“Chad” began to tell me that for the past 5 years he has had a bump on the bottom of his right foot and didn’t know what it was exactly. His doctor told him it looked like a cyst and if Chad really wanted to, his doctor could cut it open and remove it but complications may arise afterward. Chad opted not to go under the knife and leave as is. The lump on his right plantar surface of his foot never really hurt enough to motivate him to get it cut off.

Chad’s job consists of being on his feet for the majority of the day but while he is on his feet there is very little pain. He mentioned that when he goes from one job to another in his car, when he gets out, his right foot is very stiff with a dull ache. After taking a few steps, it works itself out. This same stiffness occurs in the morning first thing out of bed.

While Chad has been dealing with this lump on his right foot, he noticed about a month ago that a smaller lump was developing on his left foot as well. It was about 4 years ago that he said he started running half marathons to stay in shape and this is when he noticed the lump on his right foot starting to get bigger with increased pain and stiffness in both his calf muscles during the run and pain in both his plantar fascia bands the next morning after a long run.

During my assessment, this is what I found:

Non-weight bearing

• Neutral foot type
• Slight bilateral hallux varus
• Bilateral hallux limitus
• R plantar fascia nodule on medial side of plantar fascia band distal to 1st MTP joint
• L plantar fascia nodule on medial side of plantar fascia band distal to 1st MTP joint but not as predominant as the R nodule

Weight bearing

• Mild bilateral knee valgus
• Mild bilateral rearfoot valgus
• Neutral arch height

Gait Analysis

• Lateral heel strike
• Mild pronation during midstance
• Limited toe off due to bilateral hallux limitus resulting in bilateral whipping around of the heel going into swing phase

There was no doubt in my mind with the symptoms Chad presented was plantar fasciitis. The only difference was that Chad’s plantar fasciitis was in combination with nodules that had developed over time due to the stress placed on both plantar fascia bands.

Plantar fascia nodules or plantar fascial fibromatosis are common, non-cancerous lumps of fibrous tissue formed in the plantar fascia.  These nodules locate themselves just below the skin, usually in the central or inner part of the fascia (at the arch of the foot). They do not have a specific size and usually grow very slowly however, it is also possible that these nodules can remained unchanged for months or even years then start growing rapidly as they did in Chad’s case. When these nodules begin to develop, there can be single or multiple nodules at a time.

The precise cause of these nodules developing are yet to be discovered. Many speculate that these nodules occur as a result of repeated injury to the plantar fascia band. Small puncture wounds or tears in the plantar fascia heal by the formation of scar tissue. An increased growth of this scar tissue at a localized point leads to the formation of these nodules.

I placed a pair of custom made foot orthotics on Chad’s feet with intentions where the nodules where protruding out of his plantar fascia band.  I also suggest to update the majority of his foot wear seeing that the only pair of shoes that were recently bought was the running shoes. His dress shoes, casual shoes and work shoes were all over 2 years old and were all worn often.  I also showed Chad a couple of calf stretches to do when he was experiencing the dull ache in his feet and to hold the stretches for 1-2 minutes.

When Chad came back for his follow up, he couldn’t be more please. He said that once the orthotics were placed in his shoes, he hasn’t taken them out since. He also commented on the larger nodule on his right foot and had thought that the past two weeks of wearing his custom made foot orthotics that the nodule had gotten smaller in size.