geauxt's podiatry corner - plantar fasciitis (long, sorry)

Slow Friday morning in clinic, so I figured I could educate some folks and maybe save y'all a few bucks and a trip to the doctor...

Approximately 2 million people a year go to the doctor for heel and arch pain. The vast majority of those are suffering from plantar fasciitis. Many people like to refer to their "heel spurs". While heel spurs are often seen with plantar fasciitis, they are more of a secondary finding and rarely actually cause any problems. I'll see roughly 1,000 patients or more a year for it.

Well, what is plantar fasciitis? It is an inflammation of the plantar fascia, which is a ligament which runs from the heel to the ball of your foot. It is responsible for helping support the arch, and acts like a shock absorber while walking.



It usually has a slow, progressive onset, and there is usually no history of trauma. The most common symptoms are pain first thing in the morning, or after prolonged sitting. This is caused because while off of the affected foot there is no tension on the fascia. When you step down on it, the fascia stretches and causes pain.

Treatments:

Treatments are aimed at supporting the ligament, and reducing stress.

1. Running shoes. Studies have shown the best shoe for people with plantar fasciitis is a good, supportive running shoe (New Balance, Asics, Brooks, and Mizunos are my favorites). Your looking for a shoe with a heel higher than the toes, and one that does not fold up like a pretzel in the middle. While the condition is flared up, it is best to avoid barefoot, flip flops, sandals, and flat shoes as these put more stress on the fascia.

2. Arch support. In addition to good shoes you need additional arch support. There are 100's of different arch supports. My partner and I personally prefer Spenco. Regardless of brand, you are looking for something that has good, semi-rigid support in the arch, and slight elevation in the heel. The Spenco Polysorb is what we carry in our office.



3. Stretching. Stretching throughout the day is very important. Anytime you are stretching you calf or hamstrings, you're helping stretch the plantar fascia. I also recommend using a towel or exercise band to stretch your calf before getting out of bed in the morning to help with those first, painful steps.

4. Ice. You want to use ice, not heat. We typically recommend freezing a water bottle and rolling it under your arch.

5. Anti-inflammatory. These mostly help with breakthrough soreness.

Doing all of these treatments full time patients typically see significant improvement in 1 month. Full recovery can take up to 6-8 weeks depending on how bad the condition is.

Other conservative treatments can include steroids (shot or pills), physical therapy, night splints, boot cast immobilization, and custom made orthotics.

Surgery is rarely necessary, and only comes after many months of failed conservative treatment. Surgery involves cutting a portion of the fascia, allowing it to heal in a lengthened position.

Have a good Friday