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| Plantar fasciitis | Plantar fasciitis is a painful inflammatory condition of the foot caused by excessive wear to the plantar fascia that supports the arch or by biomechanical faults that cause abnormal pronation. The pain usually is felt on the underside of the heel, and is often most intense with the first steps of the day. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing or activity. Obesity, weight gain, jobs that require a lot of walking on hard surfaces, shoes with little or no arch support, and inactivity are also associated with the condition.
Plantar fasciitis was formerly called "a dog's heel" in the United Kingdom. It is sometimes known as "flip-flop disease" among US podiatrists. The condition often results in a heel spur on the calcaneus, in which case it is the underlying condition, and not the spur itself, which produces the pain.
Many different treatments have been effective, although without treatment resolution may be delayed for up to and over a year! Initial treatment includes stretching of the Achilles tendon and plantar fascia, keeping off the foot as much as possible, weight loss, arch support and heel lifts, and taping. Difficult cases may be referred for physical therapy. The mainstays of physical therapy include myofascial release and scar tissue breakdown of the plantar fascia, and supervised stretching. Care should be taken to wear supportive and stable shoes. Patients should avoid open-back shoes, sandals, "flip-flops", and any shoes without raised heels. Molded foam clogs such as CrocsRx have been approved by the American Podiatric Medical Association and United States Ergonomics as a healthy alternative to flip-flops. To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of limited benefit.. Patients should be encouraged to lessen activities which place more pressure on the balls of their feet because it increases tension in the plantar fascia. This is counter-intuitive because the pain is in the heel, and the heel is often sensitive to pressure which causes some patients to walk on the balls of their feet.
Local injection of corticosteroids often gives temporary or permanent relief, but may be painful, especially if not combined with a local anesthetic and injected slowly with a small-diameter needle. Recurrence rates may be lower if injection is performed under ultrasound guidance. Repeated steroid injections may result in rupture of the plantar fascia. This may actually improve pain initially, but has deleterious long-term consequences.
In cases of chronic plantar fasciitis of at least 10 months duration, one recent study has shown high success rates with a stretch of the plantar fascia. Prolotherapy has been shown to be effective in treating Plantar fasciitis.[9] Therapeutic ultrasound has been shown in a controlled study to be ineffective as a treatment for plantar fasciitis.
Pain with first steps of the day can be markedly reduced by stretching the plantar fascia and Achilles tendon before getting out of bed. Night splints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease morning pain. These have many different designs, some of which may be hard and may press on the origin of the plantar fascia. Softer, custom devices, of plastizote, poron, or leather, may be more helpful. Orthoses should always be broken in slowly.
More recently, however, extracorporeal shockwave therapy (ESWT) has been used with some success in patients with symptoms lasting more than 6 months. The treatment is a nonsurgical procedure, but is painful, and should be done either under sedation, or with local anaesthesia either with or without intravenous sedation (twilight sedation). Local anaesthesia by injection of drugs into the area can also be painful, and may incur the risks of neuritis, bleeding, and infection. ESWT re-inflames the area and in doing so increases blood flow to the area as a means to heal the area. It can take as long as six months following the procedure to see results. Results are variable, and one 2002 study reported ESWT for plantar fasciitis had no benefit.
Most patients should improve within one year of beginning non-surgical treatment, without any long-term problems. A few patients, however, will require surgery, which when needed is 95% successful.
If this sounds like someone you know, please contact us for an appointment today for a complete examination and discussion of the appropriate treatments.
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1077 East Lexington Avenue
Danville, KY 40422
859-236-3142
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Lexington, KY 40503
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Versailles, KY 40383
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