January
2008
Plantar Fasciitis
Plantar fasciitis causes pain on the bottom of the foot. (The plantar side of the foot is the sole.) Usually it occurs in one foot though 30% of the time it will affect both feet. Approximately 1 million visits to the doctor are due to plantar fasciitis. It occurs mostly in 40-60 year olds, and younger folks who have it tend to be runners.
Plantar aponeurosis is the deep layer of the plantar fascia. Fascia is fibrous tissue like you see coating a chicken breast – it is a pearly white tissue. The fibers run from the heel to each of the toes to provide support - in particular when walking. When the toes are extended and pushing off during walking, the plantar fascia elevates the arch of the foot as well as doing other functions for support. It does attach to the heel (calcaneous bone) so it is associated with heel spurs. But like the chicken and the egg, we don’t know which comes first. In plantar fasciitis, the fibrous tissue become inflamed and can even degenerated.
Risk Factors: well, as with most things, the cause is unknown. Risk factors include: obesity, flat feet, trauma/stress from jumping or standing too much, poor ankle dorsiflexion, and as mentioned above heel spurs. For runners, poor running shoes might be a reason, either flat feet or a really high arched foot, shortened Achilles Tendon (making it hard for ankle dorsiflexion – you dorsiflex when you flip your foot towards your nose…you plantar flex when you step on the gas peddle). Overtraining and running on hard cement might cause plantar fasciitis. Dancers beware too. Ballet dancers (who always say it destroys their feet) and aerobic class folks are more at risk because of the stress upon the Achilles tendon. Interestingly tight hamstrings can decrease knee extension which can lead to plantar fasciitis. Associated diseases include osteomalacia, fibromyalgia, reactive arthritis, and fluoride treatment (such as in treating osteoporosis).
Diagnosis: it is pretty easy to diagnose plantar fasciitis on physical exam because there is tenderness in the arch of the foot to the heel. It especially hurts when stretching out the fascia by extending the toes. Xrays usually aren’t needed but it can show if there is a heel spur, which might be a separate issue. I have never seen it but some reports say that an X-ray & ultrasound can see increased plantar fascia thickening and fat pad abnormalities. MRI is rarely required.
Bad cases: rupture of the plantar fascia can occur and hurt severely. Nerve damage can occur kind of like in carpal tunnel syndrome. The posterior tibial nerve can become entrapped leading to numbness of the sole and heel pain.
Treatment: ARCH SUPPORT in the shoes is most recommended. Resting padded foot splints – not proven to work but some use them. Don’t go barefoot or in slippers because there isn’t arch support so many people with plantar fasciitis complain of pain when getting out of bed and stepping barefoot onto the floor. Good padded shoes to reduce the stress from standing all day on hard floors. Avoid running, jumping, and other impacting things. Lose weight to reduce the stress on the foot. Rest, ice, taping, and even NSAIDS might be considered. Stretching out the plantar fascia with bands can be useful, curling the toes, and doing range of motion at the ankle. Steroid injections hurt terribly, and so are done in extreme cases. Steroid can be delivered by iontophoresis which is painless. Shock wave therapy has mixed results. If everything fails, about 2-5% of people end up having surgery. But for most people, plantar fasciitis goes away 80% of the time within one year.
drjohnhong 
Uncategorized, Bones & Muscles, Pain 
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