The Comprehensive Resources on Foot Pain, Foot Pain Treatment and Foot Care

Plantar fasciitis is the most common cause of heel pain. Usually, symptoms occur with activity after resting – getting out of bed in the morning, getting out of a car after driving, getting up after sitting for a while. All of these situations tend to cause immediate pain. In general, shorter periods of standing and walking may actually provide some relief after the fascia loosens up. However, if you are on your feet all day, the pain usually returns.

The causes of plantar fasciitis are due to a variety of factors. Weight, age, physical stress and foot alignment are among the culprits.

Patients who are overweight may be more likely to develop plantar fasciitis; though, the condition can occur in all weight classes. However, overweight patients may not find relief as easily. The stress of additional weight on the feet, especially the heel, can cause the condition and continue to aggravate it.

Age can affect plantar fasciitis, as well. As a patient gets older, the plantar fascia does not stretch as well as it used to. The fat pad on the bottom of the foot tends to thin out with age. This may cause more stress on the heel, since it affects the combined shock-absorbing ability of the fascia and the fat pad.

Other situations that can lead to the development of plantar fasciitis include:

* A walking or jogging program or during prolonged standing, such as a job with little sit-down time, that adds pressure to the foot.
* The use of ill-fitted shoes and shoes that do not provide appropriate support or shock absorption.
* A switch from a higher-heeled to a lower-heeled shoe that causes tightness in the calf muscle.
* Feet that are malaligned or pronated, which is an excessively flattened foot structure, as well as a high-arched foot may cause abnormality in a patient’s gait.

DO IT YOURSELF TREATMENTS

If a patient begins at-home treatment soon after symptoms start, the painful symptoms due to plantar fasciitis may be improved. Appropriate treatments include:

* Resting the foot/feet;
* Cutting back on athletic activities, or cross-training with such activities as swimming or cycling that put less stress on the foot;
* Applying ice to the area either directly after the activity for 15-20 minutes or icing the heel on a daily basis twice a day to try to reduce some of the inflammation;
* Stretching exercises for the gastrocnemius-soleus calf muscle and the plantar fascia;
* Wearing appropriate shoe gear, especially with heel support. An anti-pronatory style running shoe might be beneficial. Over-the-counter arch supports seem to work better than just a heel pad in relieving discomfort.
* Taking over-the-counter anti-inflammatory medication, such as Advil, Aleve, Tylenol;
* Starting a diet if over-weight. Any weight loss will help to reduce pressure on the feet and strain of the plantar fascia.

DIAGNOSTIC TESTING

The main standards used to try to identify a diagnosis of plantar fasciitis include x-rays, diagnostic ultrasound and magnetic resonance imaging (MRI). In addition, computed axial tomography (CT) scans and bone scans can be utilized to help rule out other associated bone conditions or fractures involving the heel. And importantly, nerve conduction testing with an Electromyography (EMG), Nerve Conduction Velocity (NCV) and neuro-sensory testing may need to be done to rule out a neurological cause of the heel pain.

MEDICAL TREATMENTS

Once the appropriate diagnosis has been made, physical therapy is often prescribed and can be quite beneficial. Options within therapy include icing, ultrasound, iontophoresis, deep massage and an aggressive stretching and strengthening program. If the pain has been long-standing and resistant to these modalities, the Graston technique can be employed. This method utilizes stainless steel tools to detect and resolve adhesions in muscles, tendons and fascia.

Another treatment option is the night splint. This removable “boot” can be worn while the patient is sleeping. It helps to maintain tension on the plantar fascia and stretch it out through the night. This frequently helps to resolve the morning pain one gets when getting out of bed.

Orthotics are yet another option. These custom-made devices can realign and compensate for foot deformity and help to redistribute pressure throughout the foot more evenly.

Trigger point injections of corticosteroids can often relieve the inflammation associated with plantar fasciitis. The injection needs to be given in an appropriate fashion within the plantar fascia. It should not be administered into the heel pad, as this would shrink the heel pad and reduce some of the soft shock absorption that is provided. Usually up to three injections can be given over the course of time to try to relief the discomfort.

TREATING PLANTAR FASCIITIS WITH SHOCK WAVE

If more conservative treatments have been tried without success, a patient and his podiatrist may consider extra-corporeal shockwave therapy (ESWT). This treatment option should be considered prior to surgical options for release of the plantar fascia. There are two types of ESWT. Low-energy shockwave uses a series of several treatments, usually not too painful and with no need for anesthesia. The high-energy shockwave tends to be more effective, but can be painful when administered. Therefore, a regional nerve block or general anesthesia is needed to lessen the patient’s discomfort. Shockwave therapy is thought to work by causing micro-trauma to the area of the plantar fascia that is affected by the fasciitis. The body then sees this micro-trauma as an area that needs to be healed. The healing response causes blood vessels and other nutrients to be brought to the affected area, thereby healing the micro-trauma, as well as healing the long-standing plantar fasciitis.

SURGERY

Surgery should be a treatment of last resort. Still, surgical intervention is needed in 1% to 2% of the population to improve nonresponsive plantar fasciitis. Studies show a success rate in the 60% to 70% range. The surgical option can take the form of a release of the plantar fascia done through an endoscope, which can be more of a closed, minimally-invasive procedure. The more traditional open procedure frequently releases the fascia, as well as removing the bone spur. Patients still may experience pain or weakening of the arch as a side effect of the surgical procedure.