Plantar fasciitis bone spur

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

Plantar fasciitis is a painful condition caused by inflammation of the plantar fascia.

The plantar fascia is a fibrous band of tissue that supports the arch. Excessive loading or stretching of this tissue produces small tears particularly where the fascia meets the calcaneus (heel bone).

Plantar fasciitis is common in obese people and pregnant women probably because the extra body weight overloads the plantar fascia. It is also more common in people with diabetes. It is probably most common in people who ramp up their training too quickly and stress the plantar fascia. While some patients have an associated bone spur on the bottom of the calcaneus (heel bone), this does not occur with everyone who has plantar fasciitis.

Plantar fasciitis, as mentioned earlier, occurs as a result of physical activities that stress the fascia, including sports, vigorous exercise, or other types of exertion. Poorly constructed shoes can cause a 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.

Symptoms can occur at any time. When they occur suddenly, there is usually intense heel pain on taking the first morning step, known as first-step pain. This pain gets better as the patient walks around, 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.

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

Response to therapy is variable sometimes taking weeks to months.

Plantar fasciitis can be prevented by maintaining normal weight, by warming up and 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 and the plantar fascia may help to prevent plantar fasciitis. Ice massage also can be used after athletic activities.

A program of conservative treatment 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

If this conservative treatment does not help, a night splint for six to eight weeks is sometimes used. The night splint will keep the foot in a neutral or slightly flexed (bent) position to maintain a slight stretch of the plantar fascia and heel cord. If this isn’t effective, a steroid injection is sometimes given.

Very rarely, a short leg cast needs to be used.

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

However, a newer treatment for tendonitis may be more effective and prevent the need for surgery. Percutaneous needle tenotomy is a technique where a small gauge needle is introduced using local anesthetic and ultrasound guidance. The needle is used to poke several small holes in the fascia. This procedure is called "tenotomy." Tenotomy induces an acute inflammatory response. Then, platelet rich plasma, obtained from a sample of the patient's whole blood is injected into the area where tenotomy has been performed. Platelets are cells that contain multiple healing and growth factors. The result? Normal good quality fascial tissue is stimulated to grow with natural healing.

For more information about this procedure, visit our sister site:
Tendonitis Tendonitisand provides reliable, accurate, and useful information on tendonitis treatment written by a board-certified rheumatologist. Learn more about how to get tendonitis relief using the most up-to-date methods.

A more recent option that is sometimes used successfully is Botox injection. Early studies are encouraging. This, like all injections needs to be performed using ultrasound guidance.

The prognosis is good for most people with plantar fasciitis. At least 95 percent of patients respond to conservative therapy.

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