What is Plantar Fasciitis?
It is an overuse injury of a ligament on the bottom of the foot called the plantar fascia. This ligament spans from the heel to the ball of the foot and can be come irritated at any point along its course – though this is most commonly in the heel. This condition is a result of improper biomechanics, whereby the structure of the foot places strain on the ligament during walking and running. When irritated, the ligament becomes inflamed.
Why does it hurt in the morning?
Many times the pain in the heel occurs with the first few steps out of bed or the first few steps after sitting a prolonged period of time. This is called post-static dyskinesia. The reason that this occurs is because when relaxed, the plantar fascia is in a functionally shortened position and the body tries to mend the small fibers that have torn from improper foot structure while walking or standing. When you get up to start walking, the fibers that have been healing are quickly re-torn and irritated.
How is Plantar Fasciitis treated?
Because the condition is comprised of inflammation and poor foot mechanics, both of these need to be addressed for treatment.
At your first appointment, your doctor will examine your feet and take x-rays of the painful foot to rule out other causes of heel pain and also to assess if there is a bone spur present. If you are diagnosed with plantar fasciitis, there are two main causes to your condition that need to be addressed.
- Inflammation: This is what causes your heel to be painful. Inflammation can be managed with oral non-steroidal anti-inflammatories, icing, and in some cases topical anti-inflammatory medicines. These methods are typically needed only in the first few weeks of treatment.
- Biomechanics: The predisposing factor in plantar fasciitis is when the heel is not properly aligned and the plantar fascia takes on more strain than normal. This is often caused by a tight Achilles tendon.
- Strappings: These are created on your first appointment to provide more support to your plantar fascia to avoid that additional strain. These are removable, but are to be worn at all times, even at home while barefoot.
- Stretching: Your doctor will provide you with instructions on stretches to perform that reduce the deforming forces of a tight Achilles tendon. These stretches may well become a long term routine to prevent recurrence of plantar fasciitis.
- Night Splint: These devices are especially useful in cases of plantar fasciitis where heel pain is worst with the first few steps out of bed in the morning.
Follow Up Appointments:
Your doctor will re-assess your condition and determine what the next step needs to be.
- If your condition is nearly 100% improved, the focus of treatment is to prevent recurrence of the condition. When the acute pain is reduced, this tells us that your inflammation has nearly completely resolved. This places our focus next onto ensuring that biomechanics are corrected and that your heels and feet are kept in a neutral position with good alignment of the heel.
- Custom orthotic inserts allow optimal support of your heels and feet to prevent further strain on the plantar fascia. If custom orthotics are recommended to you at your follow-up the next step is an appointment with highly trained staff to obtain an impression of your feet.
- If your condition has not improved, this tells your doctor that the next step will be implementation of additional therapies.
- Physical Therapy: In some instances, the at-home stretching , anti-inflammatories and icing are not be completely effective in reducing inflammation and alleviating plantar fasciitis. In tougher cases, physical therapy can be the key to getting better. There are various techniques provided by physical therapists in your area that can help get on the road to healing.
- Cortisone Injection: Injection of a steroid locally into the point of most pain has a powerful effect on inflammation. It is vital to understand that a cortisone injection is not a magic cure and that icing, stretching and supports in the shoes are still necessary to prevent a flare up of plantar fasciitis.
Still no improvement after conservative treatments:
If you have stubborn heel pain even after the above mentioned treatments, your doctor will re-assess you to determine the next course of treatment. We have several options available either in our clinic or through trusted partners.
- Amniofix: Available in our office, this is a new option in the treatment of multiple overuse injuries, including plantar fasciitis. This option uses the technology of micronized amniotic membrane which reduces inflammation and provides growth factors to the plantar fascia to heal the damaged tissue. This injection can be painful a few days following its administration, but has been shown to effectively treat plantar fascia that has been resistant to our more traditional therapies.
- EPAT: Also available in our office, Extracorporeal Pulse Activation Technology or EPAT is a treatment that transmits a wave of pressure to a painful area, increasing circulation and stimulates regeneration of damaged tissue.
- MLS Laser Therapy: This is one of our favorite newer treatments for PF. MLS stands for Multiwave Lock Systems and is a technology that delivers light in two distinct wavelengths and is perfect for PF as it addresses both inflammation and pain:
- 808 nanometer: concentrates on reducing inflammation and edema
- 905 nanometer: concentrates on pain reduction and thus an analgesic effect.
- Further Studies such as obtaining an MRI or CT scan of the heel is sometimes necessary to ensure that there are no other underlying bone cysts that may be mimicking plantar fasciitis. These cysts and masses in the heel do not typically show up on x-ray. We have trusted partners for these tests who we will recommend if this is needed.
- Surgery: Surgery is an option in plantar fasciitis, though it too is not recommended until other options have been exhausted. In surgery for heel pain, the plantar fascia is surgically lengthened to remove the tension that is present on the ligament where it attaches to the bone. In the past, if there was a heel spur present on x-ray, it was removed in surgery. However, more recent literature has found that the spur is not the cause of pain, but rather is the result of chronic tension of the ligament.
Plantar Fasciitis is tricky but treatable!
As you can see, plantar fasciitis is a multifaceted diagnosis which requires strict adherence to at-home therapies, as recommended by your doctor. It can be a very difficult condition to resolve, but there are many treatments available to ensure that you get back to your regular activities without pain.