Plantar Fasciitis 101
Are you noticing painful heels in the morning? Getting up from your desk or the couch? The instant sharp pain to the bottom of the heels could be Plantar Fasciitis, a common cause of pain in the foot.
What causes Plantar Fasciitis?
Plantar fasciitis is an inflammatory based pain at the origin of the plantar fascial tissue band on the bottom of the foot that is caused by tight calf muscles. The calf muscles form the Achilles tendon, when tight, increasing the pull on your heel bone. When this happens the plantar fascial attachment at the bottom of the heel bone is stressed even more as the foot flattens with every step, causing micro tears and eventual substantial tears of the plantar fascia.
How Do We Diagnose this?
Good clinical suspicion, presentation and physical exam allow us to have a good idea on the cause of the pain but there are several other conditions we like to rule out. In some cases, we will take a x-ray to make sure there are no signs of fractures or problems with the surrounding bones. Here we will usually see a plantar heel spur, caused by prolonged tension at the origin of the plantar fascia. This is an indicator of a tight plantar fascia, but not always a sign of pain.
In some cases, we order an MRI to evaluate for tearing of the plantar fascia, this is seen in cases of injury, feeling a pop, or chronic degeneration of the tissue in prolonged cases of plantar fasciitis.
How We Treat this Condition?
Here at Ankle and Foot Centers of Tennessee, our goal is immediately to get you out of pain, then we aim to keep you out of pain by introducing some home therapy programs.
- Steroid Injection is an effective way to deal with significant pain that targets the localized inflammation causing the pain.
- Home exercise programs targeting the tight calf muscles is discussed and demonstrated in the office. A night splint may be implemented for prolonged passive stretching. This aims to reduce the tension on the plantar fascia, allowing the band of tissue to recover and heal without constant microtearing. Physical Therapy can be introduced for further modalities.
- Increasing the support of the arch, by means of supportive shoe gear, over-the-counter and custom orthotics. These prevent the flattening of the arch and in turn decrease the stress to the plantar fascia.
- Laser Therapy can be used to target the deep inflammatory process at the heel and aid in recovery of the deeper tissues that are stuck in a pain loop of inflammation and scarring.
- Plantar Fasciotomy is performed in stubborn cases of plantar fasciitis where the plantar fascia is released either in the OR or as an in-office procedure. This is sometimes coupled with a Gastrocnemius recession to further decrease the tension.
How Do You Keep the Pain Away?
Now that the pain has subsided, the best way to prevent the recurrence is to continue with both the arch support and the stretching modalities. This ensures the plantar fascial band is not being over-worked and minimizing tears before they have a chance to start.