What Is Plantar Fasciitis?
Plantar fasciitis (pronounced PLAN-tar fashee-EYE-tiss) is an inflammation of the fascia (also called aponeurosis) on the bottom of the foot. It is often considered the same as, or seen with, heel spurs. Chronically painful feet are hard to ignore and sometimes even harder to return to a pain-free state.
What Causes Plantar Fasciitis and Heel Spurs?
Plantar fasciitis and heel spurs are conditions caused by such factors as:
- too much standing;
- unpadded shoes on hard ground;
- poor shoes (see below);
- repetitive stress;
- diets low in vitamin C;
- a change or increase in activities;
- being overweight;
- age-related shrinkage of the heel fat pad (a.k.a. fat pad atrophy);
- an injury
Bad shoes are those that ...
- have poor or no arch support;
- do not have a raised heel;
- are worn out
- do not bend at the ball of the foot
- do not have any cushion and are worn on a hard surface
What Are the Symptoms of Plantar Fasciitis and Heel Spurs?
The pain is usually in the front and bottom of the heel. It can also be over the entire bottom area of the foot. The pain can be mild or debilitating. It can last a few months or a lifetime. It can go away by itself, only to return in a few weeks or months.
If you have heel pain at the inside, front and bottom of your heel, especially if it's in the morning or after sitting a long time, then your probably have plantar fasciitis (heel spur). When the pain is severe, it is believed to be the result of bone and/or nerve irritation that is the result of too much tension, inflammation or scar tissue in the fascia. The pain often increases with more walking and standing. The pain is usually where the fascia attaches to the heel, but it can be over the entire bottom area of the foot.
If the heel pain began concurrently with a change or increase in activity, or an increase in weight, then it can be considered more of a cause of plantar fasciitis (heel spur). A stress fracture where the fascia attaches to the heel is sometimes seen in bone scans. Fifty percent of the sufferers say the pain is constant. About 90 percent say it hurts when pressed deeply with a finger.
What Is the Treatment for Plantar Fasciitis and Heel Spurs?
The most successful treatments include combinations of the following - low level laser therapy (LLLT), chiropractic joint mobilizing techniques, ultrasound, applying ice for five to six (5-6) minutes after activities, gentle stretching of the calf muscles, decreasing or changing activities, losing weight, better fitting shoes (with an arch support and raised heel), shoe inserts that have good arch support (name your favorites), heel pads (1/2" or more when compressed -- many designs like Tuli cups are often too thin), and for those that believe in OTC (over the counter) anti-inflammatory medication (which may not help or will be of some benefit for a short period of time) such as Advil (ibuprofen), Aleve, or aspirin but not Tylenol.
Many sufferers swear by computerized customized foot orthotics available in our office, at Advanced Healthcare. Relief is almost immediate in most cases. Call Dr. Pisarek for an appointment.
When constant foot pain is present, it is caused by inflammation (which may not be visible to the eye). The effects of the inflammatory process may be reduced by keeping the foot raised above the heart and/or compressed by wrapping the foot with ace bandages after long periods of being on your feet. (Add your preferred wrapping instructions here.) Trying to "walk through or ignore the pain" can cause a mild case to become long-term and debilitating.
Home Care Routines:
- Daily massage of the feet or ankles, and/or a customized arch support is often the remedy for plantar fasciitis.
- Decrease activity or switch to exercises that keep the weight off of the feet such as stationary bike riding or swimming. Avoid or modify anything that causes an increase in pain. Be patient, it may take months of reduced activity. Increase activities very slowly. Complete rest is not good, as some activity is necessary for recovery.
- Stretching is often recommended. In the few cases where it is caused by a sudden injury, stretching and strengthening may not be necessary. Stretching can re-injure the traumatized fascia.
- Taping can help to simply protect the fascia or enable a patient to walk again. The tape should be tight when you stand and the pain is immediately relieved (unless the pain is present 24 hours a day). If not, consider the "other causes" section.
- Arch supports, medial wedges, certain shoes and custom-made orthotics can give more arch support. Heel pads can sometimes be worn under inserts.
- Heel pads, 1/2" to 1" thick in both shoes. The waffle-bottomed Tuli cups or viscoelastic designs may not work as well because they are thin when compressed. Playing tennis or similar activity while wearing heel pads can cause a serious ankle injury.
- Reduce inflammation with ice, anti-inflammatory medication, compression and elevation. The swelling may not be noticeable, but it is often there and causes pain by putting pressure on tissue in the area.
- Ice immediately after activities or injury. Place ice on a towel, step on it and roll it under the feet for five minutes. Repeat every hour until bedtime.
- Massage in the morning and evening.
When Will My Feet Get Better?
It is important for you to be active in the treatment of your foot problem. Poor compliance with home care or prescribed treatment means your treatment will take far longer than it should. If there is little improvement after a few weeks or months of proper treatment, our office will refer you to a podiatrist or another appropriate specialist. Those who delay seeking treatment, have it in both feet or are overweight are more likely to have it for a long time before they see improvement.
Heel pain not specifically caused by a heel spur is often known as plantar fasciitis... a well known foot ailment caused by inflammation of the plantar fascia. The plantar fascia, a band of connective tissue that encases the muscles on the bottom of the foot, connects the heel bone to the ball of the foot. It supports the arch, protects the foot, and absorbs shock.
People with plantar fasciitis frequently complain of pain in the morning after first standing when they get out of bed and also when they stand up after having sat for a while. The pain originates just in front of the heel bone, but can spread over the entire bottom of the foot.
If left untreated, aggravation associated with the condition can lead to the development of scar tissue, calcium deposits and eventually heel spurs. Heel spurs, a bony growth on the front part of the calcaneus of the heel bone where the plantar fascia attaches, can cause a severe stabbing pain with walking.
There are many factors that are instrumental in the development of plantar fasciitis although people who have other foot conditions, especially pes planus (flat feet) and over-pronation are most susceptible. One of the most crucial contributing factors is muscle imbalances between the calf muscles and the muscles on the bottom of the foot, both of which attach to the calcaneus or heel bone. Frequently the calf muscles get short and tight exerting a strong pull upon the back of the calcaneus. This creates too much stress on the smaller and weaker plantar muscles and its fascia that adhere to the other side of the calcaneus.
In addition to running and jumping activities, wearing high heels can also produce a shortening and tightening of the calf muscles. Other factors that stress the plantar fascia include: sudden strenuous activity after a period of long-term inactivity, abnormal walking patterns, unsuitable footwear, walking on hard or uneven surfaces especially barefooted, and obesity.
Nurses, teachers, policemen and waiters who are required to be regularly on their feet, and those whose activities include aerobic, volleyball, running, basketball, and tennis are more susceptible to plantar fasciitis. It is often difficult to manage plantar fasciitis once it has developed, and the ailment can become extremely painful and ceaseless.
Dr. Pisarek will be able to determine the cause of your problem and what care is most fitting. Management might include ultrasound therapy, low lever laser therapy, joint manipulation, muscle stretching and strengthening exercises, special taping and, in some cases, customized foot orthotic therapy utilizing 'Footmaxx' computerized technology.
Call Dr. Pisarek today for an appointment at 416-633-3000.