What is Plantar Fasciitis?
The plantar fascia is a fibrous band that is similar to a large ligament. The fascia is on the bottom of the foot and stretches from the heel to the ball of the foot. This band can be over stretched, strained or injured resulting a condition known as plantar fasciitis. Plantar fasciitis is simply inflammation of this injured band. The pain of plantar fasciitis most commonly occurs on the bottom of the heel. Since the plantar fascia supports the bottom of the foot, you can also get arch pain and even weakening of the arch leading to foot instability and lack of shock absorption in the foot. More severe cases cause partial or complete rupture or tearing of the plantar fascia.
How Do You Develop Plantar Fasciitis?
Plantar fasciitis is often the result of a poor foot structure which you inherit. When the arch flattens, the fascia pulls too tight. Increased activity, weight gain, non-supportive shoes, tight calf muscles and injury can then lead to inflammation of the band and severe pain which comes on gradually. In many cases patients will report that their plantar fasciitis started after wearing a certain shoe or doing an activity. Over time the plantar fascia stays tight and pulls against the heel bone which makes a heel spur form. Heel spurs do not cause pain and are not the reason for your plantar fasciitis.
What are the Symptoms of Plantar Fasciitis?
There are several plantar fasciitis symptoms that are very common. Pain often occurs in the morning after taking those first steps out of bed. As you walk it off the pain will usually lessen. The same thing can occur after sitting and then standing up again. This happens because the plantar fascia band become contracted or tightened when there is no weight on the foot. The band also loses its warmth without activity. So those first steps cause a rapid pull of the contracted band and pain. As the band stretches out and warms with your weight on the foot, the pain decreases. Some people will also experience pain towards the end of the day and when wearing flatter shoes. Surprisingly, heels often make the heel pain better.
What are the Conservative treatments for plantar fasciitis?
At home you can ice the foot, do some stretches, wear supportive shoes and take anti-inflammatory medications. Over the counter arch supports may give some partial relief.
In the office, plantar fasciitis may be treated with cortisone or alternative medicine injections. The most important treatment for plantar fasciitis is custom orthotic devices to realign your foot. This is the treatment that is long-term and addresses your abnormal foot structure and function. Without orthotic devices, cortisone and anti-inflammatory pills will likely only provide temporary relief. Stretching is also a very important treatment that should be performed several times a day at home. Night splints may help accomplish this goal when used properly.
Regenerative medicine is an excellent option for treatment of plantar fasciitis often curing the problem when used with orthotic devices. These treatments include prolotherapy, PRP, Ozone, laser and shockwave therapy.
What are the Surgical Treatments for Plantar Fasciitis?
Traditional surgical treatment is rarely necessary in this authors opinion. Surgery involves partial cutting of the plantar fascia. This often leads to major foot instability and worsening foot problems in the long-term. However, when all other options have been exhausted then surgery may be necessary.
Cryosurgery has proven to be an excellent minimally-invasive procedure performed in the office for relief of plantar fasciitis pain. This is a great way to get back to activities more quickly. This procedure is used in combination with PRP and ozone.
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