Defining Plantar Fasciitis: Plantar fasciitis (also known as plantar fasciopathy or jogger's heel) is a common painful disorder affecting the heel and underside of the foot. It is a disorder of the insertion site of ligament on the bone and is characterized by scarring, inflammation, or structural breakdown of the foot's plantar fascia.
In the physical therapy world, a person's walking pattern is a window into their condition, it provides physical therapists with insight concerning the person's current level of function and serves as a rather plain test to determine if treatments are being effective. Evaluating how a person walks is very valuable to the rehabilitation process. Often times, a person's walking pattern or, 'gait pattern,' dramatically improves due to the treatments received from just one physical therapy session. Karen McCain, a physical therapist, describes walking speed as the, 'sixth vital sign.'
Plantar Fasciitis is usually caused by feet that roll inward too much when you walk. Shoes with poor arch support are another cause. The presentation and severity of the condition are correlated strongly with obesity, weight gain, sedentary lifestyles, as well as careers that involve standing on hard surfaces. Where athletes are concerned, running an increased number of miles, or foot injuries during activities, may initiate plantar fasciitis. Plantar fasciitis can result in a heel spur on the calcaneus, although the spur itself is the result of the underlying condition, not causing pain. Plantar fasciitis is caused by strain on the ligament which supports the arch in a person's foot. Repetitious strain can cause tiny tears to occur in the ligament. The tears can cause pain and swelling which is more likely to occur if you:
The majority of people who experience plantar fasciitis have pain when they take their first steps of the day after getting out of bed, or after sitting for a period of time.
They may experience less pain and stiffness once they have taken several steps, yet their feet might hurt more as the day continues.
Their feet might hurt them most when they climb stairs, or after standing for lengthy periods of time.
Those who experience foot pain during the night might have a different foot problem known as, 'Tarsal Tunnel Syndrome.'
To diagnose plantar fasciitis, a doctor will check the person's feet and watch as they stand and walk.
The doctor will ask questions concerning the person's prior health, to include past illnesses or injuries.
During the visit, the doctor will inquire about any symptoms the person is experiencing, such as the location of the pain and the time of day the person's foot hurts them the most.
The doctor will also want to know how active the person is, as well as the forms of physical activities the person is involved in.
An X-ray of the person's foot may be taken should the doctor suspect that there is a problem with the bones in their foot; a stress fracture, for example.
There are different forms of treatment for plantar fasciitis, from stretching to surgery.
Many people attempt to treat the condition at home prior to seeking professional treatment. Common home remedies include stretching, NSAID's, and night splints. Night splints are a good choice, with eight-three percent of persons experiencing some relief after using them. Ultrasound-guided puncturing of the heel periosteum and the insertion of the plantar fascia, with supplemental steroid injection, may eliminate plantar fasciitis.
Persons who visit a practitioner for plantar fasciitis might be treated with things such as orthotics, therapeutic shoes, or physical therapy, although these treatments can take up to a year to produce benefits; they also do not help everyone. Should first-line forms of treatment not succeed, three to six weeks in a short leg cast is often successful in reducing both pain and inflammation.
Steroid injections provide lasting relief to some persons with intractable fascia pain. Some persons might undergo surgery to detach the fascia from their heel bone and expect good results. Both steroid injections and surgery involve the risk of intense pain and fascia rupture. Surgery has the additional risks of both nerve injury and infection.
There is a form of treatment called, Extra-corporeal Shock-wave Therapy (ESWT) that is noninvasive and shows promise in treating plantar fasciitis. Researchers led by Lowell Scott Weil Jr, DPM, reported an eight-two percent success rate in its use on persons whose symptoms had not responded to other forms of noninvasive treatments. While the treatment is noninvasive, it is painful; it can also take up to three months to take full effect. The costs related to ESWT treatments are very high, with the costs for each treatment ranging between $500 and $3,000. Treatment using ESWT for plantar fasciitis generally requires two or three treatments.
One of the first things a person with foot issues visits a doctor, there are some things to try. The first of these is attempting to perform your own version of deep tissue massage by rolling a frozen bottle of water from the heel forward into the arch of the foot; gently. Do stretching, but the key to good stretching is not to stretch too hard. Generally avoid weight bearing or standing stretches, but sit on a soft surface such as your bed and pull your foot backward on your leg as far as it will go, holding for twenty seconds and relaxing for five seconds. Each set can be repeated five times - meanwhile, you have invested around two minutes and given yourself much help.
Your Feet, Shoes, Orthotics and ESWT:
Be aware of the shoes you wear on your feet. It is tempting to obtain shoes that are not only colorful, but soft. Soft shoes are not a good thing, wrap a pillow around your foot with duct tape and walk for a block or so. You will come back with your foot hurting more because your foot sand deeper into the soft surface, permitting your tendons to stretch more. The shoes you wear should be stiff in the shank and flexible in the ball. Shoes such as these are known as, 'motion control shoes,' or, 'stability shoes,' and there are various shoe stores who sell them.
