Get Well Wednesday: Your Foot Pain May Be Plantar Fasciitis

Dr. Roderick Hunter Is A Podiatrist Based In Plano, Texas Specializing In Foot Care And Corrective Procedures. He Completed His Undergraduate Studies At The University Of Texas At Dallas, Earning A B.A. In Biology With A Minor In Psychology — And Then Went On To The New York College Of Podiatric Medicine. He Has Been In Practice For Six Years.

About two million people suffer with plantar fasciitis ((plant-ar fash-ee-itis)) one of the most common causes of heel pain and very common in runners. It usually occurs between the age of 40 and 60.

Q: WHAT IS PLANTAR FASCITIS?

A: Inflammation of the plantar fascia, the bowstring-like tissue that stretches from the heel bone to the base of the toes. Plantar fasciitis can be due to calcaneal spurs, which typically cause localized tenderness and pain that is made worse by stepping down on the heel. Plantar fasciitis may be related to physical activity overload, abnormal foot mechanics, or may be due to underlying diseases that cause arthritis, such as Reiter disease, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis. Treatment is designed to decrease inflammation and avoid reinjury. Icing reduces pain and inflammation. Anti-inflammatory agents, such as ibuprofen and injections of cortisone, can help. Infrequently, surgery is done on chronically inflamed spurs. A donut-shaped shoe insert can take pressure off a calcaneal spur and lessen plantar fasciitis.

Q:  WHAT ARE THE SYMPTOMS OF PLANTAR FASCITIS?

A: Plantar fasciitis typically causes a stabbing painin the bottom of your foot near the heel. The pain is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or rising from sitting. The pain is usually worse after exercise, not during it

Q:  HOW IS PLANTAR FASCITIS DIAGNOSED?

A: Diagnosis is primarily based on history and physical examination. … Use of ultrasonography and magnetic resonance imaging is reserved for recalcitrant cases or to rule out other heel pathology; findings of increasedplantar fascia thickness and abnormal tissue signal the diagnosis ofplantar fasciitis

Q:  WHAT CAUSES IT?  ARE THING LIKES WEIGHT OR AGE A FACTOR?

A: You’re at a greater risk of developing plantar fasciitis if you’re overweight or obese. This is due to the increased pressure on your plantar fascia ligaments, especially if you have sudden weight gain.

Q: WHAT TREATMENT OPTIONS ARE AVAILABLE FOR PLANTAR FASCITIS?

A: Most people who have plantar fasciitis recover with conservative treatments, including resting, icing the painful area and stretching, in several months.

Medications

Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) can ease the pain and inflammation associated with plantar fasciitis.

Therapies

Stretching and strengthening exercises or use of specialized devices may provide symptom relief. These include:

• Physical therapy. A physical therapist can instruct you in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist might also teach you to apply athletic taping to support the bottom of your foot.
• Night splints. Your physical therapist or doctor might recommend that you wear a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and facilitates stretching.
• Orthotics. Your doctor might prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.

Surgical or other procedures

When more-conservative measures aren’t working after several months, your doctor might recommend:

• Injections. Injecting a type of steroid medication into the tender area can provide temporary pain relief. Multiple injections aren’t recommended because they can weaken your plantar fascia and possibly cause it to rupture. More recently, platelet-rich plasma has been used, under ultrasound guidance, to provide pain relief with less risk of tissue rupture.
• Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It’s usually used for chronic plantar fasciitis that hasn’t responded to more-conservative treatments. This procedure might cause bruising, swelling, pain, numbness or tingling. Some studies show promising results, but it hasn’t been shown to be consistently effective.
• Tenex procedure. This minimally invasive procedure removes the scar tissue of plantar fasciitis without surgery.
• Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It’s generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.

Q: ONCE DIAGNOSED, HOW LONG WILL IT LAST?

A: Your healing time depends on the severity of your condition. One of the best things you can do for your feet is to rest. The natural history of pain from plantar fasciitis can last up to 24 months.

Q: DOES DIET PLAY A ROLE IN PLANTAR FASCITIS, IF SO WHAT TYPES OF FOOD NEED TO BE AVOIDED?

A: The main way our diet affects plantar fasciitis is through our consumption of foodsthat have either inflammatory or anti-inflammatory qualities. … Spinach, while not one of the most popular foods, is one of the most effective anti-inflammatories, as it contains calcium, magnesium, Vitamin C, and MSM.

Dr. Hunter answers your “Text Tom” questions on the next page.

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