HEALTH ISSUES

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Plantar Fasciitis

Plantar Fasciitis
Heel Spur Syndrome

What is the plantar fascia?

The plantar fascia is a strong thick band of connective tissue that runs along the bottom of the foot. It functions to help support the arch of the foot. The plantar fascia begins at the calcaneus (heel bone) and ends at the base of the toes.

What is plantar fasciitis?

This is a term that describes inflammation of the plantar fascia. There are several terms used to describe this condition including heel spur syndrome, plantar fasciitis, and heel pain syndrome. When inflamed, the plantar fascia tends to hurt in the heel and arch areas. With long term (chronic) fasciitis, the heel bone reacts by laying down minerals within the fascia at its insertion giving the appearance of a heel spur.

Symptoms of Plantar Fasciitis?

The most consistent finding with plantar fasciitis is post-static dyskinesia. This is pain after rising from a period of non-weight bearing, such as arising from bed in the morning or standing up after working at your desk for several hours. This pain will usually subside after a short while only to return later. Other common symptoms include arch pain, fullness/swelling in the heel, or the feeling of a bone bruise.

Causes of plantar fasciitis:

Sudden increase in activity level without proper stretching

Poor foot mechanics

Pronation (foot rolls in/fallen arch)

Structural foot problems

Trauma/injury

Standing/walking on hard surfaces

Climbing ladders or stairs

Poor shoes

Flat feet

High arch feet

Weight gain

Pushing objects

Post-partum

Diagnosis

Onset:
Usually gradual with progression of symptoms. Patients average three to four months after initial onset before seeking medical attention.

Pain:
Deep ache on bottom of heel and arch pain. Especially painful when putting weight on the heel after periods of rest i.e. the first few steps.

X-rays:
Used to rule out bony abnormalities or fractures. Also helpful in visualizing tissue effusion, soft tissue swelling, and spurs.

Differential Diagnosis

Stress fracture

Bursitis

Stone bruise

Infection

Nerve entrapment

Arthritides

Tendonitis

Radiculopathy (low back)

Treatment of Plantar Fasciitis

The vast majority of patients with plantar fasciitis/heel spur syndrome improve dramatically with a course of good conservative care. The interval of time between initial onset of symptoms and beginning of therapy correlates directly with poor prognosis. In other words, the longer it takes to seek help, the longer it takes to reduce the inflammation and control the mechanics. However, it should be emphasized that conservative care is effective over 95% of the time. If conservative therapy fails, there are surgical options available. These surgeries are almost always done in an out-patient setting meaning you are able to walk in and out of the surgery center or hospital on the same day.

Conservative care

1. Control foot mechanics
The abnormal forces acting on the fascia must be controlled. If you eliminate/reduce the stress, you eliminate/reduce the cause of the inflammation. The two most effective methods are strapping (taping the foot) and orthotics (custom molded shoe inserts).

2. Anti-inflammatory modalities
The inflammation must be reduced as quickly as possible. The anti-inflammatory portion of the treatment regime is probably the least important, but it is the quickest to achieve its goal. Anti-inflammatory modalities include ice application, oral medication, and cortisone injections.

3. Physical therapy
Physical therapy is key to overcoming inflammation and decreasing the likelihood of reoccurrence. Physical therapy treatment modalities include stretching, ultrasound, iontophoresis, ice massage, and education.

Only after a full course of unsuccessful conservative therapy should surgery be considered. The goal of surgery is to functionally lengthen the plantar fascia. The procedure releases a portion of the plantar fascia near its insertion at the heel. This allows the fascia to heal in a lengthened fashion. As mentioned above, this procedure is usually performed in an out-patient setting, meaning no overnight hospital stay. Additionally, it should be noted that following the surgery you usually do not need crutches and are encouraged to walk utilizing a post-op stiff sole shoe.