any other area of his body that has similar lesions?
And no, I do not only take care of athletes but we are on ST here… hopefully athletes are reading. ERIK
, try to find out WHY this happened rather than just having the symptoms treated.
Long story/short…I have tight quads, left side in particular. Jan '08 decided to improve the range of motion with a lot of stretching and also worked with some PT. Well, it worked, but it also changed my stride (kick specifically) on my left side…which was great for my times as they came down, but I also developed pain in my lower leg on the left side.
Sxs originally presented as lower leg pain, either Flexor hallucis irritation or possible achilles -itis, b/c I was unconsciously rolling my foot outward (suppinating?) Finally realized the foot was causing all the problems and have been having it Tx as plantar fascitis since Sept. '08, which kinda made sense as I’ve had PF on/off for 20 years and effectively manage w/ orthotic & night splints. Dx today as a fibroma, had a cortisone shot around it, and now wondering what next? It’s small, but hurts like hell…so much so that I haven’t run w/ consistency since June '08, no running at all for the last 8 weeks, and I don’t really walk normal on my left foot.
Not so short, but to answer your original - WHY - I was probably over-striding w/ my improved range of motioned left leg, which I can’t help but think - if it ain’t broke, then don’t fix it - with regards to having an inflexible left quad
Hi Junior,
Sorry to hear that you have been dealing with this for so long. this sort of thing can be frustrating to say the least. I feel for you man! Anyway, it does sound like you have gotten to the root cause of this… over-striding and subsequent increased stress/strain place on the fascia especially at foot strike and with that the “windlass effect” (essentially the mechanism that gives the foot its springy nature) being overstressed and no doubt with an emphasis on hip, knee extension then ankle plantar flexion and finally toeing off forcefully will all place excessive loads on the PF (Plantar Fascia).
So… the cortizone injection is the standard of care for the medical profession (not a bad thing) BUT the problem now, perhaps, is that you will need to allow for the tissue to heal (decrease the fibrotic mass) and that means no running. After 4-6 weeks of no running and letting this thing heal, returning to the way you used to run, will probably bring it right back. However, you can change the way you run and re-educate your body on how to decrease the stress/load on the PF with much less of an emphasis on hip, knee extension and less emphasis on plantar flexion at the ankle and “toeing off.” I know this sounds like alot of work… you are right! it is. However, look at it as an adventure and something that perhaps could allow you to run late into life rather than quiting running all together becuase “running causes injuries!” It is not inherently a dangerous activity… just if you do it ‘less than optimally’ it can become dangerous.
How old are you? where do you live?
Once the cortizone has done its job, which you MUST allow for, getting aggressive with some soft tissue mobilization MAY be a part of the treatment protocol. Also, other therapies include iontophoresis (topical steroid introduced via electrical charge being passed through the tissue), ultrasound, extracoporeal shock wave treatment and Elec. Stim MAY also be utilized. I suggest that you seek out a local PT, DC or ATC that specializes in the conservative management of sports injuries and have a long discussion with them. I wish you the best and stay in touch. ERIK
I am no expert, but I recently had my first bout with PF (minus the bumps you have). after running for 6 years without it. I tried rest, cortisone injections, massage, Graston and taping with virtually no benefit. The only thing that worked for me was prolotherapy. I had three rounds (probably 20 shots per time) over three months. To those that are experts, Is there any reason to think this might also help? During the same time I was working with a PT to diagnose the root cause–for me a tight calf/soleuous from a poor pedal stroke. If I overdo it, I can feel a tiny bit of nagging in that area, which reminds me to drop my heel more when pedaling, stretch and back off if necessary.
To be honest, I have no idea of prolotherapy would be of benefit to the gentleman who is experiencing this current complaint and Dx of several Fibromas. I would think, and perhaps others can correct me if I am wrong, that prolotherapy, which is designed to cause a proliferation of ligamentous/fibrous tissue to enhance the stability of an area, may not help in this case. Not sure however. I am interested in hearing what others have experienced with this. ERIK
for plantar fasciitis (or more properly termed, plantar fasciosis), prolotherapy may have some benefit (no real scientific studies though) and the help is more likely from the “peppering” technique of the repetitive needle trauma more than anything.
For a fibroma, this would not be adviseable.