• Plantar Fasciitis

    Definition

    The plantar fascia is a thick band of tissue attached to the heel bone. It supports the arch of the foot. Plantar fasciitis is inflammation of the plantar fascia.
    Plantar Fasciitis
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    Causes

    Plantar fasciitis is caused by small, repetitive trauma to the plantar fascia. This truama can be due to activity that puts extra stress on the foot, such as:
      Physical exertion, especially in sports such as:
      • Running
      • Volleyball
      • Tennis
    • A sudden increase in exercise intensity or duration

    Risk Factors

    The main risk factor for plantar fasciitis is physical activity that stresses the plantar fascia. Other risk factors that increase your chance of getting plantar fasciitis include:
    • Age: 40-60 years
    • People who spend a lot of time standing
    • A sudden increase in activities that affect the feet
    • Obesity or weight gain
    • Pre-existing foot problems, including an abnormally tight Achilles tendon, flat feet, or an ankle that rolls inward too much (overpronation)
    • Poor footwear

    Symptoms

    Symptoms of plantar fasciitis may start gradually or happen suddenly. They include:
    • Pain on the sole of the foot near the heel
    • Heel pain when taking the first steps in the morning
    • Tenderness when touching the sole or heel

    Diagnosis

    The doctor will ask about your symptoms and medical history. A foot exam will be done.
    Tests may include an x-ray or bone scan of the foot to help rule out stress fractures or other bone abnormalities.

    Treatment

    Treatments include:

    Rehabilitation Measures to Reduce Plantar Fascia Irritation

      Activity
      • Avoid running and other activities that may worsen pain.
      • Begin stretching exercises to lengthen the Achilles tendon and plantar fascia as recommended by a healthcare professional. This is usually done when pain has lessened or improved.
    • Ice—Apply ice or a cold pack to the heel and arch for 15 to 20 minutes. Do this 4 times a day to relieve pain. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.
    • Night splint—A special splint that will hold your foot in a neutral position while sleeping.
    • Orthotics—Special shoe inserts that support the mid-arch region of your foot. Inserts that are not customized may work just as well as those that are customized.

    Medication

    Nonsteroidal anti-inflammatory drugs (eg, ibuprofen or naproxen) may be given to help relieve pain and inflammation.

    Procedures

    The use of corticosteroid injections is questionable. Doctors may consider them an option in some cases. A special type of sound wave called extracorporeal shock wave may also be considered in certain cases. This treatment happens under the care of your doctor. At this time, this is generally a treatment for long-term cases that do not respond to other treatments.

    Surgery

    In a few cases, basic treatments don't help. Surgery may be performed to cut the tight, swollen fascia.

    Prevention

    To reduce your risk of getting plantar fasciitis:
    • Wear appropriate and well-fitted footwear during sports and exercise.
    • Do stretching exercises for the Achilles tendon and plantar fascia.
    • Increase the intensity and duration of exercise gradually.
    • Maintain an appropriate weight.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org/

    American Academy of Physical Medicine and Rehabilitation http://www.aapmr.org/

    CANADIAN RESOURCES

    Ontario Podiatric Medical Association http://www.opma.ca/

    Orthogate http://www.orthogate.org/

    References

    Dyck DD, Boyajian-O'Neill LA. Plantar fasciitis. Clinical Journal of Sport Medicine. 2004;14:305-309.

    Plantar fasciitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated November 2, 2012. Accessed November 19, 2012.

    Plantar fasciitis. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/pointOfCare/perc-about . Updated September 1, 2011. Accessed November 19, 2012.

    Plantar fasciitis and bone spurs. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00149 . Updated June 2010. Accessed November 19, 2012.

    Orchard J. Plantar fasciitis. BMJ . 2012 Oct 10;345:e6603.

    Pommering TL. Ankle and foot injuries in pediatric and adult athletes. Prim Care. 2005;32:133-161.

    6/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Baldassin V, Gomes CR, Beraldo PS. Effectiveness of prefabricated and customized foot orthoses made from low-cost foam for noncomplicated plantar fasciitis: a randomized controlled trial. Arch Phys Med Rehabil. 2009;90:701-706.

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