Plantar fasciitis

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 that causes pain in the bottom of the heel.

The plantar fascia is a fibrous band of tissue that helps to support the arch. Excessive loading or stretching of this tissue produces small tears where the fascia meets the calcaneus ( heel bone). Plantar fasciitis is common in obese people and in pregnant women probably because the extra body weight overloads 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 or vigorous exercise. A sudden increase in training routine can also cause the problem. Poorly constructed shoes can lead to plantar fasciitis if they do not provide enough arch support, heel cushion, or flexibility.

Symptoms can occur at any time. There is usually intense heel pain on taking the first morning step out of bed. This pain subsides as the patient begins to walk around, but it may return later in the day. Chronic heel pain causes patients to shorten their stride while running. Patients also may shift the weight toward the toes, away from the heel.

Plantar fasciitis can be suspected based on the history and physical examination. Magnetic resonance imaging can be diagnostic.

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.

Exercises that stretch the Achilles tendon (heel cord) 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

A night splint worn for six to eight weeks may be prescribed. The night splint will keep the foot in a neutral or slightly flexed (bent) position to maintain a stretch of the plantar fascia and heel cord. If this isn’t effective, a corticosteroid injection may be administered. Sometimes a short leg cast for one to three months is also used.

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 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.

Other types of therapies with good results include ultrasound-guided injection of Botox and extracorporeal shock wave therapy.

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

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