Plantar fasciitis, the heel pain caused by irritation of the connective tissue on the bottom of the foot, can be lingering and intractable. A recent study of novice runners found that those who
developed plantar fasciitis generally required at least five months to recover, and some remained sidelined for a year or more. Until recently, first-line treatments involved stretching and
anti-inflammatory painkillers such as ibuprofen or cortisone. But many scientists now believe that anti-inflammatories are unwarranted, because the condition involves little inflammation. Stretching
is still commonly recommended.
Plantar fasciitis is common in sports which involve running, dancing or jumping. Runners who overpronate where their feet roll in or flatten too much are particularly at risk the plantar fascia is
over stretched as the foot flattens. A common factor is tight calf muscles which lead to a prolonged or high velocity pronation or rolling in of the foot. This in turn produces repetitive
over-stretching of the plantar fascia leading to possible inflammation and thickening of the tendon. As the fascia thickens it looses flexibility and strength. Other causes include either a low arch
called pes planus or a very high arched foot known as pes cavus. Assessing the foot for plantar fasciitisExcessive walking in footwear which does not provide adequate arch support has been
attributed. Footwear for plantar fasciitis should be flat, lace-up and with good arch support and cushioning. Overweight individuals are more at risk of developing plantar fasciitis due to the excess
weight impacting on the foot.
The main symptom of plantar fasciitis is heel pain when you walk. You may also feel pain when you stand and possibly even when you are resting. This pain typically occurs first thing in the morning
after you get out of bed, when your foot is placed flat on the floor. The pain occurs because you are stretching the plantar fascia. The pain usually lessens with more walking, but you may have it
again after periods of rest. You may feel no pain when you are sleeping because the position of your feet during rest allows the fascia to shorten and relax.
A physical exam performed in the office along with the diagnostic studies as an x-ray. An MRI may also be required to rule out a stress fracture, or a tear of the plantar fascia. These are conditions
that do not normally respond to common plantar fasciitis treatment.
Non Surgical Treatment
Many types of treatment have been used to combat plantar fasciitis, including injections, anti-inflammatory medications, orthotics, taping, manipulation, night splinting, and instrument-assisted
soft-tissue manipulation (IASTM). IASTM begins with heat, followed by stretching. Stretching may be enhanced by applying ice to the plantar fascia. These stretches should be performed several times
per day, with the calf in the stretched position. IASTM uses stainless-steel instruments to effectively access small areas of the foot. IASTM is believed to cause a secondary trauma to injured soft
tissues as part of the healing process. Therapeutic modalities such as low-level laser, ultrasound, and electrical muscular stimulation may be effective in the reduction of pain and inflammation. Low
Dye strapping or taping of the foot is an essential part of successful treatment of plantar fasciitis. Extracorporeal shock-wave therapy (ESWT) was introduced with great promise at one time. Recent
studies have reported less favorable results. Some report no effect. Previous local steroid injection may actually have a negative effect on results from ESWT.
The majority of patients, about 90%, will respond to appropriate non-operative treatment measures over a period of 3-6 months. Surgery is a treatment option for patients with persistent symptoms, but
is NOT recommended unless a patient has failed a minimum of 6-9 months of appropriate non-operative treatment. There are a number of reasons why surgery is not immediately entertained including.
Non-operative treatment when performed appropriately has a high rate of success. Recovery from any foot surgery often takes longer than patients expect. Complications following this type of surgery
can and DO occur! The surgery often does not fully address the underlying reason why the condition occurred therefore the surgery may not be completely effective. Prior to surgical intervention, it
is important that the treating physician ensure that the correct diagnosis has been made. This seems self-evident, but there are other potential causes of heel pain. Surgical intervention may include
extracorporeal shock wave therapy or endoscopic or open partial plantar fasciectomy.
Stretching exercises for the Achilles tendon and plantar fascia are recommend to relieve pain and aid in the healing process. Sometimes application of athletic tape is recommended. In moderate or
severe cases of plantar fasciitis, your doctor may recommend you wearing a night splint, which will stretch the arch of your foot and calf while you sleep. This helps to lengthen the Achilles tendon
and plantar fascia for symptom relief. Depending on the severity of your plantar fasciitis, your physician may prescribe a store-bought orthotic (arch support) or custom-fitted orthotic to help
distribute your foot pressure more evenly.