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Plantar Fasciitis - What is it?


Plantar fasciitis is a common foot problem that affects the old and the young. It usually presents with pain in the heel that can be quite severe. The pain can radiate to the back of the heel, and out through the arch. Pain is usually greatest when a person first gets up out of bed or long periods of sitting, and after prolonged periods of standing or walking.

The pain of plantar fasciitis is caused by an inflammation of the ligament on the bottom of the foot, the plantar fascia. The purpose of this ligament is to support the arch of the foot. If there is excessive tension on this ligament, it may become inflamed, leading to plantar fasciitis. The area of the ligament which is most susceptible to inflammation and pain is where the ligament inserts into the heel. This is why the pain people experience is usually on the bottom of the heel.

Frequently, the tension of the ligament will cause a bone spur to form on the bottom of the heel bone. While the bone spur is associated with plantar fasciitis, the bone spur itself is rarely the cause of heel pain, and therefore does not need to be removed surgically.

How is plantar fasciitis diagnosed?

The diagnosis of plantar fasciitis is made by a review of the patient's history of heel pain and physical examination which may include both x-rays and ultrasound. X-rays are useful in ruling out other causes of heel pain such as stress fractures. Ultrasound is extremely helpful, as it allows the doctor to visualize the plantar fascia itself (which is not visible on x-ray). When the plantar fascia is inflamed, it becomes thickened. This thickening can be measured, and compared to a normal plantar fascia.

 

As part of your first visit, a strapping may be applied to your foot. This relieves stress off of the plantar fascia, and quite often has the effect of relieving pain immediately. If you have strapping applied to your foot, it is important to keep it dry, and leave it in place for no longer than 3 to 5 days.

What can I do myself to relieve my heel pain?

There are numerous things the patient can do him or herself to help in the treatment of plantar fasciitis. These include stretching, icing, over-the-counter arch supports, and anti-inflammatory medications such as aspirin or ibuprofen.

What treatments will the doctor recommend?

The good news in the treatment of plantar fasciitis is that the pain usually responds well to conservative care. The first thing the doctor may recommend is to have functional foot orthotics fabricated. These are devices which are made from plaster impressions of your feet, and go in the shoes and help to properly align the foot, thereby relieving stress from the plantar fascia. Of all the treatment options available, orthotics are the only modality that has the benefit of treating the symptoms as well as the cause of the symptoms. They need to be worn in shoes, preferably shoes that lace up, such as an athletic, running, or walking shoe. For patients who love sandals, there is the option of making a second pair for sandals which are specifically designed to hold orthotics. If you have questions regarding the orthotic sandals, our staff will gladly show you a catalog of available sandals.

Other treatment options available include cortisone injections, night splints, immobilization with the use of a waking cast, Extracorporeal Shock Wave therapy, and surgery.

Although this is a condition that usually responds well to conservative treatment, the longer you have had your symptoms, the longer it may take to have them resolve. Dr. Quist and his staff are committed to helping you get back to your normal activities pain-free as soon as possible.