Plantar Fasciitis

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Category: Soft Tissue Rheumatism Articles Published on Wednesday, 25 June 2008 Written by Yong Tsai, MD
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PLANTAR FASCIITIS: OH, MY ACHING FEET!

Ever shopped ‘til you dropped? Or jogged farther than you’re used to? Did you wake up the next morning and feel like you wanted to bounce right back into bed because your feet were so sore? If so, you may have experienced an acute episode of plantar fasciitis like Patricia.

Patricia, who had been keeping long hours at work as an executive assistant, finally got a day off and decided to go to the mall with her sister. They had a great time walking around and checking out all the stores, and before they knew it, they had been there all day. The next morning, when Patricia woke up, and as soon as her feet touched the floor, she let out a scream. Just the act of putting pressure on her feet to stand up was unbearable. She hobbled around her bed and into the living room. Slowly, her pain became less excruciating, but it seemed to recur when she got out of bed or stood up after sitting down a while. She finally went to see her doctor who diagnosed her with a mild case of plantar fasciitis.

WHAT IS PLANTAR FASCIITIS?

Plantar (sole of the feet) fascia (fiber-like tissue) itis (inflammation) is a common condition that causes heel pain. The plantar fascia, a strong tissue that resembles a ligament, links the bones in your feet together, keeps them in place, and provides support to the arch like a shock-absorber. After injury or overuse, tiny rips, called “microtears” can occur in the plantar fascia, which in turn induces inflammation, known as the “healing process.” In severe cases, this process, which puts pressure on the fascia, allows for it to be torn repetitively and impairs the body’s ability to repair itself, causing chronic pain.

WHO IS SUSCEPTIBLE?

You might be at risk of experiencing plantar fasciitis if you have low arches, flat fleet, unequal leg lengths, and tight or weak calf tendons, Achilles tendon or foot muscles. Being overweight, overusing and putting too much on your calves and feet, during activities such as walking or running can stress the muscles, putting pressure on the plantar fascia. Plantar fasciitis seems to affect men more than women, and the elderly. As we age, our muscles and body’s healing capacity becomes weaker, slowing down recovery.

DIAGNOSING IT:

When Patricia went to see her doctor, she complained of pain, tenderness and slight swelling on the bottom of her feet, near the heel area, especially upon standing up and standing on her tiptoes. Her doctor asked if she was a runner, and she said no. Patricia did explain that the pain occurred after a full day of shopping at the mall, wearing flat sandals. After taking her history, Patricia’s doctor examined her feet and found tender pressure points, pain when pointing her feet upwards and tight Achilles tendons.

Due to the fact that bone spurs can occur 15 to 25% of the time without pain and are not indicative of or always present in plantar fasciitis, the use of x-rays is not very helpful in making the diagnosis. Furthermore, because no laboratory test is available, physicians must rely on physical examination and history to make a diagnosis, which in Patricia’s case was all the doctor needed.

TREATING IT:

Treatment of plantar fasciitis varies depending on its severity: muscle and tendon stretching and strengthening, wearing good arch support shoes, taping, heel cups, insoles, night splints, cortisone injections and surgery.

STRETCHING & STRENGTHENING:

Muscle and tendon stretching and strengthening are of great importance because they allow muscles and tendons to be effective shock absorbers, even under greater strain. When good support is provided, the fascia is not put under added pressure, therefore is at less risk of tearing. Exercises to perform are calf stretches (putting your hands on the wall in front of you, lunging one foot forward, knees bent, then knees straight), stair stretches (standing on a step, with your heels hanging over the edge), 2 x 4 stretches (putting a piece of 2 x 4 on the ground, and standing with your heel on the floor and the front part of your foot on the 2 x 4), towel stretches (sitting on the floor, legs straight out, and putting a towel around your foot, pulling it toward you with your hands), and the best of all, dynamic stretches (putting a 15oz can on the floor and rolling your foot arch over it).

SHOES & ORTHOTICS:

Mother was right when she told you to wear good comfortable shoes. Shoes with a good arch support, the best raising the heel horizontally about 5 mm to 10 mm, which creates an artificial arch, can truly protect your plantar fasciae from injury.

A rather inexpensive method of supporting your arch is to cut a ¼ inch thick felt in the shape of your arch, placing it on your arch and wrapping a two-inch adhesive tape around your foot to keep the arch pad in place for a few days.

Insoles are another option of providing support to you arch. The best form of insole is made from the densest material and is comfortable to walk on. Prices vary and depend on what you purchase: over-the-counter, heel cups, orthotics or custom-made orthotic insoles.

Finally, for more severe cases, the use of a night splint, to keep your foot flexed and prevent the tendons from shrinking, cortisone injections and even surgery may be used for treatment.

With the help of her doctor, a correct diagnosis and proper treatment, Patricia was on the road to recovery and soon back to shopping with her sister. This time, however, she had good arch support shoes and her daily stretching made her feet willing and ready. So, find relief for your aching feet, like Patricia. You just need to know how to treat them.

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