Plantar fasciitis in 2025

Patients (even athletes) often come with heel pain (see photo), getting out of bed just as they start walking or after getting up from prolonged sitting. Walking barefoot makes things worse and going into a pair of comfortable shoes 👟 with a heel cushion or heel lift helps. I've had this on several occasions myself, but got better after doing frequent calf raises.

 

Sports medicine physicians have started to diagnose this both with physical examination and imaging (X-ray and Ultrasound scan) for better clarity. 

Clinically, the patient may have palpation pain at the bottom of the heel (inner part more common), and occasionally also at the back of the heel (Achilles tendon). The doctor would often examine the whole plantar fascia and calf for other signs of stiffness and pain. 

A quick prescription of silicone heel cup and taping by your physiotherapist would work wonders along with calf stretching and strengthening exercises. If pain persists, you could see your doctor who could prescribe further exercises, shockwave therapy or a local Platelet rich plasma or corticosteroid injection. You may seek further evaluation with your foot and ankle surgeon if 6-12 weeks of supervised physiotherapy does not resolve the pain. 

Toe abrasions from cycling without proper footwear

I took these 2 photos of the right forefoot of a young cyclist who decided to ride to a grocery shop in slippers instead of cycling shoes. It would be prudent for cyclists to wear suitable footwear even if they are making short trips as abrasions like these are quite common otherwise.

Hallux Valgus

A fencing athlete was seen with her big toes (hallux) turned outwards (valgus), hence crowding into her second toe. She was lucky as she did not have any symptoms of pain usually seen in the prominent bunions. Gymnasts and dance athletes often suffered from painful bunions. She could consider using nights splints for the big toe, taping during training and some icing after training to assist her. If she wanted something off-training, she could buy a broad forefoot footwear and use a silicone gel spacing device between the toes.

Just don't wear the toe spreader to run or play badminton or table-tennis. You might get really bad blisters.

Tibialis Posterior Tendinopathy (Traction apophysitis)

Ms Chia is an 11 years old child who played basketball barefooted last week. She came with Right midfoot pain since a few days duration. She particularly mentioned that she had pain jumping and doing brisk walking. Her mother was worried as she thought it could be cancerous.

I examined her feet and found out that she was flat footed and had a prominent navicular tuberosity(insertion of Tibialis Posterior tendon) on both feet. She had tenderness at that spot but there were no obvious signs except that she had pain standing on her toes and resisting inversion (pushing her forefoot inward against my hand).

I explained to her mother that she would benefit by having good medial longitudinal arch support with orthoses. She could have taping of her foot to provide additional arch support. If symptoms persisted, an X-ray could be done to rule out avulsion fracture (tendon pulls off the tubercle from the bone) or other pathology.

She should recover swiftly with proper footwear, modified activity, isometric and theraband resistance exercises within 2-4 weeks.

Nike + iPod Sports Kit

Nike and Apple has come out with a gadget and software which gives athletes another excuse to run. The Sport Kit2 allows your Nike+ shoe to talk to your iPod nano. The sensor uses a sensitive accelerometer to measure your activity, then wirelessly transfers this data to the receiver on your iPod nano.



What do you need?: Get in gear.

A pair of Nike+ shoes, an iPod nano, and the Nike + iPod Sport Kit (see photo).

How it interacts?:Rock ’n’ run.

With a sensor in your shoe and a receiver on your iPod nano, your run takes on a whole new dimension. See the minutes tick by. Watch the miles unfold. Hear real-time feedback. All to your favorite music — including the one song that always gets you through the home stretch.

Review your run and interact with your trainer:Stay in sync.

Sync up after you cool down. Just as seamlessly as it syncs your music, photos, and calendars, iPod nano also syncs your run. Simply connect iPod nano to your Mac or PC, and your workout data syncs to both iTunes and nikeplus.com, where you can see your runs, set goals, and discuss with your trainer or coach. You could also utilise a running site by Nike.

Here's how the Sports Kit2 is advantages for our workout:-

1.Connect
Any mere pedometer can show you stats while you run. But thanks to the Nike + iPod sensor and receiver, iPod nano also transfers your workout data to the Internet as soon as you sync. Connect your iPod, and iTunes takes over, automatically syncing all your run data and sending it to nikeplus.com.

2.Compare
Remember each run. Analyze your performance. Break your last record. Stay in tune with your goals. Nikeplus.com keeps stats on every step. Check your speed, distance, and calories burned — by run, by week, or by month — all from a graphical interface as intuitive as it is stunning.

3.Compete
Nikeplus.com keeps you connected with runners from every corner of the web. And that’s where the real race begins. Use nikeplus.com to challenge anyone, anywhere to a virtual race. Run on your own time, on your home turf, then log on to nikeplus.com to retrieve your results. Users have cloked more than 20,000,000km globally and is increasing every second.

