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Plantar Fasciitis

Plantar fasciitis is an inflammation of a thick, fibrous ligament in the arch of the foot called the plantar fascia. The plantar fascia attaches into the heel bone and fans out toward the ball of the foot, attaching into the base of the toes. If this ligament is stretched excessively it will become inflamed and begin to cause pain. In severe instances the ligament can rupture resulting in immediate severe pain. If the ligament ruptures the pain is so great that the patient can not place weight on the foot. Should this happen, the foot should be elevated and an ice pack applied. An appointment with your foot doctor should be made at your earliest convenience. Sports such as tennis, racket ball, and aerobics can cause extreme tension on the plantar fascia resulting in small tears or rupture of the ligament. However, other less stressful activities can result in tears or rupture of the plantar fascia under the right set of circumstances. One consequence of small tears in the plantar fascia is the formation of firm nodules within the plantar fascia, called fibromas.

Diagnosis
Taking a through history of the course of the condition and physical exam makes the diagnosis of plantar fasciitis.

Treatment
Treatment of plantar fasciitis is similar to that for heel pain. Cortisone injections, used in the treatment of heel pain, are not commonly used for the treatment of plantar fasciitis. The main emphasis of treatment is to reduce the forces that are causing the plantar fascia to stretch excessively. This includes calf muscle stretching, over the counter arch supports, and orthotics. Oral anti-inflammatory medications may be useful in controlling the pain.

Surgical Treatment for Plantar Fasciitis:

Surgery is considered only after aggressive nonsurgical treatment has failed.

Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches.

In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope, an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs.

Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is partially cut to relieve tension in the tissue. Surgery can be performed both endoscopically or open incision.

Heel Spurs

The heel bone is the largest bone in the foot and absorbs the most amount of shock and pressure. A heel spur develops as an abnormal growth of the heel bone. Calcium deposits form when the plantar fascia pulls away from the heel area, causing a bony protrusion, or heel spur to develop. The plantar fascia is a broad band of fibrous tissue located along the bottom surface of the foot that runs from the heel to the forefoot. Heel spurs can cause extreme pain in the rearfoot, especially while standing or walking.

Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.

Treatment and Prevention
The key for the proper treatment of heel spurs is determining what is causing the excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an orthotic with rearfoot posting and longitudinal arch support is an effective device to reduce the over-pronation, and allow the condition to heal.

Other common treatments include stretching exercises, losing weight, wearing shoes that have a cushioned heel that absorbs shock, and elevating the heel with the use of a heel cradle, heel cup, or orthotic. Heel cradles and heel cups provide extra comfort and cushion to the heel, and reduce the amount of shock and shear forces experienced from everyday activities.