Plantar fasciitis

Plantar fasciitis
Classification and external resources
Location of pain from an online survey of 2655 people[1]
ICD-10	M72.2
ICD-9	728.71
DiseasesDB	10114
MedlinePlus	007021
eMedicine	pmr/107

Plantar fasciitis is a painful inflammatory condition of the foot caused by excessive wear to the plantar fascia or plantar aponeurosis that supports the arches of the foot or by biomechanical faults that cause abnormal pronation.^[1] 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. Jobs that require a lot of walking on hard surfaces, shoes with little or no arch support, a sudden increase in weight and over activity are also associated with the condition.

Plantar fasciitis was formerly called "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.^[1]

Treatment

Many different treatments have been effective. Without treatment resolution may be delayed for up to and over a year.^[2] Initial treatment includes stretching of the Achilles tendon and plantar fascia, keeping off the foot as much as possible, weight loss, arch support and heel lifts, and taping. People with plantar fasciitis should be careful to wear supportive and stable shoes. They should avoid open-back shoes, sandals, and flip-flops.

There are a few simple maneuvers that may bring relief without need for further intervention.^[3] Many sports medicine practitioners suggest placing a frozen bag of corn or even a cold beverage can under the affected foot and rolling it back and forth using the foot. This method provides a stretch and an ice massage simultaneously.

However, if these strategies are ineffective a physical therapist may be able to offer relief. Common treatments include iontophoresis with a steriod or acetic acid, taping, stretching exercise, and foot orthotics. There is minimal evidence to support soft tissue mobilization.

To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of limited benefit.^[4]. It's important to lessen activities which place more pressure on the balls of the feet because these increase 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 people who have plantar fasciitis 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.^[5] Recurrence rates may be lower if injection is performed under ultrasound guidance.^[6] 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.^[7][8][9]

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. The type of splint has not been shown to effect outcomes. Orthoses should always be broken in slowly.

Recently, extracorporeal shockwave therapy (ESWT) has been used with some success for symptoms lasting more than 6 months.^[10] 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.^[11][12]

Most often plantar fasciitis improves within one year of beginning non-surgical treatment, without any long-term problems. Surgery is sometimes required, and is successful about 95% of the time.

Surgery

Surgery carries the risk of nerve injury, infection, rupture of the plantar fascia, and failure of the pain to improve.^[13] 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.^[14] 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.^[15]

Coblation surgery (aka Topaz procedure) has been used successfully in the treatment of recalcitrant plantar fasciitis. This procedure utilizes radiofrequency ablation and is a minimally invasive procedure.^[16]

References

16. http://clinicaltrials.gov/ct2/show/NCT00189592

External links

• Plantar fasciitis at the Open Directory Project