Bottom foot pain plantar

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

The most common cause of pain in the bottom of the foot in the plantar region is plantar fasciitis. Plantar fasciitis is a painful problem due to inflammation of the plantar fascia. The plantar fascia is a fibrous band of tissue that connects the bottom of the heel to the metatarsal heads and helps to support the arch. Excessive loading or stretching of this tissue produces small tears where the fascia meets the calcaneus. Plantar fasciitis is particularly common in the obese and in pregnant women, probably because the extra body weight stresses the plantar fascia. It is also more common in people with diabetes.

Plantar fasciitis also occur as a result of physical activities that stress the fascia, including sports, vigorous exercise, or other types of exertion. Poorly constructed shoes can also cause the problem if they do not provide enough arch support, heel cushion, or flexibility. Plantar fasciitis may follow intense athletic training, especially in runners who push themselves too quickly.

When symptoms occur, there is usually intense heel pain on taking the first morning step, known as first-step pain. This pain subsides as the patient walks, but it may return later in the day. If symptoms occur gradually, a chronic form of heel pain causes patients to shorten their stride while running or walking. Patients also may shift the weight toward the toes, away from the heel. Sometimes the pain is felt in the arch.

Plantar fasciitis can be diagnosed based on the history and physical examination. If the diagnosis is still in doubt, magnetic resonance imaging may be diagnostic.

Response to therapy is variable.

Plantar fasciitis can be prevented by maintaining normal weight, by stretching before participating in sports, and by wearing shoes that support the arch and cushion the heel.

In people who are prone to plantar fasciitis, exercises that stretch the Achilles tendon (heel cord) and the plantar fascia may help to prevent the problem. Ice massage also can be used after athletic activities to prevent the problem.

A program of conservative treatment is usually indicated. This includes:
• Stretching exercises to lengthen the heel cord and plantar fascia
• Ice massage to the sole of the foot after activities that trigger heel pain
• A temporary switch to swimming and/or bicycling instead of sports that involve running and jumping
• Shoes with soft heels and inner soles
• Taping the sole of the injured foot
• Non-steroidal anti-inflammatory drugs (NSAIDS)
• Physical therapy using electrical stimulation with corticosteroids or massage techniques

A night splint to keep the foot in a neutral or slightly flexed (bent) position to stretch the plantar fascia and heel cord may be useful. This should be continued for about six weeks. If this isn’t effective, a corticosteroid injection into the painful area is sometimes used. Only one injection should be given since corticosteroids cause fat pad atrophy and make plantar fasciitis worse.

In patients who fail all these measures, surgery is sometimes performed, but this is rare.

Surgery is usually a last resort, particularly recently with the use of minimally invasive procedures such as percutaneous needle tenotomy with autologous tissue graft. In this procedure, a physician will- using local anesthetic- slightly irritate the plantar fascia with a small needle. He then will inject a small amount of platelet rich plasma which is derived from a blood specimen that has been drawn from the patient. Platelets are cells in the blood that contain multiple growth and healing factors. Most people who have failed other measures will respond to this treatment regimen and surgery is rarely necessary.

The prognosis is good for most people with plantar fasciitis. At least 90 percent of patients respond to conservative therapy.

Other treatments that show promise are ultrasound-guided injections of Botox and shock wave therapy.

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