Plantar Fasciitis

Plantar fasciitis is one of the most common ailments that affects the foot. It starts as a dull intermittenet pain in the heel which may progress to a sharp persistent pain. Typically, it is worse in the morning with the first few steps, after sitting or standing, or at beginning of a sport or activity.

There are more than 3 million doctor visits per year by people with heel pain. Most of these cases are plantar fasciitis and the medical literature typically reveals that up to 90 percent of the time, heel pain resolves with conservative treatment.

The plantar fascia is a think fibrous material on the bottom (plantar aspect) of the foot. The fascia is attached to the heel bone (calcaneus), extends forward toward the toes, and acts like a bowstring to maintain the arch of the foot.

The classic symptoms of plantar fasciitis include more pain with first steps in the morning and first steps after sitting. The onset is typically gradual and most of the time, the symptoms will progress unless treatment begins.

The condition occurs when the plantar fascia is stained over time beyond its normal extension, causing the soft tissue fibers of the fascia to tear or stretch at points along its length; this leads to inflammation, pain, and possibly the growth of a bone spur where the plantar fascia attaches to the heel bone. The inflammation may be aggravated by shoes that lack appropriate support, especially in the arch area, and by the chronic irritation that sometimes accompanies an athletic lifestyle.

Contributing Factors

• Flat (pronated) feet
• High-arched, rigid feet
• Improper shoes with inadequate support
• Toe running and hill running
• Soft terrain (i.e., running on sand)
• Increasind age
• Sudden weight increase
• Sudden increase in activity or training level
• Family tendency

Resting provides only temporary relief. When you resume walking, particularly after a night's sleep, you may experience a sudden elongation of the fascia band, which stretches and pulls on the heel. As you walk, the heel pain may lessen or even disappear. but that may be just a false sense of relief. The pain often returns after prolonged rest of extensive walking.

A variety of steps can be taken to avoid heel pain and accompanying afflictions:

• Wear shoes that fit well - front, back, and sides - and have shock-absorbent  soles, rigid shanks, and supportive heel counters
• Wear the proper shoes for each activity
• Do not wear shoes with excessive wear on heels or soles
• Prepare properly before exercising. Warm up and do stretching exercises before and after running
• Pace yourself when you participate in athletic activities
• Don't underestimate your body's need for rest and good nutrition
• If obese, lose weight

It is very important to see a physician for treatment if symptoms are not improving or the pain is limiting your activity. Most of the time plantar fasciitis is caused by a functional or structural problem in your foot. Your physician can determine the cause of the problem and address those problems.

Common causes include excessive pronation, tightness in the achilles tendon, overuse, an inflamed bursa or bone contusion must also be ruled out.

Your physician will examine the area and may perform diagnostic X-rays to rule out problems of the bone.

Early treatment might involve oral or injectable anti-inflammatory medication, exercise and shoe recommendations, taping or strapping, or use if shoe inserts or orthotic devices. Physical therapy may be used in conjunction with such treatments.

A functional orthotic device may be prescribed for correcting biomechanical imbalance, controlling excessive pronation, and supporting the ligaments and tendons attaching to the heel bone. It will effectively treat the majority of heel and arch pain without the need for surgery.

Only a relatively few cases of heel pain require more advanced treatments or surgery. If surgery is necessary, it may involve the release of the plantar fascia, removal of a spur, removal of a bursa, or removal of a neuroma or other soft-tissue growth.

Author

Bryan Broadbent, DPM