What is plantar fasciitis?
Plantar fasciitis (pronounced PLAN-tar fashee-EYE-tis) is the most common cause of heel pain a localized inflammation of the plantar fascia. Patients with plantar fasciitis describe an ache localized to the inside part of the heel. Other descriptions are tugging, pulling and burning. The pain can range from mild to severe and can interfere with activities. The typical clinical presentation is pain after rest most notably occuring with the first few steps in the morning and toward the end of the day, especially after excessive walking or standing.
What is the plantar fascia and how does it become inflamed?
The plantar fascia is a long arch supporting structure that resembles a ligament. It attaches to the bottom of the heel bone (calcaneus) traverses the arch, and attaches to tissue at the base of the toes, thereby functioning as a major support for the arch of the foot. The structure is susceptible to overuse injury that leads to localized inflammation at the heel and thickening of the fascia. Overtime a bone spur can form on the heel by the constant pulling of the plantar fascia on the heel. A common misconception is that the bone spur is the cause of pain, however it is the inflammation of the plantar fascia that is responsible for pain. The condition then tends to linger because normal activities can perpetuate the inflammation and delay healing.
Are some people more susceptible in getting the condition?
Biomechanical factors may be involved and can magnify the stress and strain placed on the plantar fascia, making an individual more susceptible to developing plantar fasciitis. In these cases, biomechanical factors such as foot pronation (arch collapse), excessive weight, and calf muscle tightness (Equinus) need to be addressed or negated.
What is the quickest cure for the problem?
The treatment of plantar fasciitis is a process. There are no quick cures for immediate relief that are permanent. To achieve resolution of symptoms, there needs to be steady improvement of symptom intensity with near 90 percent resolution of pain for at least 3 months. In order to cure the condition, which can take 3-12 months, it is imperative to control the symptoms and change the mechanical environment to which the foot is exposed.
Patient Directed Care
The following recommended treatments which you can start on your own, will often resolve mild cases of plantar fasciitis.
- Weight loss
- Use of stiffer more supportive shoes
- Avoid barefoot walking or walking in non-supportive slippers or sandals
- Add an over-the-counter arch support to your shoes (use of heel pads rarely helps).
- Perform calf stretching 2-3 times per day (see exercise section on web site)
- Modify activities to walk less and avoid impact activities
- Ice the heel at end of the day or shift for 15 minutes (Try an ice massage by freezing a water bottle and rolling it back and forth along the arch). Caution do not ice if you have poor circulation or foot numbness.
- Consider use of over-the-counter anti-inflammatories (Caution: as long as there are no medical conditions that prevent use (i.e. stomach ulcers, kidney disease, bleeding disorders, already on prescription antiinflammatory, or other blood thinners like Plavix or Coumadin, or allergies or other adverse reactions).
- Note: recommend formal treatment and medical evaluation if you have not responded to self directed care within 8 weeks.
There are additional treatments that the doctors at Ankle & Foot Clinic Northwest will suggest in addition to your self-directed treatments.
- Cortisone injections A powerful tool to significantly reduce inflammation at the heel (Other treatments need to be in place to get maximum benefit from these injections).
- Physical therapy referral
- Use of night splint
- Cast immobilization
- Custom Orthotics
- Serial taping
- Surgery (rarely indicated)
Other Types of Heel Pain
There are many other forms of heel pain, though rare, that can present clinically similar toplantar fasciitis. However, this is why a complete foot & ankle evaluation is often necessary if self directed treatments fail.
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