What Triggers Plantar Fasciitis To Appear

Feet Pain

Overview

Plantar fasciitis causes pain in the bottom of the heel. The plantar fascia is a thin ligament that connects your heel to the front of your foot. It supports the arch in your foot and is important in helping you walk. Plantar fasciitis is one of the most common orthopedic complaints. Your plantar fascia ligaments experience a lot of wear and tear in your daily life. Normally, these ligaments act as shock absorbers, supporting the arch of the foot. Too much pressure on your feet can damage or tear the ligaments. The plantar fascia becomes inflamed, and the inflammation causes heel pain and stiffness.




Causes

You're more likely to develop the condition if you're female, overweight or have a job that requires a lot of walking or standing on hard surfaces. You're also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches also are more prone to plantar fasciitis.




Symptoms

Plantar fasciitis generally occurs in one foot. Bilateral plantar fasciitis is unusual and tends to be the result of a systemic arthritic condition that is exceptionally rare among athletes. Males suffer from a somewhat greater incidence of plantar fasciitis than females, perhaps as a result of greater weight coupled with greater speed and ground impact, as well as less flexibility in the foot. Typically, the sufferer of plantar fasciitis experiences pain upon rising after sleep, particularly the first step out of bed. Such pain is tightly localized at the bony landmark on the anterior medial tubercle of the calcaneus. In some cases, pain may prevent the athlete from walking in a normal heel-toe gait, causing an irregular walk as means of compensation. Less common areas of pain include the forefoot, Achilles tendon, or subtalar joint. After a brief period of walking, the pain usually subsides, but returns again either with vigorous activity or prolonged standing or walking. On the field, an altered gait or abnormal stride pattern, along with pain during running or jumping activities are tell-tale signs of plantar fasciitis and should be given prompt attention. Further indications of the injury include poor dorsiflexion (lifting the forefoot off the ground) due to a shortened gastroc complex, (muscles of the calf). Crouching in a full squat position with the sole of the foot flat on the ground can be used as a test, as pain will preclude it for the athlete suffering from plantar fasciitis, causing an elevation of the heel due to tension in the gastroc complex.




Diagnosis

Your doctor will check your feet and watch you stand and walk. He or she will also ask questions about your past health, including what illnesses or injuries you have had. Your symptoms, such as where the pain is and what time of day your foot hurts most. How active you are and what types of physical activity you do. Your doctor may take an X-ray of your foot if he or she suspects a problem with the bones of your foot, such as a stress fracture.




Non Surgical Treatment

Most health care providers agree that initial treatment for plantar fasciitis should be quite conservative. You'll probably be advised to avoid any exercise that is making your pain worse. Your doctor may also advise one or more of these treatment options. A heel pad. In plantar fasciitis, a heel pad is sometimes used to cushion the painful heel if you spend a great deal of time on your feet on hard surfaces. Also, over-the-counter or custom-made orthotics, which fit inside your shoes, may be constructed to address specific imbalances you may have with foot placement or gait. Stretching: Stretching exercises performed three to five times a day can help elongate the heel cord. Ice: You may be advised to apply ice packs to your heel or to use an ice block to massage the plantar fascia before going to bed each night. Pain relievers: Simple over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in decreasing inflammation and pain. If you have stomach trouble from such drugs, your health care provider may prescribe an alternative. A night splint: A night splint is sometimes used to hold your foot at a specific angle, which prevents the plantar fascia from shortening during sleep. Ultrasound: Ultrasound therapy can be performed to decrease inflammation and aid healing. Steroid injections: Anti-inflammatory steroid injections directly into the tissue around your heel may be temporarily helpful. However, if these injections are used too many times, you may suffer other complications, such as shrinking of the fat pad of your heel, which you need for insulation. Loss of the fat pad could actually increase your pain, or could even rupture the plantar fascia in rare cases. Walking cast: In cases of long-term plantar fasciitis unresponsive to usual treatments, your doctor may recommend that you wear a short walking cast for about three weeks. This ensures that your foot is held in a position that allows the plantar fascia to heal in a stretched, rather than shortened, position. Shock wave therapy, Extracorporeal shock wave therapy which may be prescribed prior to considering surgery if your symptoms have persisted for more than six months. This treatment does not involve any actual incisions being made rather it uses a high intensity shock wave to stimulate healing of the plantar fascia.

Heel Discomfort




Surgical Treatment

In cases that do not respond to any conservative treatment, surgical release of the plantar fascia may be considered. Plantar fasciotomy may be performed using open, endoscopic or radiofrequency lesioning techniques. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. Potential risk factors include flattening of the longitudinal arch and heel hypoesthesia as well as the potential complications associated with rupture of the plantar fascia and complications related to anesthesia.

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