|
Many of us wake up each morning to find that we have gone temporarily lame. A serious pain message comes from our foot as soon as we try to put weight on it. The good news is that we can “walk it off” after getting up and toughing out the pain for a little while. It usually gets better with walking, but may return if we rest the foot for prolonged periods of time during the day.
The problem is called plantar fasciitis: Pronounced “plantar fash-eee-eye-tiss.”
The plantar fascia is a very thick band of tissue that covers the bones on the bottom of the foot. Plantar fasciitis is due to tiny tears in the fibers of this band. This fascia becomes painful due to overuse. Symptoms are due to strain at the take-off phase of walking, running or climbing, not due to heel impact.
As I have described, the most common complaint is pain in the bottom of the heel, usually worst in the morning and improving throughout the day, although it may return, especially with certain activities such as walking up stairs. By the end of the day, the pain may be replaced by a dull aching that improves with rest.
Although some victims of plantar fasciitis experience mild swelling and/or redness on the bottom of the heel, the main physical finding is tenderness.
Risk factors for plantar fasciitis include foot arch problems (both flat foot and high arches), overweight or obesity, diabetes, running, sudden weight gain, or tight Achilles tendon (the tendon connecting the calf muscles to the heel).
This condition is one of the most common orthopedic complaints relating to the foot. Although almost anyone can develop this problem, we should look for alternative causes of pain in teens and elderly patients. The typical patient is an active man age 40-70.
Plantar fasciitis was commonly thought to be caused by a heel spur, but research has found that this is not the case. On x-ray, heel spurs are seen in people with and without plantar fasciitis. However, x-rays may be used to rule out other problems, especially in the young and old victims. Up to 85 percent of patients will improve, independent of the therapy used (including no therapy at all). Therefore, conservative treatment is almost always successful, given enough time. Most patients will be better in less than nine months. However, treatment may last up to two years before symptoms get better.
Initial treatment should consist of rest and pain medications (like acetaminophen, ibuprofen, or naproxen). Stretching and strengthening exercises are also good. Massaging your foot across the width of the plantar fascia before getting out of bed often helps lessen the pain from standing. Regular calf stretching will help your pain and help prevent future episodes.
Strengthening exercises may include:
Towel curls - To do a towel curl, sit with your foot flat on the end of a towel placed on a smooth surface. Keeping your heel on the floor, pull the towel toward your body by curling up the towel with your toes.
Marble or coin pick-ups - To do marble pick-ups, put a few marbles on the floor near a cup. Keeping your heel on the floor, pick up the marbles with your toes and drop them in the cup. For a greater challenge, you may try to pick up coins instead of marbles.
Toe taps - To do toe taps, you will lift all your toes off the floor and, while keeping your heel on the floor and the outside four toes in the air, tap just the big toe to the floor. Next you will change the order and tap the outside four toes to the floor a number of times while keeping the big toe in the air. Start with 10 taps and work up to 50 taps per session.
Inflammation can be treated in several ways. An ice massage or an ice pack may help.
For ice massage, freeze water in a small paper cup. Then rub the exposed end of the ice over the painful heel using a circular motion and medium pressure for five to ten minutes.
Make an ice pack by putting crushed ice in a plastic bag wrapped in a dry towel and molding it to the foot. Another good way is to use a bag of frozen corn or peas wrapped in a towel. Use the package for 15 to 20 minutes. Icing your heel after exercising, stretching, strengthening and working can help prevent inflammation.
Non-custom-made orthotics, night splints (holding the foot up about five degrees while sleeping), or heel pads may not be beneficial. More effective custom-made orthotics are very expensive.
If these fail, putting the affected foot in a short leg cast (a cast up to but not above the knee) for three to six weeks is very often successful in solving the problem. Alternatively, a cast boot (which looks like a ski boot) may be used. It is still worn full time, but can be removed for bathing.
Some physicians offer steroid injections, which provide only short-term relief in most cases (though they can provide lasting relief in some people). However, this injection is very painful and increases the risk of rupture of the plantar fascia.
Extracorporeal shock-wave therapy may be considered before resorting to surgery. Impulses of low-energy shock waves (guided by ultrasound) are focused at the point of maximal tenderness across the base of the heel. These waves may help to speed up the healing process. However, its use is controversial.
In a few patients, non-surgical treatment fails and surgery to release the fascia (and remove the heel spur) becomes necessary. However, we should consider surgery as the last option for people who fail to respond to conservative measures after a year or more.
Complications of surgery include infection, nerve injury, no improvement in pain, and may lead to problems with pain in the midfoot and forefoot because the support from the plantar fascia is lost.
As with every medical problem, prevention is better than treatment. In the case of plantar fasciitis, maintaining good flexibility around the ankle, particularly the Achilles tendon and calf muscles is probably the best way to prevent plantar fasciitis. If you think you might have symptoms of plantar fasciitis, you should contact your health care provider.
|
