Recovery Guide : Plantar Fasciitis

What Is It?

Plantar fasciitis is a common foot problem effecting an estimated 10% of the population at some time during their lifetime. Millions of Americans are diagnosed with Plantar Fasciitis each year.  The plantar fascia is the tough fibrous band under the sole of the foot that is responsible for maintaining the integrity and arch of the foot.  Since the foot is used in many types of activities, it is subject to numerous types of traumatic, degenerative, and inflammatory conditions and many of these involve the plantar fascia.  Therefor the causes of plantar fasciitis are numerous.  Some of the more common causes include;

1. Repetitive trauma. Very common in athletes especially distance runners.

2. Obesity

3. Flat feet

4. Bone spurs

5. Poor fitting footwear

6. Aging

7. Degenerative conditions such as arthritis.

Diagnosis

Pain is the most common symptom.  The pain often begins in the heel area, but may be in any part of the fascia.  It is typically worse when beginning to use the foot such as getting out of bed only to subside somewhat after the foot stretches and then get worse with prolonged weight bearing or activity.  There is often point tenderness to touch in the afflicted area.  Typical signs of inflammation such as redness and swelling are usually not present.  For the most part, the diagnosis is based on the historical and clinical findings.

The finding of pain, especially in the heel, point tenderness, one of the causative factors, and the clinical presentation is often enough to give the Doctor a presumptive diagnosis of plantar fasciitis.  Routine foot x-rays are sometimes done to rule out other causes of pain such as a stress fracture, or a degenerative condition like arthritis.  Other more complex radiological studies such as CT, MRI or ultrasonography are usually not needed unless there has been treatment failure and other conditions must be ruled out.  Once a presumptive diagnosis is made the initial treatment is usually conservative.

Treatment

The initial treatment is to rest the foot as much as possible and to minimize trauma and irritation to the afflicted area.  Several simple things can be done such as;

1. Avoid flat shoes, flip-flops or going barefoot

2. Use over-the- counter heel inserts or foot pads to provide arch support

3. Stretching exercises first thing in the morning and through out the day

4. Minimizing (if possible) the aggravating factors such as running, dancing or jumping. Icing the instep.

5. Rolling the instep over a frozen water bottle is an easy way to do this.

6. If expecting a lot of walking such as visiting a theme park, consider using a knee walker or wheelchair.

If focal areas of tenderness are located, injections with glucocorticoids and a local anesthetic provide immediate and sometimes long-lasting relief.  The use of mild analgesics such as aspirin or Tylenol often helps.  Non-steroidal anti-inflammatory drugs (NSAIDs) are helpful but they should not be given for more than a few weeks.  Initial conservative treatment often results in up to 90% of the patients getting relief or improvement of the pain.  If the condition persists, more aggressive and costly treatments can be considered.

1. Custom molded shoes

2. Night splints

3. Immobilization in a cast.

4. Extracorporeal shock wave therapy

5. Surgery is indicated in very few cases

In summary, plantar fasciitis is a common foot problem affecting in millions of Americans each year causing inconvenience, and pain.  The diagnosis is usually by clinical means and the initial treatment conservative.  Improvement or cure can be expected in most cases.

Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with physicians. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.

Bibliography “21 Surprising Plantar Fasciitis Statistics.” Heel That Pain. November 20, 2016. https://heelthatpain.com/plantar-fasciitis- statistics/. Karl B. Fields, MD. “Evaluation and diagnosis of common causes of foot pain in adults.” UpToDate (Wolters Kluwer ), January 2018. Rachelle Buchbinder, MMBS, MSc, PhD, FRACP. "Plantar Fasciitis." UpToDate, (Wolters Kluwer) May 5, 2017.

#KneeScooter #KneeWalker