Plantar Fasciitis

What is Plantar Fasciitis?

Plantar fasciitis is one of the most common conditions causing heel pain. The condition involves inflammation of the plantar fascia — a tough, fibrous band of tissue that runs along the sole of the foot with attachments to the calcaneus (or heel bone) and to the base of the toes. The plantar fascia provides some structural support to the arch of the foot and has an important role in normal foot mechanics during ambulation. Tension in the plantar fascia increases with dorsiflexion (motion towards the head or ceiling) of the ankle and toes – motions which occur during normal walking or running.

Inflammation starts in the fascia either as a result of an increase in activity level (as in initiating a walking or running program) or in association with the normal aging process (with aging, the fascia loses some of its normal elasticity and resilience). Thus, in general, the inflammation results from a relative increase in the stresses or tension placed on the plantar fascia during activity. Less commonly, plantar fasciitis can develop in association with systemic inflammatory conditions such as rheumatoid arthritis.

What are the Symptoms of Plantar Fasciitis?

The pain associated with plantar fasciitis is typically insidious in onset and is usually located over the medial attachment of the plantar fascia onto the heel bone. Occasionally, the pain will be acute in onset, occurring after missing a step or after jumping from a height. The pain is often worse upon arising from bed in the morning or after periods of rest during the day. Thus, it causes what is known as “first step pain”. The degree of discomfort generally lessens with activity during the course of the day or after “warming-up”, but can become worse if prolonged or vigorous activity is undertaken. The pain is also often noted to be more severe in bare feet or in shoes with minimal or no padding at the sole.

How is the Diagnosis of Plantar Fasciitis Made?

As mentioned previously, plantar fasciitis is one of many conditions causing “heel pain”. Some other possible causes include nerve compression either in the foot or in the back, stress fracture of the calcaneus, and atrophy of the fatty tissue under the heel. Plantar fasciitis can be differentiated from these and other conditions based on history and examination.

It should be noted that heel spurs are often inappropriately thought to be the cause of heel pain. In fact, spurs are common and are nothing more than the bone’s response to traction forces from the plantar fascia. They are commonly present in patients without pain, and frequently absent in those who have pain. It is the rare patient who has a truly enlarged and problematic spur, and the presence of a spur often only serves to divert attention from the true cause of the heel pain.

What is the Treatment for Plantar Fasciitis?

The treatment of plantar fasciitis is relatively simple, yet it may take 6 to 12 weeks or more for symptoms to resolve. The key components to treatment are as follows:

  • Rest – decreasing distances and duration of walking, or particularly running.
  • Massage – local, deep massage to the fascial tissues at the heel, usually done in the morning after a warm bath or shower.Stretching – most important; requires
    routine, daily stretching of the heel cord and plantar tissues to help lengthen and “recondition” the tight fascial structures.
  • Anti-Inflammatory Medications – includes aspirin and other medication such as ibuprofen (Motrin, Nuprin, Advil, etc.), Naprosyn, Voltaren, Celebrex, etc. (all known as “nonsteroidal anti-inflammatory drugs”).
  • Proper Shoe Wear – shoes must be comfortable; this usually means a minimal heel and a well-cushioned sole; avoid rigid arch supports or orthotics (they may increase pressure on the inflamed fascia); consider using padded inserts (i.e.; Spenco heel pads).
  • Gradual Return to Increased Levels of Activity – once the pain and stiffness have resolved; continue stretching, make it a habit. The majority of cases will resolve with the above treatment measures provided that they are faithfully followed. In the persistent case, the use of a local steroid injection may be considered. Additional treatment including high intensity shock wave therapy (ie Ossatron) is a noninvasvive option for refractory cases.

Surgical Treatment for Plantar Fasciitis

The majority of cases will resolve with the above treatment measures provided that they are faithfully followed. In the persistent case, the use of a local steroid injection may be considered. Additional treatment including high intensity shock wave therapy (ie Ossatron) is a noninvasvive option for refractory cases. It is only in the extremely rare case that consideration of surgical intervention is necessary.

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