Symptoms
occur most commonly at the inside part of the heel and are
often most severe when first stepping down in the morning or
after long periods of rest. It may feel like a
"stone bruise" with intense localized discomfort.
The pain may resolve as one "warms up", only to
return as activity is continued. It is rare to see any
swelling or redness in the inflamed region as the swelling is
deep within the foot.
Plantar Fascitis is an overuse injury
caused by an excessive amount of activity over a certain
period of time. The increased strain of the foot results
in pulling on the attachment of the plantar fascia to the
calcaneus resulting in small tears (micro-tears) in the
fascia. When a person sleeps or rests for an extended
time the foot and fascia relax and are re-stretched when
stepping down (first step pain). Over time the pulling
or traction on the bone can also cause the formation of a heel
spur which can be seen on x-ray. The spur doesn't cause
the pain but is a result of the injury. X-rays are taken
to rule out other arthritic or pathologic factors.
Treatment
of Plantar Fascitis consists of decreasing inflammation
and supporting the arch of the foot. Initial treatment
consists of:
1. Supportive/Stable Shoes
2. Supporting the arch with pads or strappings
3. Stretching exercises for the back of the leg
(Achilles tendon) to decrease stress on the foot.
4. Anti-inflammatory medicines taken by mouth.
5. Ice massage twice daily and after activities.
It takes time to develop Plantar Fascitis
therefore obtaining compete relief may take four - twelve
weeks. In resistant cases the following may be necessary
to cure the problem:
1. Local anesthetic and steroid
injection
2. Custom orthotics (Shoe inserts)
3. Physical therapy
4. Night Splints - Hold the plantar fascia stretched
while sleeping
5. Immobilization in a walking cast/boot.
For patients who don't respond to
conservative therapy and who have had to problem for longer
than 6 months, there is now a new treatment available to them.
In December of 2000, Dr. Siwicki was one of the first
Podiatrists trained in the United States with the use of
OssaTron to perform Extracorporeal Shock Wave Therapy for
treatment of chronic heel pain (Plantar Fascitis or heel
spur). He has been doing this procedure at HealthSouth
Crestview Surgery Center since January 2001.
