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The Ever Chronic Condition: Plantar Fasciitis
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| The cardinal symptom of plantar fasciitis is severe pain on the bottom of and on the inner side of the foot, in the morning when first taking a few steps. Common in dancers and runners, although it can occur in anyone, the pain is often described as “knife-like.” It occurs due to repetitive stretching of tight plantar fascial bands (see figures) creating micro tears. Factors that influence the occurrence include the following: obesity or sudden weight gain, tight Achilles Tendon (heel cord), an increase or change in physical activity, shoes with poor support, change in running or walking surface, occupation which involves prolonged weight bearing, and foot structure. Unless treated appropriately, this can become chronic and debilitating. | |
As far as diagnosing plantar fasciitis, a physician or physical therapist is able to do so from a patient’s history and from an exam. Imaging studies and lab work may be performed to rule out other problems such as fracture, rheumatoid arthritis, tumor, plantar fascial rupture, infection, sciatica, or other conditions. A heel spur, where the plantar fascia pulls on the bottom of foot at the heel bone creating extra calcium deposits, can occur in conjunction with plantar fasciitis. |
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Although the factors listed above are commonsensical, many discount the biomechanics (structure) of the foot. Those with high-arched feet are at risk because the plantar fascia is constantly in a stretched position. Flat feet can result in a person pronating (rolling the foot inward), as there is very little support at the arch. Other biomechanical factors are tight Achilles Tendons, and too much or too little movement in the joints of the foot and ankle. A factor that is often ignored is that the foot structure actually changes as we age. |
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| Treatment of plantar fasciitis focuses first on eliminating pain and inflammation. This is achieved through the combination of the following: icing, ultrasound or phonophoresis, stretching, deep tissue manual therapy, joint mobilization, and anti-inflammatories as recommended by your physician. Night splints may be prescribed to maintain the plantar fascia in a stretched position. Eliminating pain is not sufficient though to prevent this chronic condition from reoccurring. Flexibility exercises, such as calf stretches need to be implemented on a regular basis. Strengthening exercises, as recommended by your physical therapist, will address any weaknesses present in the foot and ankle. Wearing appropriate footwear at all times is imperative. Flip-flops and heels although fashionable and practical in Florida, do not provide the necessary arch support. The most important facet of treatment is correcting any faulty biomechanics. This could simply mean selecting the appropriate shoe, using a shoe insert, or can be more involved, such as designing an orthotic. Unfortunately, because patients have difficulties complying with all of the components of the treatment plan, the condition becomes chronic, and limits patients from performing physical activities they enjoy. In rare cases, more aggressive treatment such as corticosteroid injections are used. Injections are not encouraged, as they are often temporary, and can cause destruction of the plantar fat pad or rupture of the plantar fascia. If all conservative methods of treatment have failed, Plantar Fasciotomy (surgery which releases the plantar fascia) can be performed. The success rate for pain relief after surgery is 70 - 90%. How much do you know about Plantar Fasciitis? The reason those with Plantar Fasciitis have so much pain in the morning when they take their first steps, is because when we sleep, our foot relaxes and drops. In the morning when we first set our feet on the floor, the bottom of the foot (and plantar fascia) are stretched. Pain can be avoided or minimized by using a night splint or gently stretching or massaging the bottom of the foot before getting out of bed. References |
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