Plantar Fasciitis
WHAT'S THE PROBLEM?
Plantar fasciitis/heel pain syndrome is an inflammation of a thick band of tissue
at the bottom of the foot called the plantar fascia. The inflammation of the plantar
fascia, at it's origin at the heel bone (calcaneus), causes the classic symptoms
of pain at the bottom and/or side of the heel facing the opposite foot, often the
most painful upon arising in the morning or when standing after sitting for prolonged
periods. We call this post-static pain...pain after rest. This is because the plantar
fascia is tight after rest, and the stretching inflames the painful area even more,
therefore increasing the discomfort. The pain can exist with or WITHOUT a "heel spur".
It is the feeling of most physicians that treat this condition often, that the pain
is caused by the stretching and inflammation of the plantar fascia, and NOT by the
bone spur. The spur is a result of pulling of the plantar fascia at the heel bone,
resulting in proliferation of bone, often referred to as a "heel spur".
HOW DOES IT FEEL?
The classic symptoms are pain and a feeling of stiffness in the bottom and/or side
of the heel. This pain is often a sharp pain that is described as a feeling of stepping
on a stone or nail. The pain often reduces after a few steps, though it may still
persist. This pain can also occur when walking after sitting for a prolonged time,
such as sifting at work, driving a car, etc.
LET'S DO A TEST!
A thorough examination by a doctor of the clinical signs and symptoms will usually
result in a clear diagnosis. X-rays will usually be taken to determine if any abnormality
is present in the heel bone (calcaneus). On occasion, fractures, bone cysts, or foreign
objects (pieces of metal, splinters, broken needles, glass) can be discovered as
the cause of heel pain. If the presentation is not clear, other diagnostic tests
may be utilized. Bone scans are often used if a bone cyst or abnormality in the bone
are suspected or if a fracture is suspected. An MRI may be performed if a small "stress"
type fracture is suspected. Additionally, an MRI is useful in determining the status
of the surrounding tissue and can determine if there is a tear of the fascia or any
other soft tissue and bone abnormalities. A CT scan is useful when suspecting a fracture
of the heel bone and the extent of the fracture. Additionally, blood tests can be
utilized to rule out arthritic or infectious disorders.
HOW DID THIS HAPPEN?
Plantar fasciitis heel pain syndrome can occur via a myriad of causes. Risk factors
such as weight gain, foot type (flat feet, high arched feet), a high level of activity,
sports,
overuse, improper shoegear, improper support of the feet, trauma, tightness
of muscles and daily activities can trigger the classic symptoms. Often, there is
no single cause, but a culmination of several risk factors. It is imperative to address
all of these factors to treat this condition successfully.
WHAT CAN I DO FOR IT?
Switching shoe gear to a well supportive running shoe can be effective. Reducing
your level of activity helps. When you are off your feet, the injury is healing,
it's getting better. When you are standing with inadequate foot support, it is getting
injured. An orthotic or arch support can support your foot well enough to virtually
eliminate the injury that is occurring while standing and walking.
WHAT WILL MY DOCTOR DO FOR IT?
Your podiatrist will perform a thorough examination and history of your condition.
He/she will explain the cause of the problem and offer you various treatment options.
X-rays will usually be taken to assess the status of the heel bone (calcaneus) and
to check for other findings such as arthritis, foreign objects, fractures, etc. There
are numerous treatment options, and the treatment protocol will vary according to
the severity of the patient's symptoms.
Treatment options can include oral anti-inflammatory
medications, heel cushions, heel cups, physical therapy, stretching exercises, taping/strapping
of the foot, over-the-counter inserts, custom orthoses, injections, soft tissue wraps,
weight loss, change of shoes, casting, night splints and surgery. Each option has
advantages and disadvantages, and must be tailored to the needs and unique characteristics
of each patient.
Conservative care is successful 85% of the time, and surgical treatment
is usually performed 5-10% of the time. The surgical techniques differ according
to the surgeon's preference. The surgery is usually performed as an outpatient and
can be performed "traditionally", with removal of the spur and surgical release of
the ligament, or via newer techniques utilizing endoscopic equipment. This newer
technique utilizes two very small incisions and surgically releases a portion of
the plantar fascia, and the "spur" is left undisturbed. The technique utilized should
be discussed with the patient and will depend on x-ray and clinical findings.
ESWT-extra
corporeal shock wave therapy is a newer method that utilizes sound waves/shock waves
to help alleviate the pain associated with plantar fasciitis. This method has been
used in Europe for many years and has been used in the United States for the past
2-3 years. ESWT is presently an FDA approved modality for plantar fasciitis. Although
there are only a limited number of doctors performing this procedure, it is becoming
more widely available. As a general rule, ESWT is an excellent alternative to surgery
for those patients that haven't responded to approximately six months of conservative
therapy with no relief of symptoms.
CAN I PREVENT IT FROM HAPPENING AGAIN?
Controlling body weight, wearing supportive shoes and having additional support in
your shoes can decrease the chance of recurrence. Additionally, stretching the Achilles
Tendon and hamstrings and maintaining flexibility are extremely important in preventing
recurrence of the problem. Most importantly, pain and discomfort are your body's
signals that a problem exists. Prompt attention and treatment can often result in
significant relief with the avoidance of complications.
