 |
 |
PLANTAR FASCIITIS
|
 |
The plantar fascia travels from the heel to the metatarsal heads; it is at the area near its attachment that often becomes inflamed and painful. |
 |
Plantar fasciitis is an overuse-related inflammation of the plantar fascia, a dense fibrous band of connective tissue that extends from the calcaneus to the metatarsals. The condition typically causes heel pain at the origin of the plantar aponeurosis and along the medial arch. |
Pain is the most severe upon putting the foot down in the morning when getting out of bed. As you walk, the pain lessens. If untreated the pain often worsens. As the condition worsens with time the foot will start to develop pain throughout the day. Shooting pain may also develop in the heel. Tenderness is often present on the under surface or on the inside of the heel. Diffuse tenderness may be present in the arch area. Rarely is discoloration or swelling seen. Occasionally touching the inside of the heel may cause pain that radiates up the leg or into the toe area. This is indicative of a more advanced problem.
Treatment early for this condition often will enable us to help our patients resolve their pain and condition quickly. The longer a patient waits to get care the longer it may take to get well. Having treated thousands of people with heel pain, we are able to identify different foot types and aggravating factors that may contribute to the problem. Despite claims that surgery is the cure-all for this condition, it is not. It is necessary in less than one percent of the people who develop heel or arch pain.
Treatment - Conservative, Nonsurgical
First it is necessary to identify why the problem has occurred. A thorough history needs to be taken and any risk factors identifies. Assessment of lower extremity mechanics, overall muscle flexibility and watching people walk will often show us something that may be primarily causing the condition or at least aggravating it as well. Shoe gear needs to be inspected, mostly worn shoes, to inspect the wear pattern. Treatment is usually broken down into three areas.
1) Addressing the mechanics of the foot in order to reduce the pulling of the ligament on the heel. This may be in the form of extensive taping or strapping of the foot and arch area, orthotics (over the counter or custom molded) or even temporary immobilization in the form of a removable cast that may be worn throughout the day and often as a night splint.
An orthotic will help support the foot and take tension off of the
plantar fascia.
2) Oral anti-inflammatory Medications. This may be necessary as an adjunct to mechanical control of the heel. This will help decrease the inflammation of the ligament as it attaches to the heel. It can come in the form of medication (Motrin, Aleve, Voltaren, Relafen, Vioxx, Celebrex), cortisone injections, ice, or Physical therapy. Some or none of these may be necessary to help with the inflammatory process.
3) To try identify and eliminate aggravating factors such as muscle tightness, training errors in athletics, and to possibly change shoe gear if necessary.
The 3 most common areas of tightness are in the hips, hamstrings,
and calf muscles. Performing 5 repetitions per leg of each of the
above exercises, 3 sessions per day, should help to reduce muscle
tightness which may be contributing to improper mechanics associated
with heel and arch pain.
Most patients will respond quickly to conservative care. Compliance
is important. We do not like people to stop exercising
or working. We encourage them to cross train or modify their activities.
This assists us in helping you both physically and physiologically.
