Are you suffering
from Plantar Fasciitis?
Getting
to Know Plantar Fasciitis
Heel pain accounts for a
large number of patient visits to foot and ankle specialists. The most common
cause of this heel pain is “plantar fasciitis” (also known in some circles as
“heel spur syndrome”) [1]. More than two million Americans receive treatment
for plantar fasciitis each year [2]. Patients classically complain of intense
heel pain after periods of rest that improves with activity. Fortunately,
plantar fasciitis is treatable. Sixty-five to 95% of patients suffering from
plantar fasciitis respond to conservative (non-surgical) therapies [3)
What is Plantar Fasciitis?
Plantar fasciitis
is an inflammation of the plantar fascia-a band of dense fibrous tissue (i.e.,
fascia) located along the bottom of the foot (i.e., plantar surface) extending
from the heel bone (i.e., calcaneus) to the ball of the foot. It is the most
important structure in maintaining the longitudinal arch of the foot [4]. With
every step forward, bodyweight follows-starting at the heel, progressing
through the midfoot (arch area), ending with the toes pushing off the ground.
When bodyweight is shifted to the midfoot, the arch normally flattens, and in
doing so, acts as a shock absorber to the body by dissipating forces from the
ground. The extent to which the arch flattens is limited by the degree at which
the plantar fascia can hold it. Here in lies the problem. Unlike tendon, the
plantar fascia is not elastic and therefore cannot stretch when forces on the
foot to flatten the arch become too great. If it was elastic, the arch would
collapse and rebound excessively with every step-imagine bouncing down the
street without need of a pogo stick. Because of its inelasticity, the plantar
fascia begins to separate from its weakest point of attachment, often the heel
bone, resulting in pain and inflammation that is distinct and treatable.
Think of the foot as an archer's bow where
the bowstring is your plantar fascia and the bow is your arch. If the tips of
the bow were brought closer together, the bowstring would be limp. In the case
of plantar fasciitis, the tips of the bow are brought further apart, thus
increasing the tension on the bowstring to a point where it will snap, tearing
the plantar fascia from its heel bone insertion resulting in heel pain.
Treatment
Options
There are two
objectives in treating plantar fasciitis: alleviate the symptoms (pain and
inflammation) and correct the underlying deformity (excessive tension on the
plantar fascia). Conservative therapies can meet both objectives. Surgery is
usually warranted only after conservative therapies have failed over a period
of 6 months or more. Without response to conservative measures, a doctor is
more likely to question his/her original diagnosis than schedule your trip to
the operating room. There are many different causes of heel pain and perhaps
your pain might be caused, at least in part, by another condition (such as
nerve entrapment, muscle strain, bursitis, arthritis, or stress fracture of the
calcaneus). Unfortunately, it takes time. Your podiatrist will prescribe a
combination of conservative therapies that have proven effective in their
practice. Only when these therapies fail will your doctor consider surgery. The
best way to protect your feet is not to ignore them.