08 Apr PLANTAR FASCIITIS BY KAMRAN HUSSAIN, DPM
Almost 2 million Americans are affected by Plantar Fasciitis every year and 10 percent of the population will experience this condition within their lifetime. Athletes such as Drew Brees, Damian Lillard and Peyton Manning have at some point in their career dealt with this condition.
PLANTAR FASCIITIS is one of the most common causes of heel pain. It is often characterized by pain on the bottom of the heel when you take your first steps in the morning, but can also last all day long with pain often progressing the longer the condition remains untreated. Plantar fasciitis can be caused by a number of factors, including weight gain, worn-out shoes, walking barefoot, increasing exercise, and walking on hard surfaces without proper support. Because of its high incidence among runners, plantar fasciitis is commonly assumed to be caused by repetitive micro-trauma. Symptoms do resolve in 80% of patients within 12 months, with up to 5% of patients needing some type of surgical intervention.
Diagnosis of the symptoms can be made with reasonable certainty by clinical assessment. Patients typically report a gradual onset of pain to the bottom of the heel, which is worse with their first steps in the morning or after a period of inactivity. The pain will then tend to worsen towards the end of the day with increased duration of weight bearing activity.
X-rays do help provide insight that allows for the diagnosis of plantar fasciitis. X-rays may also help rule out a stress fracture of the heel or any bony lesions that could also cause this pain. In some cases the x-ray may reveal a heel spur however, this is generally not the cause of the pain. The formation of a spur is a sign that too much tension has developed within the plantar fascia, partially tearing from its origin at the heel.
Treatment recommendations include anti-inflammatory drugs such as Naproxen and Ibuprofen. Other conservative treatments that can be used would be padding and strapping of the foot, injections of corticosteroids, stretching of the calf muscles, and use of a night splint. Try to avoid the use of flat shoes, flip flops and walking barefoot. Another way of helping with the swelling would be the application of ice or a frozen water bottle to the affected area. The use of over the counter or pre-fabricated inserts in ones shoes also helps alleviate some of the discomfort associated with plantar fasciitis. A custom orthotic is an insert that is placed in your shoes to provide elevation, arch support and heel cushion which allows for more individualized support rather than an over the counter device. Physical Therapy is an option that can provide ultrasound and low level laser treatment. If after 6 weeks, if there is no improvement noted then the use of custom orthotics or immobilization of the foot in a walking boot or cast can be utilized for 4-6 additional weeks. Ultimately surgery should be reserved for those patients that do not have relief after 8-12 months of conservative care.
Dr. Kamran Hussain, DPM
ADVANCED FOOT SPECIALISTS, PLLC
201 E. Interstate 30
Rockwall, TX 75087