Plantar fasciitis is the most common cause of heel pain. It is a condition seen in the old the young, the active and inactive. It can be incapacitating if early efforts in treatment are not made. The good news is that 80-85% of the time, it is successfully treated conservatively. The odds are in your favor if you act quickly to heal it.
Plantar fasciitis is an inflammatory condition where pressure in and around the arch of your foot causes a strain and sometimes even a tear in the main ligament (the plantar fascia) that helps to hold up the arch. This ligament spans the bottom of the foot from heel to the ball of the foot. Think of the plantar fascia ligament as a rope made of many fibers. The fibers can tear and shred causing pain and inflammation. The most common area for pain occurs at the heel, which is the weakest attachment of this ligament. Yet, there are many cases where pain is felt along the course of this ligament especially right underneath the arch itself.
Once the strain and pain occurs, you may notice a pattern in the way it feels. Commonly, you may feel mild to intense pain with the first few steps out of bed in the morning or after sitting, or even after a long drive. When you think about it, our feet tend to point slightly down ward in these instances. This temporarily relaxes the arch and the ligament tightens. When you stand up, you place all of your weight on the foot and the arch once again strains downward. This puts tension on an already injured plantar fascia, essentially re-injuring it every time this occurs. You may then find early on in the injury, that once your ligament has stretched somewhat, after the first few steps, that the pain resolves. Over time however, you may discover that the pain lingers longer than before. This is when plantar fasciitis becomes a real problem and when most people seek help.
The challenge for a podiatrist is to get the injured ligament to heal even though you are constantly using it. This requires a lot of patient involvement in the healing process.
Healing the plantar fascia requires patience and persistence. Stretching plays a big role in helping this condition. The more you stretch, the better. Your doctor will give you information on the proper stretches that target the plantar fascia. By keeping the ligament limber, it will strain less under your weight.
You may be dispensed something called a “night splint”. This comes in the form of what looks like half of a boot-type splint. This splint rests against your leg and foot to hold your foot up, keeping it from pointing down while you sleep. This keeps a constant stretch on the ligament and surrounding tendons as well. This stretch lessens the strain and can help in healing and improving your pain.
Supporting the arch is essential in preventing further strain and inflammation of the plantar fascia. Too many shoes have poor excuses for an arch support. Even what you may buy as an over-the –counter arch support may not be adequate for your foot type. Your doctor will make the proper recommendations for what your foot needs.
Icing the heel and arch can help as this is an inflammatory process. Taking an anti-inflammatory as needed for the pain may help as well. If your inflammation is beyond what an oral anti-inflammatory can manage, you may be offered a cortisone injection in the heel. Nobody likes them, but they sure can help!
Your doctor may also recommend physical therapy to help with deeper stretches and manipulations, as well as also working on areas that may be constricted or tight in other area of your body. They may also choose to use other modalities such as ultra sound and even cold laser therapy.
Extracorporeal Pulse Activation Treatment (EPAT) is a wonderful modality used to deliver pulses of acoustic waves to treat chronic plantar fasciitis and can be performed at FAANT’s office
This fancy stuff is worth every visit if it means getting you better quicker.
In the very worst of cases, surgical intervention may become necessary. Your doctor will discuss this thoroughly with you if conservative treatment has been exhausted.
Finally, you may now understand what can potentially aggravate this condition. The types of exercises you perform may play a role. For the time being, any exercise that causes excessive impact on the arch and plantar fascia such as running or jumping should be replaced with exercises that are more lenient on the injury. Biking, swimming, ellipse cycle and arc trainer are effective aerobic options and much gentler on your healing fascia.
Weight gain plays a role in aggravating plantar fasciitis. Increased weight means increased strain. The non-impact exercises just mentioned are great options to get some of the weight off the ligament and off your body.
Supportive shoes are just as important as the arches inside them. Flip flops and barefoot walking needs to be placed to the side for now since you will get the most strain in the ligament if nothing is keeping the tension off of it. If you want to wear a slipper instead of a shoe around the house, then look for options with good arch support.
Lastly, just be good to your feet. They are the only set of tires you’ve got. Get them to my office at the first signs of fatigue or the first signs of pain. Don’t wait till you have a blow out!