Plantar fasciitis is one of the most common, painful foot problems. It is a syndrome where degeneration of the band of tissue that runs from the heel along the arch of the foot develops. Often, a heel spur accompanies the problem. Contrary to belief, the spur is the result of, and not the cause of the fasciitis.
Approximately, 70 of patients with plantar fasciitis have a heel spur that is visible on x ray.
The plantar fascia is strong and thick and is responsible for maintaining the arch of the foot. Since it bears the brunt of weight on the foot with walking and running, it is the recipient of a tremendous amount of stress.
Plantar fasciitis occurs in two million Americans a year and 10 of the population over a lifetime. It is commonly associated with prolonged periods of weight bearing. Obesity is a big risk factor.
Symptoms of plantar fasciitis are typically worse early in the morning after a night’s sleep. When a patient arises, the pain in the bottom of the heel is excruciating… “like an ice pick has been jammed into the heel.” The pain subsides gradually with walking.
During the day, if a patient sits for any length of time, then gets up and walks again, the pain returns.
With a bit more walking, the pain soon decreases, only to return again with prolonged weight bearing.
Treatment of plantar fasciitis involves the following:
Avoiding the inciting activity; As an example, a patient should take a few day off jogging or prolonged standing or walking. Resting usually helps to eliminate the pain, and will allow the discomfort to cool down.
Icing will help to reduce some of the symptoms and control the heel pain. Icing is especially helpful after an acute flare of symptoms.
Exercises and stretches are designed to relax the tissues that surround the heel bone. Some simple exercises, performed in the morning and evening, can help patients feel better quickly.
Anti inflammatory medications help to relieve pain and decrease inflammation. Both over the counter and prescription options may be helpful.
Shoe inserts can lead to successful treatment of plantar fasciitis. The shoe inserts often permit patients to continue their routine activities without pain. They work by supporting the arch.
Night splints are worn to keep the heel stretched during sleep. By doing so, the arch of the foot does not contract at night, and is less painful in the morning.
If the pain does not resolve, the old approach was to administer a shot of cortisone to relieve inflammation.
However, there are potentially serious problems with cortisone injections. The two problems that can occur are fat pad atrophy and plantar fascial rupture. Both of these problems occur in a very small percentage of patients, but they can cause a worsening of heel pain symptoms.
A new treatment for chronic plantar fasciitis, called extracorporeal shock wave therapy, or ESWT, uses energy pulses to induce microtrauma to the tissue of the plantar fascia. This microtrauma is thought to induce tissue repair. Some people do well with this.
The treatment approach of choice though is percutaneous needle tenotomy with autologous tissue grafting. In this procedure, a physician will introduce a small needle under ultrasound guidance and used it to poke small holes in the plantar fascial attachment at the heel.
Following this, platelet rich plasma, a concentrate of plasma from the patient’s own blood is injected into the tenotomized area. The platelet rich plasma contains abundant growth and healing factors. The planatar fascial tissue is regenerated.
In patients who do not respond to these measures, surgery is suggested.
Author Resource:
Nathan Wei, MD FACP FACR is a board-certified rheumatologist and arthritis expert. He is Director of the Arthritis Treatment Center located in Frederick, Maryland.
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