Health Care and Plantar Fasciitis

People who have plantar fasciitis typically experience terrible foot pain on the bottom of their foot. Often, the pain can be excruciating to the point of someone having the inability to walk without difficulty. Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time.

 This type of health problem of the heel and plantar surface of the foot is characterized by inflammation, fibrosis, or structural deterioration of the plantar fascia of the foot. The plantar fascia is a thick fibrous band of connective tissue that originates on the medial tubercle of the heel bone and extends along the sole of the foot towards the toes and supports the arch of the foot. The condition is often caused by overuse of the plantar fascia, increases in physical activity, weight or age. Chronic cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, according to the Journal of the American Podiatric Medical Association.

Plantar fasciitis is the most common injury of the plantar fascia and is the most common cause of heel pain. Approximately 10% of people have plantar fasciitis at some point during their lifetime. It is commonly associated with long periods of weight bearing and is much more prevalent in individuals with hyperpronation (flat feet). Among non-athletic populations, it is associated with obesity. Plantar fasciitis pain is usually felt on the underside of the heel and is often most intense with the first steps of the day.

Those with plantar fasciitis often have difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle) due to tightness of the gastrocnemius muscle or Achilles tendon. Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling.

In general, plantar fasciitis is a self-limiting condition, according to the Association of American Family Physicians. Unfortunately, the time until resolution is often six to 18 months, which can lead to frustration for patients and physicians. Rest was cited by 25 percent of patients with plantar fasciitis in one study as the treatment that worked best. Athletes, active adults and persons whose occupations require lots of walking may not be compliant if instructed to stop all activity. Many sports medicine physicians have found that outlining a plan of “relative rest” that substitutes alternative forms of activity for activities that aggravate the symptoms will increase the chance of compliance with the treatment plan.

It is equally important to correct the problems that place individuals at risk for plantar fasciitis, such as increased amount of weight-bearing activity, increased intensity of activity, hard walking/running surfaces and worn shoes. Early recognition and treatment usually lead to a shorter course of treatment as well as increased probability of success with conservative treatment measures. More info can be found at this website: http://www.aafp.org/afp/2001/0201/p467.html.

According to the National Institutes of Health,your health care provider will usually first recommend:

Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation

·         Heel and foot stretching exercises

·         Night splints to wear while sleeping to stretch the foot

·         Resting as much as possible for at least a week

·         Wearing shoes with good support and cushions

Other steps to relieve pain include:

·         Apply ice to the painful area. Do this at least twice a day for 10 - 15 minutes, more often in the first couple of days.

·         Try wearing a heel cup, felt pads in the heel area, or shoe inserts.

·         Use night splints to stretch the injured fascia and allow it to heal.

If these treatments do not work, your health care provider may recommend:

·         Wearing a boot cast, which looks like a ski boot, for 3-6 weeks. It can be removed for bathing.

·         Custom-made shoe inserts (orthotics)

·         Steroid shots or injections into the heel

Sometimes, foot surgery is needed. Nonsurgical treatments almost always improve the pain. Treatment can last from several months to 2 years before symptoms get better. Most patients feel better in 9 months. Some people need surgery to relieve the pain. More material on this subject can be found at this site: http://www.nlm.nih.gov/medlineplus/ency/article/007021.htm.

What if your symptoms of plantar fasciitis do not resolve with time? As stated above, simple treatment measures will usually work in the treatment of plantar fasciitis. These treatments include anti-inflammatory medication, shoe inserts, and stretching exercises. In cases where a good effort with these treatments fails to provide adequate relief, some more aggressive treatments may be attempted. These include cortisone injections or extracorporeal shock wave treatments.

Although surgery may be recommended for extreme cases, there can be problems that result. Some of the complications of surgery for plantar fasciitis include:

Over release of the plantar fascia: When your surgeon releases the plantar fascia, it is important to only release about 30-50% of the fascia. Release of more of the plantar fascia during surgery may cause a flat foot deformity due to the loss of the arch of the foot. Flat foot after surgery can lead to chronic problems that may be as bad as the plantar fasciitis.

Nerve injury to the foot: There are small nerves that travel just adjacent to the plantar fascia. These nerves, even with protection, may be damaged during surgery to release of the plantar fascia. Because of this, a small percentage of patients may have pain or numbness in areas of the foot following plantar fasciitis surgery.

While there are potential complications, about 70-80% of patients will find relief after plantar fascia release surgery. This may not be perfect, but if plantar fasciitis has been slowing you down for a year or more, it may well be worth these potential risks of surgery. More info can be located at this site: http://orthopedics.about.com/od/footankle/a/fasciitis.htm.

As noted, plantar fasciitis is a painful problem, but there can be relief. It just won’t happen overnight. The first thing to do is to see your family doctor and then get a recommendation to see a specialist for treatment. Most people suffering from the malady get over in time, but a few have chronic issues. The key is to not postpone treatment, and be consistent with what the diagnosis has prescribed.

Until next time.