Wednesday, September 17, 2008
Plantar fasciitis is a painful inflammatory condition of the foot caused by excessive wear to the plantar fascia that supports the arch or by biomechanical faults that cause abnormal pronation. The pain usually is felt on the underside of the heel, and is often most intense with the first steps of the day. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing or activity. Obesity, weight gain, jobs that require a lot of walking on hard surfaces, shoes with little or no arch support, and inactivity are also associated with the condition.
Plantar fasciitis was formerly called "a dog's heel" in the United Kingdom. It is sometimes known as "flip-flop disease" among US podiatrists. The condition often results in a heel spur on the calcaneus, in which case it is the underlying condition, and not the spur itself, which produces the pain.
Many different treatments have been effective, and although it typically takes six to eighteen months to find a favorable resolution, plantar fasciitis has a generally good long-term prognosis. The mainstays of treatment are stretching the Achilles tendon and plantar fascia, resting, keeping off the foot as much as possible, discontinuing aggravating activity, cold compression therapy, contrast bath therapy, weight loss, arch support and heel lifts, and taping. Care should be taken to wear supportive and stable shoes. Patients should avoid open-back shoes, sandals, "flip-flops", and any shoes without a raised heel. Molded foam clogs such as CrocsRx have been approved by the American Podiatric Medical Association and United States Ergonomics as a healthy alternative to flip-flops. To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of limited benefit.. Patients should be encouraged to lessen activities which place more pressure on the balls of their feet because it increases tension in the plantar fascia. This is counter-intuitive because the pain is in the heel, and the heel is often sensitive to pressure which causes some patients to walk on the balls of their feet.
Local injection of corticosteroids often gives temporary or permanent relief, but may be painful, especially if not combined with a local anesthetic and injected slowly with a small-diameter needle. Recurrence rates may be lower if injection is performed under ultrasound guidance. Repeated steroid injections may result in rupture of the plantar fascia. This may actually improve pain initially, but has deleterious long-term consequences.
In cases of chronic plantar fasciitis of at least 10 months duration, one recent study has shown high success rates with a stretch of the plantar fascia.
Pain with first steps of the day can be markedly reduced by stretching the plantar fascia and Achilles tendon before getting out of bed. Night splints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease morning pain. These have many different designs, some of which may be hard and may press on the origin of the plantar fascia. Softer, custom devices, of plastizote, poron, or leather, may be more helpful. Orthoses should always be broken in slowly.
Therapeutic ultrasound has been shown in a controlled study to be ineffective as a treatment for plantar fasciitis. More recently, however, extracorporeal shockwave therapy (ESWT) has been used with some success in patients with symptoms lasting more than 6 months. The treatment is a nonsurgical procedure, but is painful, and should be done either under sedation, or with local anaesthesia either with or without intravenous sedation (twilight sedation). Local anaesthesia by injection of drugs into the area can also be painful, and may incur the risks of neuritis, bleeding, and infection. ESWT re-inflames the area and in doing so increases blood flow to the area as a means to heal the area. It can take as long as six months following the procedure to see results. Results are variable, and one 2002 study reported ESWT for plantar fasciitis had no benefit.
Most patients should improve within one year of beginning non-surgical treatment, without any long-term problems. A few patients, however, will require surgery. Over 95% will then be relieved of their heel pain.
Prolotherapy has been shown to be effective in treating Plantar fasciitis.
Surgery carries the risk of nerve injury, infection, rupture of the plantar fascia, and failure of the pain to improve.  Surgical procedures, such as plantar fascia release, are a last resort, and often lead to further complications such as a lowering of the arch and pain in the supero-lateral side of the foot due to compression of the cuboid bone. An ultrasound guided needle fasciotomy can be used as a minimally invasive surgical intervention for Plantar Fasciitis. A needle is inserted into the Plantar Fascia and moved back and forwards to disrupt the fibrous tissue.
My Plantar Fascitis treatment involves
As published in
Plantar Fasciitis Treatment
by Mike Ploski, PT, ATC, OCS
© 2007 BioMechanics
Plantar fasciitis is an inflammatory condition of the plantar fascia characterized by pain at the heel and the medial arch of the foot. Clinical findings often reveal limited range of motion with ankle dorsiflexion and first metatarsophalangeal joint extension, an abnormal gait pattern, decreased foot strength, or abnormal posturing of the subtalar joint.
Conservative treatment approaches are often successful in managing this condition and revolve around reducing pain, promoting healing, restoring ROM and strength, and limiting those biomechanical deviations caused by structural abnormalities.
Soft tissue mobilization techniques can restore functional mobility to the plantar flexors and plantar fascia. They can be performed manually or with instruments. These procedures also can be used to promote tissue healing in chronic stages of soft tissue dysfunction.
The Graston Technique is a form of manual therapy that uses patented stainless steel instruments to restore soft tissue motion. The tools help the clinician to detect and then break up fascial restrictions (scar tissue). This procedure has been shown to be highly effective in the management of both acute and chronic cases of plantar fasciitis.
Along the gastrocnemius muscle: The rough, granular feel of fascial restrictions will be palpable as the Graston tool is drawn across dysfunctional tissue.
At the 1st MTP joint: Once lesions are found, the clinician can use smaller instruments to manipulate the soft tissue and break them up.
At the medial calcaneal tuberosity: When friction-type motion is applied at the origin of the plantar fascia on the medial calcaneal tuberosity, blood flow to the area is stimulated. This can result in new collagen production that in turn can accelerate the healing process.
Go to this link to see full article
in conjunction with
Cold laser therapy
Recent Harvard study Cold laser more beneficial than Ultrasound-Click to view
Muscles constantly extend and contract within a normal range, however, when muscles over-extend or over contract, such as when lifting an excessive amount of weight, muscles can not recover and become inflamed. When a muscle is inflamed, swollen or stiff due to fatigue, the space between the skin and muscle is compressed, resulting in constriction to the flow of lymphatic fluid. This compression also applies pressure to the pain receptors beneath the skin, which in turn communicates "discomfort signals" to the brain and emdash, thus the person experiences pain. This type of pain is known as myalgia, or muscular pain.Kinesio Taping® alleviates pain and facilitates lymphatic drainage by microscopically lifting the skin. The taped portion forms convolutions in the skin, thus increasing interstitial space. The result is that pressure and irritation are taken off the neural and sensory receptors, alleviating pain. Pressure is gradually taken off the lymphatic system, allowing it to channel more freely.
Posted by Dr. Steve Shoshany at 9:06 PM