Sunday, January 27, 2008

Plantar Fasciitis

What is it?

Plantar Fasciitis (pronounced plan-tar fash-ee-eye-tis) is a common cause of heel and foot pain in adults. “Plantar” means the bottom of the foot; “fascia” is a type of connective tissue, and “itis” means “inflammation”. The classic symptoms of plantar fasciitis include heel pain that is usually most severe first thing in the morning. This condition is characterized by inflamma­tion at the insertion point of the plantar fascia on the heel bone. Plantar fascia is a layer of tough fibrous tissue that runs along the bottom of your foot and supports the arch. This is one of the longest and strongest ligaments in the body. As the plantar fascia pulls on the heel, the body will respond by lay­ing down more bone in the area. This can be seen on an x-ray and is known as a heel spur.

How did I get it?

Common contributors to this condition in­clude: progressive flattening of the arches over time (primary reason), lack of flexibility in the calf muscles, changes in activity levels, over­use, and weight gain. When the arch drops, the plantar fascia begins to tear away from its inser­tion at the heel. When this happens over a long period of time, it can overcome the body’s abil­ity to repair itself.

How is it treated?

The initial goal in the relieving the symptoms of plantar fasciitis is to reduce the inflammation of the fascia and any symptoms of pain that may be present. The next step is to address the underlying cause of the symptoms associated with plantar fasciitis.

Exercises:

To lessen the pull at the heel stretching exercises that are aimed at lengthening the plantar fascia will help. A regular calf stretching routine should be a part of any treatment regimen. Increasing the length of the calf muscles is a very im­portant part of any treatment. Tightness in this muscle group can cause excess pronation (arch drop).

Anti-Inflammatory Agents:

These may in­clude ice and oral anti-inflammatory medica­tions. These may provide some temporary re­lief from the pain of inflammation, but are not helpful in addressing the underlying cause of the condition.

Night Splints:

A night splint is a device worn at night to help prevent contraction of the plantar fascia and to maintain calf flexibility. This will usually lessen the “first step in the morning” pain and relieve symp­toms temporarily. They can be uncomfortable to wear for some, but generally provide some relief.

Corticosteroid Injections:

This involves the in­jection of a steroid directly into the heel and site of inflammation. Usually reserved for intractable or difficult cases, this may provide more relief than oral anti-inflammatory medications. Talk to more than one doctor about the indications and risks for this treatment.

Extracorporeal Shock Wave Therapy:

A high or low frequency sound wave is delivered to the area in an attempt to speed the healing process. Usually 1 to 3 treatments are required, and de­pending on the intensity of the sound wave an anesthetic may be used. The outcomes of this treatment are unproven and discussing the risks with more than one doctor is recommended.

Surgery:

In cases that do not respond to conser­vative measures, surgical release of the plantar fascia may be a consideration. Cutting the plantar fascia will lessen the pull on the heel, but may have long term consequences including further flattening of the arch (since the plantar fascia con­tributes about 30% to the stability of the arch).

Custom Foot Orthotics:

Custom made CBAS foot orthotics will address plantar fasciitis by restoring arch height and function then completely supporting the arch. This will effectively help the plantar fascia being pulled on excessively, and tearing away from its inser­tion at the heel. When this is done the cause of plantar fasciitis is being addressed rather than just the symptoms.

CBAS unlike typical custom orthot­ics, are designed to help restore proper arch height and function of an individual foot, determined by a unique way of capturing an impression of the arch with the foot arranged in an optimal position, then completely supporting it. Only allowing the arch to flex accurately at a calibrated rate. The CBAS orthotic is the only calibrated custom orthotic that is designed with an individual’s body weight, foot flexibility, and activity level in mind, creating true biomechanical shock absorption. This truly restores proper foot function so that abnormal joint posi­tions and stresses can be reversed allowing affected tissues to heal and normal joint function to be restored. In this way the CBAS custom orthotics provide the best option for both the primary therapy and preventative care in helping relieve the symptoms associated with plantar fasciitis.

With a proper diagnosis along with a well-rounded management plan including CBAS othotics, the forecast is excellent. It’s not unusual get a 50-70% relief in the first month, 70-90% the second month and 90-100% the third. Regular orthotic use can insure that the problem does not return.

If left alone plantar fasciitis can take from 6 to 18 months to heal, and symptoms can reoccur on various occasions, even before the last flair up has completely dissipated. Interfering with the ability to work and activities.

This page provides a general overview on this topic and may not apply to everyone. Please talk to your health care provider to address your individual situation.