Plantar Fasciitis
Heel pain is most often caused by plantar fasciitis. This condition in the past has also been known as heel spur syndrome. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation or rarely, a cyst.
Heel pain is most often caused by plantar fasciitis.
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed resulting in heel pain. The symptoms of plantar fasciitis are pain in the bottom of the heel, usually worse upon arising, and increases over a period of months. People with plantar fasciitis often describe the pain as worse when they get op in the morning or after they have been sitting for long periods of time. After a few minutes of walking the pain decreases because walking stretches the fascia as well as increases the oxygen demand to the area. When we have more oxygen and more circulation to the area the pain reduces. For some people, the pain subsides but returns after spending long periods of time on their feet. One way to distinguish plantar fascial pain from other types of heel pain is when there is no pain upon getting out of bed in the morning but increasing pain thought out the day and at night when trying to sleep, this type of pain more points to a stress fracture or tarsal tunnel. Those who have a stress fracture often have swelling, redness, and an increase in warmth when compared to the other side. Those who have more of a nerve issue will have burning and tingling upon tapping of the nerve that runs along the inside of the ankle to the heel.
Causes of Plantar Fasciitis
The most common cause of plantar fasciitis is a short tight Achilles tendon. This most often leads to a faulty foot structure. The tight Achilles tendon can pull against the back of the heel causing the heel to collapse. This leads to an over pronated foot type or otherwise known as a flatfoot. This stretches the ligament and causes tension at the attachment sight. This leads to the overuse injury and chronic inflammation of the fascia. We can also see plantar fasciitis in the patient with an over supinated foot type or high arched foot type. In this foot type the patient is missing the ability to pronate enough at heel strike to allow for shock absorption. Therefore, he strikes the foot very hard against the ground, this leads to abuse of the heel and plantar fascial ligament chronic injury and pain.
Diagnosis of Plantar Fasciitis
To diagnosis plantar fasciitis we obtain a medical history and examine your foot. We will take x-rays. These x-rays are load bearing x-rays. Therefore, we can not only see if there is a fracture, a cyst or other bony issue with the foot, I can also examine the structure of your foot during stance and load bearing activities. At times if the heel pain is not reducing after a bit of conservative therapy or you show early signs of a stress fracture that is not identified on x-ray you may need to be sent for an MRI.
Treatment of Plantar Fasciitis
It has been a misnomer throughout the years that the heel spur is the cause of the pain. The heel spur is there due to a law in since called wolf’s law. It simply states that bone will grow in areas of stress. Due to the tension against the attachment sight of the plantar fascia it can grow bone in the direction of that stress. The spur that forms runs in a parallel fashion to the heel and within the substance of the plantar fascia. It does not poke into any structure or nerve. Therefore, the treatment is centered around the inflamed/injured plantar fascia. When treating plantar fasciitis you have to treat all that is involved. You must treat the short tight Achilles tendon, the inflammation around the ligament and the collapse of the foot if you have overpronation or increasing the shock absorption if you have a cavus foot type. The Achilles tendon crossed the knee joint and attaches to the femur, so if you are tight from the hip down it will affect the Achilles tendon and possibly the plantar fascia. Therefore, we recommend stretching from the hips down. I highly recommend that you do not go barefoot and always wear a good supportive shoe like a tennis shoe. Ice is also beneficial to inflamed tissue. The best way to ice is to roll your foot over a frozen water bottle. Often these treatments along are not enough to stop the pain in the inflamed heel. At that time and injection of steroid and a good pair of custom-made inserts are the next steps in treatment. 90% of patients can heal from plantar fasciitis with the above treatment. Should you be one of the 10% who fail conservative therapy we then start to discuss a more aggressive form of treatment. This can range from immobilization in a boot, physical therapy or a noninvasive surgical procedure. The surgery to correct the plantar fasciitis is centered around lengthening the gastroc aponeurosis and as well as address the chronic inflamed injury to the plantar fascia. We do this by lengthening the gastroc aponeurosis through a small incision and camera along the inside of the leg. We then direct our attention to the plantar fascia where we use the topaz wand to convert the chronic injury to an acute injury and allow the body to heal itself. This procedure is done percutaneously without making an incision along the bottom of the foot. Many patients do fantastic with these two procedures. The plantar fascial ligament is the primary supporting ligament of your foot. At our practice we recognize the significance of this fact and will not cut the plantar fascial ligament to stop the planta fasciitis. This type of procedure can lead to other significant foot deformities and often does not stop the heel pain. If you have heel pain and have tried various forms of at home care to stop the pain and still did not find relief come and see us, I would love to help.