Orthotics is defined as a specialty within the medical field concerned with the design, manufacture and application of orthoses. An Orthotic is a support, brace, or splint used to support, align, prevent, or correct the function of movable parts of the body. Shoe inserts are a type of orthotic intended to correct an abnormal or irregular walking pattern. Other orthotics include neck braces, lumbosacral supports, knee braces, and wrist supports.
Orthotics, through treatment of the cause of the issue, lead to the cure more than 90% of the time. A small number of people have waited so long that their plantar fascia has become thickened and filled with scar tissue and are not helped by conventional means. These are the people who have traditionally needed surgical treatment in which the plantar fascia is cut off the person's heel bone. The majority of surgeries have been replaced by a fairly new mode of treatment called, 'Extracorporeal Shockwave Therapy (ESWT).' ESWT involves the application of multiple shock-waves to the person's tendon or ligament and has a success rate of between 85-90%. Bear in mind the people who receive treatment are from a population of, 'tough cases,' who have already received conventional treatment.
ESWT machines look like miniature renal lithtripsors or, 'kidney stone crushers.' There are almost no side-effects to ESWT other than the price - only around 30% of insurance companies will cover it. Insurance companies realize it is less costly and safer than surgery, yet also know that many more people who would avoid surgery would also have no problem with receiving ESWT so the volume of services would increase.
Karen McCain, a physical therapist, describes walking speed as the, 'sixth vital sign.' In her article on the subject Karen stated, "It is important because walking speed depends on many factors, such as motor control, muscle strength, sensation, cognition, motivation, and overall health status."
Along with these essential elements of treating people, therapists also pay very close attention to the position of the person's foot and ankle as they walk. Pronation and supination are two very common foot and ankle conditions treated through physical therapy, which may lead to:
According to a new study from the Journal of Bone and Joint Surgery (JBJS), patients with acute plantar fasciitis who perform manual plantar fasciitis stretching exercises, as opposed to shockwave therapy, had superior results and higher patient satisfaction.
Study details and findings:
A total of 102 patients who had acute plantar fasciitis pain, were randomly assigned to two groups. Acute is defined as any patient that experiences pain for less than six weeks. 54 people performed an eight-week stretching program, while 48 people received repetitive low-energy radial shock-wave therapy once a week for three weeks. Each group was asked to refrain from any other forms of physical therapy.
Patients in the stretching group, were told to perform stretching exercises three times a day, for eight weeks. All patients were contacted by phone every two weeks to check on training compliance. After four weeks, the patients were told to slowly return to their previous sport and/or recreational activity. Patients in group two received three sessions of radial shock-wave therapy, three times a week.
Patients were given follow-up evaluations at two, four and fifteen months. At both the two and fourth month evaluation, 65 percent of patients who performed the plantar fascia-specific stretch reported total satisfaction with treatment or satisfaction with treatment with minor reservations. Only 29 percent did so after shockwave therapy.
John Furia, MD, an orthopaedic surgeon in Pennsylvania and one of the study authors added that those who develop plantar fascia pain should begin non-operative treatment promptly. "The earlier you understand how stretching fits in, and the earlier you learn how frequently to perform the simple plantar stretch, the less likely you will require a more invasive treatment method," stated Dr. Furia. "Shockwave therapy has been shown to be a very effective treatment for patients with chronic plantar fasciitis (pain for more than six to eight weeks), however acute cases are probably best treated with more simple measures," he added.
How to do the stretch:
According to the American Academy of Orthopaedic Surgeons (AAOS), this stretch should be performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and bring your ankle up and your toes up. Place your thumb along the plantar fascia and rub it to stretch it. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 10-20 times for each foot. Dr. Furia and Dr. Judy Baumhauer, orthopaedic surgeon and president-elect of the American Orthopaedic Foot and Ankle Society (AOFAS) recommend that this exercise be performed initially in the morning, before getting out of bed and after any long periods of sitting. If there is a sharp pain in your heel when getting up, a stretch should have been done before standing or walking. Dr. Baumhauer gives her patients a visual as a reference for this exercise.
Dr. Baumhauer, who was not involved in this study, has been counseling patients on the plantar fascia stretch for 15 years. "I am a firm believer in this type of stretch and nearly 80 percent of my patients have shown improvement in just eight weeks of stretching therapy."
There is no one, single treatment that works best for every single person where plantar fasciitis is concerned. There are a number of things that people can try:
If these forms of self-treatment do not help, a doctor might provide you with splints to wear at night. The doctor may give you steroid shots in your heel, or other forms of treatments. You most likely will not need surgery. A doctor only suggests surgery for persons who still experience pain after attempting other forms of treatment for a period of six to twelve months.
Dr. Salvino's Plantar Fasciitis Kit by Everheel - Review of Dr. Salvino's Plantar Fasciitis Kit designed for the relief of heel and foot pain - Thomas C. Weiss