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Plantar fasciitis

Plantar fasciitis refers to the syndrome of inflammation of the band of tissue that runs from the heel along the arch of the foot; a heel spur is a hook of bone that can form on the heel bone (calcaneus). About 70% of patients with plantar fasciitis have been noted to have a heel spur that can be seen on X-Ray.

Plantar fasciitis is most often seen in middle-aged men and women, but can be found in all age groups. Plantar fasciitis is diagnosed with the classic symptoms of pain well localized over the heel area of the bottom of the foot. Often the pain from plantar fasciitis is most severe when you first stand on your feet in the morning. Pain often subsides quite quickly, but then returns after prolonged standing or walking.

Plantar fasciitis is sometimes, but not always, associated with a rapid gain of weight. Plantar fasciitis is also sometimes seen in recreational athletes, especially runners. In these athletes, it is thought that the repetitive nature of the sports causes the damage to the fibrous tissue that forms the arch of the foot.

Plantar fasciitis can be confused with a condition called tarsal tunnel syndrome. In tarsal tunnel syndrome, an important nerve in the foot, the tibial nerve, is trapped and pinched as it passes through the tarsal tunnel, a condition analogous to carpal tunnel syndrome in the wrist. This may cause symptoms similar to the pain of a plantar fasciitis.

There are also other less common problems such as nerve entrapments, stress fractures, and fat pad necrosis, all of which can cause foot pain. Finally, several rheumatologic conditions can cause heel pain. These syndromes such as Reiter's syndrome and ankylosing spondylitis can cause heel pain similar to plantar fasciitis. If your symptoms are not typical for plantar fasciitis, or if your symptoms do not resolve with treatment, your doctor will consider these possible diagnoses.

Plantar fasciitis occurs because of irritation to the thick ligamentous connective tissue that runs from the heel bone to the ball of the foot. This strong and tight tissue contributes to maintaining the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. Therefore, the stress placed on the this tissue is tremendous.

When a patient has plantar fasciitis, the connective tissue that forms the arch of the foot becomes inflamed (tendonitis) and degenerative (tendinosis)--these abnormalities cause plantar fasciitis and can make normal activities quite painful.

Symptoms of plantar fasciitis are typically worsened early in the morning after sleep. At that time, the arch tissue is tight and simple movements stretch the contracted tissue. As you begin to loosen the foot, the pain usually subsides, but often returns with prolonged standing or walking.

Plantar fasciitis is inflammation, usually due to injury, of the plantar fascia, the ligament between the front of the heel bone and the base of the toes that helps to support the arch.

It causes severe pain on the bottoms of the feet, especially in the morning.

Excess stress absorbed by the foot may irritate or tear the plantar fascia, making this a common disorder among athletes, especially runners.

Plantar fasciitis can be caused by a tendency of the foot to roll inward (pronation) upon walking.

Other factors may be stress on the heel due to repeated hard pounding or quick turns, often from long-distance running, jogging, or basketball; wearing shoes that lack proper heel support or that have thin or stiff soles; age-related loss of resiliency in the ligaments; and some forms of arthritis, such as ankylosing spondylitis or Reiter's syndrome.

Plantar fasciitis occurs only on the sole and heel of the foot. It can cause pain along the entire length of the plantar fasciae and where these ligaments attach to the heel bone in the rear foot and the five metatarsal bones.

Patients often report severe pain on the bottoms of their feet in the morning, especially the first steps out of bed. The pain subsides after a few minutes of walking.

The diagnosis is made by medical history and physical exam.

Treatment of Plantar Fasciitis

In severe cases, a corticosteroid injection into the tender area may provide relief. Rarely, surgery to release the plantar fascia from its attachment may be necessary.

Self Care

     Rest the foot as much as possible, especially during the first week. Avoid jogging, running, and excess standing; instead, substitute exercises that do not put undue stress on the injured ligament, like bicycling or swimming.

  • Apply ice to the tender area a few times daily to reduce inflammation. Try rolling the arch of the foot over an empty tennis ball can that has been filled with water and frozen; this both cools and stretches the affected area.

  • Take over-the-counter pain relievers (ibuprofen, naproxen) to reduce pain and inflammation.

  • Insert an over-the-counter arch support and heel support cushion into the shoe. Cut a hole in the pad to relieve pressure on the tender area if necessary. Try to avoid walking barefoot, since it may put added stress on the plantar ligament.

  • Sit on a table with your knees bent. Loop a towel under the ball of the injured foot and pull, flexing the front of your foot upward. Keep your knee bent and try to press your foot against the towel.

  • Sit on a chair and cross the ankle of the injured foot over the opposite knee. Slowly push the toes backward with your hand until you feel the stretch in the bottom of your foot.

  • Stand facing a wall, about one foot away, with the injured foot about six inches farther back. Put your hands on the wall and gently lean forward, stretching the lower calf.

  • Stand facing a wall, about two feet away, with the injured foot about six inches farther back. Keep both feet slightly turned outward. Put your hands on the wall and gently lean forward, bending the front knee and keeping the back heel on the floor.

         
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