Plantar fasciitis is an inflammation of the long band of connective tissue running from the heel to the ball of the foot. The plantar fascia acts like a bowstring and supports the arch and several muscles inside the foot. When there is increased stress on the arch, microscopic tears can occur within the plantar fascia, usually at its attachment on the heel. This results in inflammation and Heel Pain with standing and walking and sometimes at rest.
Achilles tendon rupture, the tendon of the heel cord behind the ankle is torn. Bone bruise. Bone cyst, a solitary fluid-filled cyst (cavity) in a bone. Gout, levels of uric acid in the blood rise until the level becomes excessive (hyperuricemia), causing urate crystals to build up around the joints. This causes inflammation and severe pain when a gout attack happens. Neuroma (Morton’s neuroma) a swollen nerve in the ball of the foot, commonly between the base of the second and third toes. Osteomyelitis , osteomyelitis means infection of the bone or bone marrow; inflammation of the bone due to infection. Osteomyelitis sometimes occurs as a complication of injury or surgery. In some cases, the infection may get into bone tissue from the bloodstream. Patients with osteomyelitis typically experience deep pain and muscle spasms in the inflammation area, as well as fever. Peripheral neuropathy, neuropathy is a collection of disorders that occurs when nerves of the peripheral nervous system (the part of the nervous system outside of the brain and spinal cord) are damaged. The condition is generally referred to as peripheral neuropathy, and it is most commonly due to damage to nerve axons. Neuropathy usually causes pain and numbness in the hands and feet. It can result from traumatic injuries, infections, metabolic disorders and exposure to toxins. One of the most common causes of neuropathy is diabetes. Problems with your gait, wrong posture when walking/running. Rheumatoid arthritis, rheumatoid arthritis, sometimes referred to as rheumatoid disease, is a chronic (long lasting), progressive and disabling auto-immune disease condition that causes inflammation and pain in the joints, the tissue around the joints, and other organs in the human body. Rheumatoid arthritis usually affects the joints in the hands and feet first, but any joint may become affected. Patients with rheumatoid arthritis commonly have stiff joints and feel generally unwell and tired.
Symptoms may also include swelling that is quite tender to the touch. Standing, walking and constrictive shoe wear typically aggravate symptoms. Many patients with this problem are middle-aged and may be slightly overweight. Another group of patients who suffer from this condition are young, active runners.
The diagnosis of plantar fasciitis is generally made during the history and physical examination. There are several conditions that can cause heel pain, and plantar fasciitis must be distinguished from these conditions. Pain can be referred to the heel and foot from other areas of the body such as the low back, hip, knee, and/or ankle. Special tests to challenge these areas are performed to help confirm the problem is truly coming from the plantar fascia. An X-ray may be ordered to rule out a stress fracture of the heel bone and to see if a bone spur is present that is large enough to cause problems. Other helpful imaging studies include bone scans, MRI, and ultrasound. Ultrasonographic exam may be favored as it is quick, less expensive, and does not expose you to radiation. Laboratory investigation may be necessary in some cases to rule out a systemic illness causing the heel pain, such as rheumatoid arthritis, Reiter’s syndrome, or ankylosing spondylitis. These are diseases that affect the entire body but may show up at first as pain in the heel.
Non Surgical Treatment
If the plantar fasciitis is acute, that is, a sprain of the plantar fascia then it is basically treated as a sprain, with anti-inflammatory drugs, ice, rest, possibly physical therapy. If chronic, the poor foot mechanics need be addressed. Foot mechanics are changed by use of specially moulded shoe inserts known as orthotics. Someone with plantar fasciitis needs an orthotic designed to relieve strain on the plantar fascia. Orthotics are often confused with arch supports. Arch supports, by holding up the arch can remove some of the tension from the plantar fascia. Orthotics, on the other hand, do most of their work on the heel and ball of the foot repositioning the foot for maximized function. What can you do before you see the foot doctor? First, try doing your own version of deep tissue massage by rolling a frozen cola bottle or can from the heel forward into the arch. Do it gently. Do stretching but the key to good stretching is not to stretch too hard so generally avoid weight bearing (standing) stretches but sit on a soft surface like your bed and pull the foot backward on the leg as far as it will go, holding for 20 seconds and relaxing for 5 seconds. Each 25 second ?set? can be repeated 5 times and you have invested about 2 minutes in giving yourself a lot of help. Watch out for the shoes you wear. It is tempting to obtain shoes that are colorful and soft. Here is the proof that soft shoes are bad. Wrap a pillow around your foot with duct tape and walk for a block or two. You will come back with your foot hurting more because your foot sank down deeper into the soft surface, allowing the ligament to stretch more. The shoes should be stiff in the shank and flexible at the ball. Such shoes, to running buffs, are known as motion control shoes or stability shoes so going to one of the small specialty running shoes stores is a good place to start. If you don?t have a desk job, or have an industrial job see if light duty is available. A note from your doc may be all that is required in most cases and most doctors are happy to oblige.
When a diagnosis of plantar fasciitis is made early, most patients respond to conservative treatment and don?t require surgical intervention. Often, when there is a secondary diagnosis contributing to your pain, such as an entrapped nerve, and you are non-responsive to conservative care, surgery may be considered. Dr. Talarico will discuss all options and which approach would be the most beneficial for your condition.
Before you get out of bed in the morning, and then periodically throughout the day, do the following exercises to increase flexibility and ease pain. Slowly flex your foot and toes to stretch the tissue on the bottom of your sore foot. Hold the stretch for 10 counts. Relax and repeat. Do gentle ankle rolls to keep the tissues around the ankle and on the back of the heel flexible. Sit on the edge of your bed and roll your foot back and forth over a tennis ball.