Plantar Fasciitis
Plantar fasciitis affects over 2 million people a year and is thought to be the most common cause of pain in the inferior heel. If left untreated plantar fasciitis can become a disabling long-term condition. Plantar fasciitis affects a patient’s level of activity and affect mobility. The natural history of plantar fasciitis can mean pain lasts up to two years without proper treatment. If treatment is implemented correctly and in a timely manner the patient can return to their regular activities quickly.
Anatomy
The plantar fascia is a band of fascia that runs directly beneath the skin and subcutaneous fat on the bottom of the foot. The plantar fascia connects the heel to the front of the foot and supports the arch. Passively the plantar fascia helps bear the weight of the body and some studies estimate it supports as much as 14 percent of the total load of the foot. The plantar fascia is also important during gait because it elongates as you move throughout the motion. As the plantar fascia elongates or stretches it provides increasing support to the arch and augments foot movement/function.
Causes
Since the plantar fascia functions as one of the primary support structures in the foot is prone to being overstressed. Too much pressure or overexertion can damage or tear the tissue. People who are overweight or constantly on their feet are specifically susceptible to developing plantar fasciitis. Individuals with flat feet or high arches are also more likely to develop the condition. People who participate in running or walking are capable of developing plantar fasciitis because of the stress placed on the feet during these activities. Many people who have heel spurs develop plantar fasciitis however heel spurs are not the cause of plantar fasciitis. Nonetheless, the size of one’s heel spur corresponds to the intensity of pain.
Symptoms
If you feel pain in the heel and/or arch as soon as you step out of bed in the morning you may have plantar fasciitis. Patients who suffer from plantar fasciitis often report pain after long periods of being inactive; for instance, heel pain after a long drive or after working at a desk. Pain can also begin after periods of heavy activity; this is likely due to the stressors placed on the structure.
Treatment
Simple home-based treatments can be effective in about 10 months for over 90 percent of patients struggling with plantar fasciitis. Reducing or stopping activities that make the pain worst can quickly reduce pain in most patients. However, over time inactivity is actually worse for the foot. Icing the heel three to four times a day can also be effective. Plantar fasciitis can be worsened if the muscles in the leg and foot are tight. Stretching and exercises can reduce pain and improve mobility. Physician directed treatment could further shorten healing time to one to three months.
Anti-inflammatory medication can reduce pain and inflammation as well. Supportive shoes and orthotics can benefit the plantar fascia as well and provide essential support. Night splints are sometimes recommended to wear as you sleep to stretch the plantar fascia as you sleep. Physical therapy is an excellent treatment for this condition. Occasionally injections are required. PRP therapy is also known to work for plantar fasciitis as well.
Surgical treatment is only recommended after 12 months of non-surgical treatment if the pain is still present. Plantar fascia release is a surgery some doctors recommend if you still have normal range of motion but continued heel pain. During this procedure the ligament is partially cut to relieve stress and tension in the plantar fascia. Gastrocnemius recession is a surgery that lengthens the calf muscles to decrease stress on the plantar fascia. Tight calf muscles increase tension in the plantar fascia and gastrocnemius recession aims to reduce the amount of stress caused by plantar fasciitis. It is the goal at Warner Orthopedics to avoid surgery for plantar fasciitis if at all possible.
For more information about Plantar Fasciitis visit the American Academy of Orthopedic Surgeons.
