Diving with Plantar Faciitis

[TSandM]

Yes, these are all inconsistencies, and are what has me puzzled and a bit worried about your case.

 

[tkdgodess]

I have plantar fasciitis. Its manageable and flareups can be controlled. I wouldn't worry about that right now, infection is your main concern. Once you get rid of that and and your skin had healed, then worry about plantar fasciitis. Separate the two in your mind. I treat mine with a special dorsi flexion boot that i sleep in when it flares up. We can talk about that when your infection is gone

 

[buddhasummer]

I have plantar fasciitis. Its manageable and flareups can be controlled. I wouldn't worry about that right now, infection is your main concern. Once you get rid of that and and your skin had healed, then worry about plantar fasciitis. Separate the two in your mind. I treat mine with a special dorsi flexion boot that i sleep in when it flares up. We can talk about that when your infection is gone

Thank you. Probably wise advice, ill try to focus on clearing the infection and then deal with what's left.

 

[uncfnp]

And if there actually is some PF, the enforced rest caused by the infection may well solve that problem. While stretching, etc helps the problem, I've found the best "cure" is a break from the activity that lead to the problem. You may find that once the infection is gone and you ease back into activities, and continue to stretch (by the way, a good exercise for this is drawing the alphabet in the air with your foot), that the PF has resolved.

 

[Dhboner]

I've had 2 major bouts of plantar fasciitis (I am a marathoner) and it really doesn't sound like that's your issue. But, if it is, it will not affect your diving at all. The only issue might be the walk to the water (if you shore dive). Stepping on a stone with PF will hurt like hell and be a set-back.

 

[buddhasummer]

Update:

hospital have now finished with me. They said I no longer need medicine and no longer need to apply topical ointment and do not need to come back. I asked what happens now and they didn't offer much in the way of advice except to say I shouldn't dive due to the possibility of re infection. I asked how long I should wait or how will I know that it's ok to dive and they just said "wait a little longer". I asked when could I start putting weight on it and again they were suitably vague and just said "take it slow".

If I stretch it too hard is there a possibility of re opening the wound? After trying to very gently put weight on it the other day the small red hole in the middle of the wound appeared (visible in the photo) it wasn't there prior to trying to weight bare so can only assume it was from movement.

Im getting more than a little frustrated and somewhat depressed. I've been on crutches coming on a month, and am more immobile than before treatment started. My right leg at the calf is very visibly smaller than my left. I am unable to put any weight on it and when I try to I get a sharp shooting pain in the middle of my foot originating from the ball, toe end, for about 6cm toward the arch. This is a new development and prior to the infection I was walking without issue on the ball of my foot.

I don't know what I'm supposed to now, how can I expedite the healing, should I be resting it longer? At some stage I'm going to have to start walking on it, I can't be on crutches for months on end as its affecting day to day life including work. I'm a very skinny guy and worry that if I use crutches much longer my right leg will become so weak that I might end up rolling my ankle or worse.

Any advice on what I can do or should not be doing to get back on my feet would be greatly appreciated. I know it's hard to offer advice over the net but given I'm getting so little love from the hospital over here I'm game to try anything and would gratefully welcome any suggestions.

thanks in advance.

 

[TSandM]

The problem with this area is that it takes a lot of impact with each step, which is why the callus is so thick there. Right now, you have what looks like a very tenuous layer of epithelialization over the open area, and this is fragile and quite susceptible to damage with impact or stretch. Eventually, the healing will thicken and contract, and become more tolerant of stress. How long this takes depends on your own rate of healing, but the final stages of it are not complete for six months to a year. This does not mean that you can't walk at all for that long! But the photo you have posted is pretty good proof that the wound is not ready for much stress at this point.

You CAN do some things to reduce the atrophy -- I can't think of any reason why you should be toe-touch weight bearing at this point, or why you couldn't do calf exercises. (Stand on ball of foot with heel just off the floor, raise heel further off floor, then return to starting position -- just don't put the heel down.) Obviously, if you do them and see more of the red in the area, back off for another week or so.

I don't know what you do for work, but if being able to stand on the other foot with the toes of this one down for balance makes it more possible, you should be able to do that.

I would periodically try the dorsiflexion stretching again. One of the biggest problems with this kind of injury is that the Achilles tendon shortens when it is not regularly stretched, and it can be VERY difficult to get all the range of motion back. I had the same issue when I had a major laceration to my right heel. I was on crutches for a month, and then in a cast boot -- my Achilles shortened, and it took months to get it pulled back out to length. (And then I broke my ankle and had surgery on THAT, and never got the motion back )

 

[buddhasummer]

The problem with this area is that it takes a lot of impact with each step, which is why the callus is so thick there. Right now, you have what looks like a very tenuous layer of epithelialization over the open area, and this is fragile and quite susceptible to damage with impact or stretch. Eventually, the healing will thicken and contract, and become more tolerant of stress. How long this takes depends on your own rate of healing, but the final stages of it are not complete for six months to a year. This does not mean that you can't walk at all for that long! But the photo you have posted is pretty good proof that the wound is not ready for much stress at this point.

You CAN do some things to reduce the atrophy -- I can't think of any reason why you should be toe-touch weight bearing at this point, or why you couldn't do calf exercises. (Stand on ball of foot with heel just off the floor, raise heel further off floor, then return to starting position -- just don't put the heel down.) Obviously, if you do them and see more of the red in the area, back off for another week or so.

I don't know what you do for work, but if being able to stand on the other foot with the toes of this one down for balance makes it more possible, you should be able to do that.

