Plantar Fasciitis


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Plantar Fasciitis


Plantar fasciitis is the #1 cause of heel pain in the United States. Fascia is a semi-dense organization of collagen to form connective tissue. This connective tissue is located beneath the skin and is responsible for providing support and additive function of muscle tissue. The plantar fascia specifically is a flat ligament that stretches from the heel to the toes on the undersurface of the foot. It encloses, supports, and separates the muscles in the foot to maintain the arch at this location. After time with strain on the plantar fascia, it can become weak, swollen, and irritated (inflamed). At that time, the heel or the bottom of the foot begins to generate pain.

 Most people that suffer from plantar fasciitis describe the pain as being worse with standing and especially with the first few steps of the day. It is common in middle-aged people. It also occurs in younger people who are on their feet a lot, like athletes or soldiers. Plantar fasciitis can present in one foot or both feet, either concurrently or at separate times. In the next paragraph we will discuss the treatment options so before everything, is vital that the underlying cause of plantar fasciitis be identified. For example, certain malalignments of the foot can cause excess stress on this area and perpetuate symptoms. Overall, the goals of treatment are not unlike most other conditions.

Ultimately, the objective of treatment is achieving complete functional restoration and symptomatic relief. The first step is to mitigate the inflammatory process in the area. Whether this is result of overuse or secondary to small tears in the plantar fascia, activity modification should be put in place to allow the area to heal. As mentioned above, if plantar fasciitis is present because of an anatomic problem, the underlying problem need be corrected. The use of orthopedic shoe inserts is the most commonly utilized entity. Another step that is equally important for long term maintenance is to consider improving strength and flexibility in the muscle. 

Stretching is the mainstay of treatment regardless of the cause. A tight Achilles tendon is almost always extant on the initial presentation of plantar fasciitis. Calf stretches and toe stretches should be started immediately and repeated several times per day. Before or after each session of stretching, foam rolling for the lower body should also be carried out. For larger areas like glutes, hamstrings, quads, and calves traditional foam rollers are very effective. For rolling of the foot itself, even household items like tennis balls or frozen water bottles can be used very effectively. Unfortunately, even with a combination of conservative treatments, certain circumstances still fail to meet the objectives of treatment. For these more resistant cases, the gold standard method then would be a local steroid injection administered directly into the plantar fascia. These are relatively well tolerated and by far the fastest acting treatment.  



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