PLANTAR FASCIITIS

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Plantar fasciitis is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).

Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move, the pain normally decreases, but it might return after long periods of standing or when you stand up after sitting.

Plantar fasciitis is more common in runners. People who are overweight and those who wear shoes with inadequate support also have an increased risk of plantar fasciitis.

PLANTAR FASCIA ANATOMY

DISEASE EXPLAINED

SYMPTOMS

Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or when you get up after sitting. The pain is usually worse after exercise, not during it.

CAUSES

Your plantar fascia is in the shape of a bowstring, supporting the arch of your foot and absorbing shock when you walk. If tension and stress on this bowstring become too great, small tears can occur in the fascia. Repeated stretching and tearing can irritate or inflame the fascia, although the cause remains unclear in many cases of plantar fasciitis.

TREATMENT

TREATMENT OPTIONS

Most people who have plantar fasciitis recover in several months with conservative treatment, including resting, icing the painful area and stretching.

MEDICATIONS
Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) may ease the pain and inflammation caused by plantar fasciitis.

THERAPIES
Stretching and strengthening exercises or using special devices may relieve symptoms. They include:

PHYSICAL THERAPY.
A physical therapist can show you a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles. A therapist might also teach you to apply athletic taping to support the bottom of your foot.

NIGHT SPLINTS.
Your physical therapist or doctor might recommend that you wear a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight to promote stretching.

ORTHOTICS.
Your doctor might prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.

If more-conservative measures aren't working after several months, your doctor might recommend:

INJECTIONS.
Injecting steroid medication into the tender area can provide temporary pain relief. Multiple shots aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture. Using ultrasound imaging, platelet-rich plasma obtained from the patient's own blood can be injected to promote tissue healing.

EXTRACORPOREAL SHOCK WAVE THERAPY.
In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It's usually used for chronic plantar fasciitis that hasn't responded to more-conservative treatments. Some studies show promising results, but it hasn't been shown to be consistently effective.

ULTRASONIC TISSUE REPAIR.
This minimally invasive technology was developed in part by Mayo Clinic doctors. It uses ultrasound imaging to guide a needlelike probe into the damaged plantar fascia tissue. Using ultrasound energy, the probe tip vibrates rapidly to break up the damaged tissue, which is then suctioned out.

SURGERY.
Few people need surgery to detach the plantar fascia from the heel bone. It is generally an option only when the pain is severe and other treatments have failed. It can be done as an open procedure or through a small incision with local anesthesia.

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