Plantar Fasciitis
Plantar fasciitis is a painful inflammatory condition of the foot. It is caused by excessive wear to the fascia that supports the arch of the foot. The pain usually is felt on the underside of the heel, and is often most intense with the first steps of the day. Once your foot limbers up, the pain usually decreases, but it may return after long periods of standing or after getting up from a seated position. This condition has been called heel spur syndrome, although a heel spur is usually not present.
Causes
The plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing causes the fascia to become inflamed. Contributors to plantar fasciitis include: 1.) Overuse from running, walking, prolonged standing, or being overweight 2.) Faulty foot mechanics such as flat feet, high arches, or an abnormal pattern of walking. 3.) Improper shoes or going bare footed.
Treatment
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Stretching is a key component of treatment. Stretch your calf muscles, arch and Achilles tendon several times a day. This helps reverse the tightening of the plantar fascia.
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Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 to 20 minutes three or four times a day. Or try ice massage. Freeze a water-filled water bottle and roll it under the site of discomfort for about five to seven minutes. This method provides a stretch and an ice massage simultaneously.
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Ultrasound is very beneficial and may be used by your doctor. Anti-inflammatories such as aspirin and ibuprofen can be used but are of limited benefit.
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Support the arch. Your doctor may recommend off-the-shelf arch supports or custom-fitted orthotics to help distribute pressure to your feet more evenly. Good shoes are essential. Do not go bare foot.
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Night splints. Your doctor may recommend wearing a splint fitted to your calf and foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight so that they can be stretched more effectively. NightSock by Prostretch can be ordered online.
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Soft tissue techniques. Apply pressure to your heel by rolling a golf ball or tennis ball under the arch of your foot. Deep myofascial massage can be helpful.
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Rest. Avoid weight bearing exercise. Swap swimming or bicycling for walking or jogging. When symptoms have improved, implement exercise gradually, stretching and warming up first. Maintain a healthy weight.
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Surgery is a last resort. Surgery carries the risk of nerve injury, infection, rupture of the plantar fascia, and failure of the pain to improve. Surgical procedures often lead to further complications such as a lowering of the arch and pain in the supero-lateral side of the foot due to compression of the cuboid bone.
Local injection of corticosteroids often gives temporary relief. Repeated steroid injections may improve pain initially, but there are deleterious long-term consequences. This may even result in rupture of the plantar fascia.