Plantar fasciitis is a painful condition affecting the connective tissue that stretches between the heel and the middle of the foot. It is usually caused by overuse, injury or muscular abnormalities. In extracorporeal shockwave therapy, a machine is used to deliver sound waves to the painful area. It is not known exactly how it works, but it is thought that it might stimulate healing of the fascia.
A variety of causes exist for plantar fasciitis. Some of the most common causes include excessive weight load on the foot due to obesity or prolonged standing, mechanical imbalances of the foot, osteoarthritis and rheumatoid arthritis, sudden increase in body weight (e.g., pregnancy), sudden increase in walking or running, tight calf muscles is a very common cause of the disorder, wearing shoes with poor support, including flip-flops. Another cause of pain is the shortening of the plantar fascia overnight due to the ankle bending, causing the toes to point towards the ground. The plantar fascia stretches in the morning when you stand. The act of lengthening it causes a great deal of pain. However, this is not limited to an overnight occurrence, it can happen any time the foot is flexed (i.e., pointed) for extended periods of time. For example, driving in the car for long periods can cause fasciitis in the right foot, which steps on the accelerator.
Pain is the main symptom. This can be anywhere on the underside of your heel. However, commonly, one spot is found as the main source of pain. This is often about 4 cm forward from your heel, and may be tender to touch. The pain is often worst when you take your first steps on getting up in the morning, or after long periods of rest where no weight is placed on your foot. Gentle exercise may ease things a little as the day goes by, but a long walk or being on your feet for a long time often makes the pain worse. Resting your foot usually eases the pain. Sudden stretching of the sole of your foot may make the pain worse, for example, walking up stairs or on tiptoes. You may limp because of pain. Some people have plantar fasciitis in both feet at the same time.
Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your plantar fasciitis they will investigate WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts. X-rays may show calcification within the plantar fascia or at its insertion into the calcaneus, which is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests (including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.
Non Surgical Treatment
The following self-help treatments have been found to be most effective. Rest your foot. Reduce the amount of weight-bearing activities you participate in. Get off of your feet and elevate them. This will allow healing to begin. Apply ice to your foot. Applications of ice packs that provide a comfortable cooling to the heel and arch (not a freezing cold) will help reduce pain, swelling, and inflammation. Apply the ice to the heel and arch (not the toes). Make sure it is comfortable, and leave on your foot for about 20 minutes, 3 times a day. If you have any medical problems such as diabetes, poor circulation, etc., discuss the use of ice with your doctor before applying the ice. ActiveWrap allows you to apply comfortable cold therapy to your foot without messy ice cubes. Use while on the “go.” Do not walk with bare feet. Always protect your heels, arches, and plantar fascia with good supportive shoes. Orthaheel Orthotic Flip Flops For Men and Women are designed for walking comfort with built in orthotic footbeds that help reduce foot pain from plantar fasciitis. Use in the house or on the beach. Stretch the Plantar Fascia while sleeping. Plantar Fasciitis and Heel Spur pain is usually worse with the first steps in the morning. This is due to the Plantar Fascia tightening up, or contracting while we sleep. To prevent these pain producing contractures of the plantar fascia, the foot must be held in its normal or neutral position while we sleep. This optimal position of the foot is maintained with our comfortable and supportive Night Splint. When foot contractures are prevented during sleep, the “first step pains” Plantar Fasciitis and Heel Spurs will gradually subside. Stretch the Plantar Fascia during the day. Even though the Plantar Fascia is a thick tissue band with very little “give” to it, with the proper care (a Night Splint and the following exercises) it can be stretched a small amount. By stretching the Plantar Fascia even a bit, its abnormal pull on the heel is reduced. This will help to reduce pain and inflammation in the heel and arch. Two of the most effective exercises recommended are. Before stepping down, especially after sleeping or resting, stretch the arch of the foot by stretching your legs out in front of you (do not bend the knee). Place a towel around the ball of the foot. Slowly pull on the ends of the towel, pulling the toes and ball of the foot back as far as is comfortable. Hold the foot in this position for ten seconds. Repeat at least ten times. You should feel a pull on the bottom of the foot, especially in the arch. This stretches the plantar fascia, and reduces its pull on the heel. Stand about 2 to 3 feet from a wall. Lean forward with your hands against the wall. With the painful foot behind, place the other foot forward. Press against the wall, shifting weight over the front foot, while straightening the back leg. Keep the heel of the back foot on the floor and feel the stretch in the heel, Achilles tendon, and calf. Hold this position for ten seconds. Repeat at least ten times, and try to do this three times a day. When these things are achieved, the inflammation and pain of Plantar Fasciitis and Heel Spurs will gradually subside. If you are unsure of the nature of your foot problem, if your pain is intense and does not subside, if you are a diabetic or have other medical problems, if your pain is due to an injury, if an open sore is present, if a mass can be felt, or if you think that you may have an infection, we suggest that before beginning any of the above treatments you consult with your doctor.
The majority of patients, about 90%, will respond to appropriate non-operative treatment measures over a period of 3-6 months. Surgery is a treatment option for patients with persistent symptoms, but is NOT recommended unless a patient has failed a minimum of 6-9 months of appropriate non-operative treatment. There are a number of reasons why surgery is not immediately entertained including. Non-operative treatment when performed appropriately has a high rate of success. Recovery from any foot surgery often takes longer than patients expect. Complications following this type of surgery can and DO occur! The surgery often does not fully address the underlying reason why the condition occurred therefore the surgery may not be completely effective. Prior to surgical intervention, it is important that the treating physician ensure that the correct diagnosis has been made. This seems self-evident, but there are other potential causes of heel pain. Surgical intervention may include extracorporeal shock wave therapy or endoscopic or open partial plantar fasciectomy.