Plantar fasciitisPlantar fasciitis is a painful condition due to inflammation of the plantar fascia. 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 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. 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 subsides as the patient begins to walk 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. A physician will take a careful history. They will ask you whether you have first-step pain and about your activities. They’ll ask if you recently increased your activity or exercise pattern. Plantar fasciitis can be diagnosed based on the history and physical examination. If the diagnosis is still in doubt, your doctor may order x-rays or magnetic resonance imaging scan. Response to therapy is variable sometimes taking weeks to months. Plantar fasciitis can be prevented by maintaining normal weight, by warming upand 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 plantar fasciitis. Ice massage also can be used after athletic activities. Most doctors recommend a program of conservative treatment, including: • 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 • Nonsteroidal anti-inflammatory drugs (NSAIDS) • Physical therapy using electrical stimulation with corticosteroids or massage techniques If this conservative treatment does not help, your physician may recommend a night splint for six to eight weeks. 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, your doctor may inject a corticosteroid into the painful area . Sometimes a short leg cast for one to three months is also used. In patients who fail all these measures, surgery is sometimes performed. The prognosis is good for most people with plantar fasciitis. At least 90 percent of patients respond to conservative therapy.
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