What is it?
Plantar fasciitis involves a localized
swelling, irritation, and/or bursitis of the thickened
fibrous bands supporting the bottom of one's foot. These tendon like bands
run length wise from underneath
the heel and fan out into the metatarsal heads or fat pad area of the foot.
In most cases, painful symptoms
arise at or near the point at which the bands are attached to the heel. When
a person stands, these fibrous bands stretch and elongate under the pressure
and pull on the heel. Eventually, a heel spur or calcium deposit may
actually form in response to this constant pulling. Many of the patients who
have this condition seem to have a similar presentation. There is frequently
pain upon rising out of bed in the morning. The first few steps are
excruciating but reduce quickly in their intensity. Later in the day, the
individual with plantar fasciitis will notice pain after sitting and then
getting up again. The pain is mostly localized to the heel and arch areas
with occasional radiation of discomfort up the back of the leg. Well-padded
shoes are helpful but rarely rectify the condition.
What causes it?
We are unsure as to why certain
people get plantar fasciitis while others do not. Trauma, repetitive stress
and strain, overweight conditions, hereditary tendencies, and various soft
tissue abnormalities can all playa causative role but as of yet, a clear and
identifiable culprit has not been found. We can however, discuss why the
pain onset seems to follow with rising or weight bearing periods after
sitting. In a lying down or sitting position, the long plantar fascial bands
are relaxed and contracted. There is little to no pulling on the heel and
therefore, absent pain in most cases. Once we stand, these bands suddenly
elongate or stretch, thus putting a strain on the bottom of the heel.
Considering the fact that this pulling pressure is of a cumulative nature,
sooner or later, symptoms may arise.
How do you treat it?
The treatment of a plantar fasciitis
condition initially includes stretching exercises, shoe modifications, foot
taping and padding, possible injection of an anti-inflammatory medication,
physical therapy, and the use of oral medications. Orthotics, which provide
support and stability to the foot and ankle, improve weight distribution,
and increase lower extremity function are in most cases, an essential part
of therapy. Controlling the arch during weight bearing along with
conservative care can make 90% of true plantar fascial pain become
asymptomatic. In certain cases where conservative care has failed to relieve
the involved discomfort and disability, surgery might then become a