Plantar Fasciitis
WHAT IS IT?
Plantar fasciitis involves a localized swelling, irritation, and/or
bursitis of the thickened fibrous bands supporting the bottom of
one's foot. These tendon like bands run length wise from
underneath the heel and fan out into the metatarsal heads or fat
pad area of the foot. In most cases, painful symptoms arise at or
near the point at which the bands are attached to the heel. When
a person stands, these fibrous bands stretch and elongate under
the pressure and pull on the heel. Eventually, a heel spur or
calcium deposit may actually form in response to this constant
pulling. Many of the patients who have this condition seem to
have a similar presentation. There is frequently pain upon rising
out of bed in the morning. The first few steps are excruciating but
reduce quickly in their intensity. Later in the day, the individual with plantar fasciitis will notice pain after sitting and then getting up again. The pain is mostly localized to the heel and arch areas with occasional radiation of discomfort up the back of the leg. Well-padded shoes are helpful but rarely rectify the condition.
CAUSES
We are unsure as to why certain people get plantar fasciitis while others do not. Trauma, repetitive stress and strain, overweight conditions, hereditary tendencies, and various soft tissue abnormalities can all playa causative role but as of yet, a clear and identifiable culprit has not been found. We can however, discuss why the pain onset seems to follow with rising or weight bearing periods after sitting. In a lying down or sitting position, the long plantar fascia bands are relaxed and contracted. There is little to no pulling on the heel and therefore, absent pain in most cases. Once we stand, these bands suddenly elongate or stretch, thus putting a strain on the bottom of the heel. Considering the fact that this pulling pressure is of a cumulative nature, sooner or later, symptoms may arise.
TREATMENT
The treatment of a plantar fasciitis condition initially includes stretching exercises, shoe modifications, foot taping and padding, possible injection of an anti-inflammatory medication, physical therapy, and the use of oral medications. Orthotics, which provide support and stability to the foot and ankle, improve weight distribution, and increase lower extremity function are in most cases, an essential part of therapy. Controlling the arch during weight bearing along with conservative care can make 90% of true plantar fascia pain become asymptomatic. In certain cases where conservative care has failed to relieve the involved discomfort and disability, surgery might then become a consideration.