Disadvantages:
1. You will need a pair of Nike shoes and an iPod before you start.

What's the price? US$29 for the kit; (RM138 at Nike, One Utama)

Leg Contusion after kick!

A futsal player came in walking this morning. He showed me his swollen right leg and I thought it was just a contusion (soft tissue injury). He was able to do heel-raises and even hop on the injured leg!

After careful examination, I found a defect in his right tibial bone (as he received the kick from the midline outward). I took a marker to delineate the defect (see picture). I gave him some NSAIDS, Arnica Comp gel and told him to apply RICE treatment. He was also sent for an X-ray but it came back normal. He was told to return for a review in 1 week's duration.

He should have been wearing his shin guard!

Ingrown Toenail

Anthony is a 10 year old basketball player and cyclist who weighs 60 kgs. He came this afternoon with a recurrent left big toe painful swelling since 1 year duration. He has seen several doctors but he said, "Nothing they did worked!".

I examined his toe and found that the swelling was already resolving. There were signs that probably it was oozing pus over the past few days. Somehow he came in as he felt it was "too much of a hassle".

I got him to agree not to trim his toenails so deep. I was also concerned whether he was diabetic as he had a strong family history of diabetes in his family. I gave him a course of oral antibiotics and an antiseptic for dressing. Told him to bring his footwear for examination and stay off playing games until it healed. I thought, who would stay with this for a whole year?!!

Plantar Fasciitis (Ouch!)

Brian is a 'recreational' badminton player who just returned to play after a 1 month celebration of Chinese New Year. For obvious reasons he wanted to get rid of some of the 'excess' weight that he gained. 2 days after play he started having severe hindfoot pain in the mornings. The pain subsides after walking for half and hour. He seemed to feel better walking in his leather shoes but playing badminton was a painful affair.

The pain was spot on the calcaneal attachment of the plantar fascia (see the mark 'X' on the photo). He also had tightness in the calf muscles and was flat footed. He had difficulty doing calf stretching. "I never did this before", he said.

We got him to wear a slipper with raised heel support (1/4"), a pair of preformed insoles for his flat foot, daily calf stretching when he got back from work, and ice-massage over the spot. He also saw a physiotherapist for myofascial release for his calf. Within 2 weeks he was back playing. Obviously, he was told to avoid playing to vigorously!

Low Backache

Ms Lim, a lady in her twenties came to see me this morning with complaints of low backache after waking up from sleep. She told me that she did not do any physical activity except the washing the corridor the previous day. However, she was able to sit with mild pain and did not have 'shooting' pain to her legs. She was previously seen by my colleague 1 month ago for the same problem but it resolved with some vitamin B12 supplementation and an analgesic.

She bent her back backward and forward and had moderate pain on the left side but her range of movement was full. She had some tenderness of the left quadratus lumborum muscle and the posterior superior iliac spine on both sides.

She was not keen on doing exercises or investigating further as she felt it was not a serious injury. I left her with a muscle relaxant, 5 days of moderate analgesics and advice to remain 'active'. She was told she could return to see me again if symptoms did not resolve as 50% of non-specific low back pain tends to resolve on their own within a week. I informed her that she probably should not use the corset (see picture attached) for longer than 2 weeks duration.

Footwear and my feet

I don't really look at the price of the pair of running shoe when I go shopping for one. More often than not, I would already have an idea of a reputable shoe manufacturer. My brother and I both have flat feet and overpronation. For obvious reasons, we would look for something light, breathable, durable, an insole with proper arch support, semi-rigid mid-sole with good stability. However, my requirements are generally for running on the treadmill and some cycling. Even my working leather shoes are selected with such specifications to allow me to occasionally jog down the alley when I need to. I have a 2 pairs of running shoes, 4 pairs of costly leather shoes and another 2 pairs of cheap shoes.


Every athlete should find out whether they have special requirements due to abnormalities in walking, running and jumping pattern (gait) required during training and competition. Check with your shoe manufacturer whether they have shoes which are specific for your condition. Not all expensive shoes have such requirements. Check whether the mid-sole provides sufficient stability, support and flexibility. Check whether the outer-sole is suitable for the different surfaces of the court or field. You may need to check with a podiatrist if you constantly find it difficult to obtain good shoes which do not cause pain to your feet, ankle and knees. A video of your walking and running pattern could highlight some possible problems and solutions.


You should always try out the shoe first and do all the different skills required in your sport with it. However, it will often take 2 weeks (at least) before you will find the shoe comfortable enough to be worn (break-in). I also use some preformed orthotics for some of my patients if they have abnormalities in gait and recurrent ankle, foot and knee problems with good results.