What is plantar fasciitis?
Plantar fasciitis is an irritation to a ligament on the bottom of the foot. It can be experienced after new shoe wear, after an intense workout, or unknown cause. Many people feel an intense sharp pain on the bottom of their foot. It is usually more evident in the morning after the first few steps out of bed. Many people will have symptoms resolve after continued walking. Symptoms can also be experienced after prolonged sitting at a desk. The pain is sharp and stabbing in the arch of the foot. This commonly will cause limping and an alteration in walking, causing patients to walk on their toes. Some patients experience symptoms for only a short time, others will have lasting symptoms.
Diagnosis and Exam
Obtaining a thorough history is important because typically this presents similarly between patients. It is usually a gradual onset but can have an abrupt onset on occasion. Diagnosis is typically made with history as well as recreation of symptoms by pressing at the insertion of the plantar fascia. This is just in front of the heel on the inside of the foot. Pain is recreated and the patient will typically withdrawal there foot from the exam. Also curling the toes up will cause a tightness in the bottom of the foot, occasionally this will also recreate symptoms.
Initial treatment should consist of rest and stretching. There are certain stretching exercises that have shown to alleviate 90% of symptoms if done correctly and consistently. Commonly the symptoms are exacerbated by a tight Achilles tendon. This can be stretched easily off of a stair. You will first place the ball of your foot on the edge of the step and allow your heel to drop and extend past your foot allowing a nice gradual stretch. This should be held for 5 minutes at a time. Usually 3 sets 3 times a day is sufficient, any more is still beneficial. Another more isolating stretch is curling the toes back and allowing the plantar fascia to be stretched directly. This can be accomplished by pressing your toes against a wall. Again, this should be held for 5 minutes for 3 sets and performed 3 times a day. Physical Therapy can also be valuable. This is helpful because another individual can perform the stretch allowing you to relax, which improves your stretching capabilities. Another line of treatment is a night splint. This can allow stretching to continue even through the night. This can be added if the initial stretching regimen does not prove successful.
Injections are a common question for initial treatment. At this time, there is not sufficient data to prove for or against injections. There is, however, data to support continued stretching to resolve symptoms. This stretching sometimes will need to be continued indefinitely.
How long does it take to get over plantar fasciitis?
Depending on the severity, it is difficult to determine how long it will last. If the stretching regimen is followed consistently, then symptoms may resolve within 6 weeks. Sometimes the symptoms improve but are not completely resolved. Patients in this category typically have minor symptoms that do not prevent their daily activities. Typically, symptoms correlate with the duration of symptoms. The longer the symptoms have been present, the longer it takes to resolve.
How do I prevent plantar fasciitis?
Prevention falls into the same category as treatment, if symptoms were present, but then resolved after stretching. Stretching is the sole method to preventing recurrence. After symptoms have resolved, the stretching does not need to be as intense or as consistent.
Why do I still have problems?
If symptoms are still present after a regimen of physical therapy and home stretching then there could be a chronic inflammatory phase that has set in. patients who have symptoms for over a year or so can experience this. If the insertion of the plantar fascia has gotten to this state, stretching may not improve symptoms. At this point the treatment discussion will fall in the surgical category.
What happens if I need surgery?
For those patients with persistent pain despite a well followed physical therapy protocol, surgery is the final discussion. This is rare and only is necessary in a select few patients. Surgical treatment can consist of a couple different techniques. The most common of the techniques is to perform a partial release of the Achilles tendon. This is accomplished by a small incision in the back of the calf muscle. One of the two conjoining tendons of the Achilles is released. Patients are then splinted in the operating room to maintain the increased range of motion of the ankle. In very extreme cases, were patients have developed a “heel spur” on the bottom of their foot, the plantar fascia is partially released. Outcomes with this portion of the operation are variable and is why it is not commonly performed. Recovery is usually slow for the first couple weeks with gradual return to low impact activities by the first 6 weeks.
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DiGiovanni et al: Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up.
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