I would periodically try the dorsiflexion stretching again. One of the biggest problems with this kind of injury is that the Achilles tendon shortens when it is not regularly stretched, and it can be VERY difficult to get all the range of motion back. I had the same issue when I had a major laceration to my right heel. I was on crutches for a month, and then in a cast boot -- my Achilles shortened, and it took months to get it pulled back out to length. (And then I broke my ankle and had surgery on THAT, and never got the motion back )

Thank you for the reply. I'm an English teacher for kids so my job involves a lot of dancing, jumping around etc. obviously this has had to stop as is very difficult to do on crutches. I was hoping that as the first layer of skin was forming I'd be fine in a week or so but looks like I was dreaming there.

I think you are correct re it being a tenuous layer as two days ago there was no red hole and obviously my attempting to put weight on the ball of my foot yesterday was enough to stretch it/tear it open. I guess I'll have to slow down on the walking and stretching for a little longer. Ill do calf exercises as you suggest but assume I shouldn't stretch too far?

At what stage can I consider diving? Does the skin need to be thicker? I was hoping to be in the water in the next two weeks, am I dreaming again?

As much as I want to start walking and get into the water again sooner rather than later I don't want push too hard too fast and end up complicating my condition. I can't believe how possibly treading on something I didn't even notice has created such an issue, it's a little depressing. I certainly took for granted having two mobile functioning legs, I can't believe how difficult almost everything thing is having only one. I'm lucky though my leg will eventually heal, many are not so lucky and have to permanently live with it.

Thanks again.

 

[TSandM]

Immersion causes what is called maceration . . . the new tissue will get soft and may have trouble holding together. I wouldn't dive until you can do some moderate stretching or even weight bearing without seeing the red center come back.

Plantarflexion, or pointing the toes, shouldn't stress the healing area at all, and this is what will minimize the calf atrophy. Dorsiflexion, which is the stretching which is recommended for plantar fasciitis, WILL stress the area, and should be deferred until the new skin is somewhat thicker and tougher.

Skin has two layers to it, the epidermis, which is the top layer and creates the keratin that keeps the skin dry and tough, and the dermis, which is more heavily vascularized, and contains the base structures for hairs and sweat glands (neither of which is present in large numbers on the heel). When skin is destroyed, it regenerates in two ways. Epithelium migrates into the wound from the edges, and also spreads upward out of the hair follicles and sweat glands. If the dermis is destroyed, those structures are gone as well. Two things then happen -- the healing will be slower, because it depends entirely on migration from the sides, and it will be more tenuous, because there is no dermis to anchor the epidermis that is forming. It is not possible for me to tell, from the photographs, whether you had complete destruction of the dermis, but it appears likely; I also don't know exactly what the dimensions of the wound were at maximum (one centimeter is often cited as the maximum area that can reepithelialize from the edges).

If epithelialization fails, the wound will heal by fibrosis and contraction, basically filling in with scar tissue, rather than forming normal skin again. This process is the slowest, but may be your best bet, because it's better than tenuous epithelialization over an area that is high impact.

The care you are getting, and the communication you describe, is not giving me a warm fuzzy feeling.

 

[buddhasummer]

Immersion causes what is called maceration . . . the new tissue will get soft and may have trouble holding together. I wouldn't dive until you can do some moderate stretching or even weight bearing without seeing the red center come back.

Plantarflexion, or pointing the toes, shouldn't stress the healing area at all, and this is what will minimize the calf atrophy. Dorsiflexion, which is the stretching which is recommended for plantar fasciitis, WILL stress the area, and should be deferred until the new skin is somewhat thicker and tougher.

Skin has two layers to it, the epidermis, which is the top layer and creates the keratin that keeps the skin dry and tough, and the dermis, which is more heavily vascularized, and contains the base structures for hairs and sweat glands (neither of which is present in large numbers on the heel). When skin is destroyed, it regenerates in two ways. Epithelium migrates into the wound from the edges, and also spreads upward out of the hair follicles and sweat glands. If the dermis is destroyed, those structures are gone as well. Two things then happen -- the healing will be slower, because it depends entirely on migration from the sides, and it will be more tenuous, because there is no dermis to anchor the epidermis that is forming. It is not possible for me to tell, from the photographs, whether you had complete destruction of the dermis, but it appears likely; I also don't know exactly what the dimensions of the wound were at maximum (one centimeter is often cited as the maximum area that can reepithelialize from the edges).

If epithelialization fails, the wound will heal by fibrosis and contraction, basically filling in with scar tissue, rather than forming normal skin again. This process is the slowest, but may be your best bet, because it's better than tenuous epithelialization over an area that is high impact.

The care you are getting, and the communication you describe, is not giving me a warm fuzzy feeling.

Again thank you so much for taking the time to write such a detailed reply.

The wound was almost 3cms in diameter.

Ok I'll go back to crutches for another two weeks and hold off on attempting to weight bare. I will do the plantarflexion and hold off the dorsifkexion for another couple of weeks.

I know this is hard to answer but is it possible that I might be able to dive in a month?

Again thank you for your thoughts and advice even though I was hoping to hear that it will be fine in a week, just having more detailed info makes me feel a little better. The care, or lack of, I've received here has been dreadful. It's ironic I pay a fortune in mandatory health insurance but have received better care from a person I've never met on a diving forum based on the other side of the world.

Thank you Lynne and thank you SB, I'd be lost without both at present.

---------- Post added May 17th, 2013 at 11:51 PM ----------

What about using a waterproof band aide or the like?