Dr. Marc Blatstein comments about Plantar Fascitis
The most common patients complaint is: ‘Doc, when I first get out of bed in the morning- that first step is very excruciating’. Then after walking around for a while the pain may subside only to come back with a vengeance after sitting and standing up again.
The plantar fascia, is a ligament attached to the bottom of the heel, and then fanning out into the ball of the foot, and into the base of the toes acting like a shock absorber. When walking the foot impacts the ground, and with each step the plantar fascia, stretches slightly. This repetitive ‘pulling on the heel’ per Dr Blatstein, pressures on the heel these create a small tears where the plantar fascia attaches to the heel (calcaneus) resulting in pain. To be clear in years past it was thought that heel pain was due to a bone spur on the bottom of the heel bone (calcaneus). We now know that the pain is due to excessive tension of the plantar fascia producing micro tears at its attachment into the heel bone. At times a preliminary clinical diagnosis can be made when either you or your physician applies pressure right where the medial band of the plantar fascia attached to the heel. This more often than not will result in eliciting severe pain.
Dr. Marc Blatstein talks about Diagnosing Plantar Fascitis
Thus the diagnosis of heel pain (plantar fasciitis) can be made by a complete history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present, and/or to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connects tissue disorders.
Plantar fascitis occurs more frequently in women, but can also be seen in runners and those who participate in activities where there is repetitive motion over time affecting the plantar (bottom) aspect of the heel. At the same time just the simple stepping off the curb when crossing the street, or stepping in a hole while walking can all precipitate this syndrome.
Following a diagnosis there is a wide range of initial treatments available, some of which you can do at home, but when unsuccessful then seeking out professional treatment is a must. Initial treatment can consist of a change in the level or type of activity. Making sure that you are wearing the correct shoe gear, stretching your Achilles tendon & calf muscle (correctly), applying ice to the bottom of your foot, possible taking it easy for a while and lastly for a short duration (7-10) days taking an OTC NSAID with the permission of your doctor.
If you’ve made it to your doctor’s office here too there is a wide range of treatments available. Padding & taping the foot in a supportive nature, night splints, over the counter arch supports heel pad or heel cup ending with a prescription functional foot orthotics for support. Additionally, taking an oral anti-inflammatory medications (NSAIDS), and if all of these are not successful then cortisone injections might be considered.
Should all of these treatments fail, and after a detailed review of your condition of all options; Surgery to correct heel pain (focusing of the plantar fascia ligament) is an option to be considered. Depending on what you and your surgeon decide, some options are: Endoscopic Plantar Fasciotomy, Extracorporeal Shock Wave Therapy are just 2 options, there are others and this decision is between you & your doctor.
The good news is that Plantar fascitis is treatable, the longer you wait and the symptoms persist will result in the healing taking longer. So why wait, let’s get started- because life is meant to be lived