Question
A year ago I developed plantar fasciitis in my right foot as well as pain in my right hip.  I am a runner but I think the fasciitis arose from walking in very flat shoes.  Since then I have had physiotherapy that involved gait analysis and various gluteal strengthening exercises.  I was told I could keep running despite the injury.  Unfortunately the pain did not go away so I went to see a podiatrist who prescribed orthotics and 8 weeks of rest (i.e. no running but cycling instead).  My foot did improve with the 8 weeks of rest although the inside of my heel is still slightly tender to touch.  However, since beginning to run again with the orthotics I have developed pain that seems to jump from the inside of my ankle (possibly the posterior tibialis), to the outside of my ankle and foot and even to the front of my foot.  Also, the pain in my hip has worsened and now radiates down my leg.  I am now seeing a sports doctor who has been attempting to realign my hips by physical manipulation as he says the right hip is higher and more forward than the left.  Will this course of treatment be effective in treating my hip problem and associated foot pain (which I am not sure is purely a plantar fasciia problem anymore)?  I really want to be able to run without pain again - I am 26 years old, fit and healthy so it is really frustrating!

Answer
Dorothy,

Ask your sports doctor:  "Isn't everybody's hips a little off?"  If the doctor believe he is "aligning" your hips, that's a flawed paradigm to begin with.  This doesn't mean that pelvic joint manipulation isn't helpful. I'm just making a point...  I would be more concerned about the orthotics.  They could be causing the problem.   Maybe they are off and not your hips.  Orthotics should be comfortable, and when you stand on them in your shoe it should feel alleviating.   You shouldn't feel like your standing on rocks and it should not cause you to have more pain.  As a very general rule, high-arched and stiff-footed people need soft/flexible orthotics that support the high arch, while those with overpronated arches and overly flexible foot joints need more rigid support.  Also, what is being done to the foot?   Are all the foot and ankle joints moving freely? If not, then a doctor with training in ankle and foot joint manipulation would be the ticket.   What about the actual plantar fascia and it's common tendinous connection to the inside portion of your heel (at the calcaneus bone)?   Is somebody debriding any of the junk away from this tissue.  The tendon that anchors itself into the inside portion of the calcaneus is like any other tendon.   It can be subject to repetitive overload and develop microtearing and healing cycles that leaves the tendon full of debris.  That's what the so-called "tendinitis" is.  It's not an "-itis" but instead is an "-osis."  For the best way to address this, see www.grastontechnique.com    I would suggest finding a sports chiropractor that really knows how to address your foot as well as your pelvis, knees, hamstrings, etc...  

'Hope this helps.

Dr. G