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June 8, 2015
A common foot malady we see is plantar fasciitis. A frustrating condition that does not have an overnight or immediate cure, plantar fasciitis can truly wreck a person's day because of the pain. The pain classically is on the bottom of the heel that is usually felt on the first step out of the bed in the morning, or when walking again after resting from the walk or run activity. Radiating pain can extend from the heel to the toes across the sole of the foot.
What is the plantar fascia? It is a tough, dense band of tissue that connects from the heel bone to the toes. Small micro tears in this tissue, usually around the area of insertion on the heel bone, create the classic heel pain seen on weightbearing. I am convinced many people think they have heel spurs, when in reality, they have an inflamed plantar fascia.
What causes this to suddenly go haywire and create such discomfort? The current thought is that it arises slowly from chronic irritation or inflammation due to overactivity or sudden weight gain. Both will increase stresses across this tissue, and they reach a limit by which eventually inflammation flares up and the pain cycle starts. X-rays will show bone spurs coming from the heel bone, but it is not the spur which causes the pain, but rather the result of chronic irritation and inflammation caused from the tight pressures and pulling on this dense tissue during weightbearing.
How do we treat this? Smoke and mirrors, sometimes, as this can be tough to cure. Sometimes custom shoe arches help, to lend support during the weightbearing phase of the step cycle. Stretching exercises to increase the flexibility of the plantar fascia and calf muscles can be promising. One would think if you have tight calf muscles that might have help start this problem, then getting them stretched and flexible might allow some tight tensions to be released and allow for some pain relief. Stretching can be accomplished by putting the ball of the foot on the edge of a step, and lowering the heel lower than the step while leaning forward on a straight knee. Rolling the foot over a rolling pin after a nice hot foot soak can create deep tissue massage. Always remember to warm up well before doing any muscle or plantar fascia stretching, and cold tissues do not stretch as well. I think ice therapy is an excellent idea after you have done your stretching, and place the ice on the most tender spot for about 30 minutes.
Taking non-steroidal anti-inflammatory medicines are beneficial, and some advocate night splints to create a stretched environment over night. Ultrasound may play a role as well, but has yet to be proved. Surgical plantar fascia release is an option, but we generally save that as a last effort, if all else is failed.
Plantar fasciitis can be a real problem, just ask anyone who has had it. I think changing shoe wear oftentimes plays a great role, and trying to change the lifestyle and the demands on one's foot can be difficult while trying to treat this problematic condition. Thank goodness it usually heals by itself, and most people get over it without surgery.