What Is Plantar Fasciitis

Plantar Fascitis

Overview

Plantar fasciitis was previously believed to be inflammation of the fascia near its insertion on the heel bone. The suffix (-itis) means inflammation. Studies, however, reveal that changes in the tissue associated with the injury are degenerative and not related to inflammation, at least not in the way most people typically think of inflammation. Sudden onset of heel pain may indeed be related to acute inflammation. For persistent heel pain the condition more closely resembles long-standing degeneration of the plantar fascia near its attachment than inflammation. This could explain why anti-inflammatory medications and injections have been unsuccessful at treating it. But there is more to heel pain than just the plantar fascia.




Causes

As a person gets older, the plantar fascia becomes less like a rubber band and more like a rope that doesn't stretch very well. The fat pad on the heel becomes thinner and can't absorb as much of the shock caused by walking. The extra shock damages the plantar fascia and may cause it to swell, tear or bruise. You may notice a bruise or swelling on your heel. Other risk factors for plantar fasciitis include being overweight and obesity. Diabetes. Spending most of the day on your feet. Becoming very active in a short period of time. Being flat-footed or having a high arch.




Symptoms

Pain is the main symptom. This can be anywhere on the underside of your heel. However, commonly, one spot is found as the main source of pain. This is often about 4 cm forward from your heel, and may be tender to touch. The pain is often worst when you take your first steps on getting up in the morning, or after long periods of rest where no weight is placed on your foot. Gentle exercise may ease things a little as the day goes by, but a long walk or being on your feet for a long time often makes the pain worse. Resting your foot usually eases the pain. Sudden stretching of the sole of your foot may make the pain worse, for example, walking up stairs or on tiptoes. You may limp because of pain. Some people have plantar fasciitis in both feet at the same time.




Diagnosis

Most cases of plantar fasciitis are diagnosed by a health care provider who listens carefully to your description of symptoms. During an examination of your feet, your health care provider will have to press on the bottom of your feet, the area most likely to be painful in plantar fasciitis. Because the pain of plantar fasciitis has unique characteristics, pain upon rising, improvement after walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas, your health care provider will probably feel comfortable making the diagnosis based on your symptoms and a physical examination. Your health care provider may suggest that you have an X-ray of your foot to verify that there is no stress fracture causing your pain.




Non Surgical Treatment

Talk to your doctor about the best treatment plan for you. Options include. Apply ice or a cold pack to the heel and arch for 15 to 20 minutes several times a day. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin. A special splint that will hold your foot in a neutral position while sleeping. Special shoe inserts that support the mid-arch region of your foot. Inserts that are not customized may work just as well as those that are customized. Activity. Avoid running and other activities that may worsen pain. Begin stretching exercises to lengthen the Achilles tendon and plantar fascia as recommended by your doctor. This is usually done when pain has lessened or improved. To help manage pain, your doctor may recommend over-the-counter nonsteroidal anti-inflammatory medication (NSAIDs), such as ibuprofen or naproxen. Prescription pain relievers may also be required. Steroid injections may be used in some cases or if other treatment is not working. A special type of sound wave called extracorporeal shock wave may also be considered in certain cases. This treatment happens under the care of your doctor. At this time, this is generally a treatment for long-term cases that do not respond to other treatments. Massage therapy or accupuncture may also be effective for long-term cases. In a few cases, basic treatments don't help. Surgery may be performed to cut the tight, swollen fascia.

Painful Heel




Surgical Treatment

In very rare cases plantar fascia surgery is suggested, as a last resort. In this case the surgeon makes an incision into the ligament, partially cutting the plantar fascia to release it. If a heel spur is present, the surgeon will remove it. Plantar Fasciitis surgery should always be considered the last resort when all the conventional treatment methods have failed to succeed. Endoscopic plantar fasciotomy (EPF) is a form of surgery whereby two incisions are made around the heel and the ligament is being detached from the heel bone allowing the new ligament to develop in the same place. In some cases the surgeon may decide to remove the heel spur itself, if present. Just like any type of surgery, Plantar Fascia surgery comes with certain risks and side effects. For example, the arch of the foot may drop and become weak. Wearing an arch support after surgery is therefore recommended. Heel spur surgeries may also do some damage to veins and arteries of your foot that allow blood supply in the area. This will increase the time of recovery.




Stretching Exercises

Calf stretch. Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch. Plantar fascia stretch. This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you in a controlled fashion. If it is difficult to reach your foot, wrap a towel around your big toe to help pull your toes toward you. Place your other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or walking.

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