by Badash M

Plantar Fasciitis

Definition

The plantar fascia is a thick band of tissue attached to the heel bone. It supports the arch of the foot. Plantar fasciitis is inflammation of this plantar fascia.
It causes pain in the heel of the foot. Treatment depends on the severity of the condition.
Plantar Fasciitis
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Causes

Plantar fasciitis is caused by small, repetitive trauma to the plantar fascia. This trauma can be due to activity that puts extra stress on the foot.

Risk Factors

Plantar fasciitis is most common in people who are 40-60 years old. Other risk factors that increase your chance of getting plantar fasciitis include:
  • Physical exertion, especially in sports such as:
    • Running
    • Volleyball
    • Tennis
  • A sudden increase in exercise intensity or duration
  • Physical activity that stresses the plantar fascia
  • People who spend a lot of time standing
  • A sudden increase in activities that affect the feet
  • Obesity or weight gain
  • Pre-existing foot problems, including an abnormally tight Achilles tendon, flat feet, or an ankle that rolls inward too much
  • Poor footwear
  • Heel spurs

Symptoms

Symptoms of plantar fasciitis may start gradually or happen suddenly. They include:
  • Pain on the sole of the foot near the heel
  • Heel pain when taking the first steps in the morning
  • Tenderness when touching the sole or heel
  • Pain that increases over a period of months

Diagnosis

The doctor will ask about your symptoms and medical history. A foot exam will be done. This will usually make the diagnosis.
Imaging studies of the foot may be done to help rule out stress fractures or other bone abnormalities. These include:

Treatment

Talk to your doctor about the best treatment plan for you. Options include:

Home Care

  • Ice—Apply ice or a cold pack to the heel and arch for 15 to 20 minutes several times a day. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.
  • Night splint—A special splint that will hold your foot in a neutral position while sleeping.
  • Orthotics—Special shoe inserts that support the mid-arch region of your foot. Inserts that are not customized may work just as well as those that are customized.
  • Activity
    • Avoid running and other activities that may worsen pain.
    • Begin stretching exercises to lengthen the Achilles tendon and plantar fascia as recommended by your doctor. This is usually done when pain has lessened or improved.

Medication

To help manage pain, your doctor may recommend over-the-counter nonsteroidal anti-inflammatory medication (NSAIDs), such as ibuprofen or naproxen. Prescription pain relievers may also be required. Steroid injections may be used in some cases or if other treatment is not working.

Procedures

A special type of sound wave called extracorporeal shock wave may also be considered in certain cases. This treatment happens under the care of your doctor. At this time, this is generally a treatment for long-term cases that do not respond to other treatments. Massage therapy or accupuncture may also be effective for long-term cases.

Surgery

In a few cases, basic treatments don't help. Surgery may be performed to cut the tight, swollen fascia.

Prevention

To reduce your risk of getting plantar fasciitis take these steps:
  • Wear appropriate and well-fitted footwear during sports and exercise.
  • Do stretching exercises for the Achilles tendon and plantar fascia.
  • Increase the intensity and duration of exercise gradually.
  • Maintain an appropriate weight.

RESOURCES

American Academy of Physical Medicine and Rehabilitation http://www.aapmr.org

OrthoInfo.org—American Academy of Orthopaedic Surgeons http://orthoinfo.org

CANADIAN RESOURCES

Ontario Podiatric Medical Association http://www.opma.ca

Orthogate http://www.orthogate.org

References

Plantar fasciitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 2, 2012. Accessed February 18, 2014.

Plantar fasciitis. Focus on the basics. Mayo Clin Health Lett. 2012;30(8):7.

Plantar fasciitis and bone spurs. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00149. Updated June 2010. Accessed November 19, 2012.

Pommering TL. Ankle and foot injuries in pediatric and adult athletes. Prim Care. 2005;32:133-161.

6/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Baldassin V, Gomes CR, et al. Effectiveness of prefabricated and customized foot orthoses made from low-cost foam for noncomplicated plantar fasciitis: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90:701-706.

4/24/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Wise JN, Weissman BN, et al. American College of Radiology (ACR) Appropriateness Criteria for chronic foot pain. Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/ChronicFootPain.pdf. Updated 2013. Accessed April 24, 2014.

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