Plantar fasciitis is one of the most common causes of heel pain in athletes and non-athletes alike. Typically it comes about without any inciting event or trauma, although it can occur after events such as sudden exertion.
Signs and symptoms of plantar fasciitis
It often manifests as pain at the base of the heel on the sole of the foot rather than the back of the heel where the Achilles tendon inserts. Most commonly patients complain of pain first thing in the morning when they first step out of bed. They also complain of pain when they take their first steps after sitting or lying down for an extended period of time. It is often fairly debilitating to athletes with the condition, as it causes pain that limits the ability to run.
Tests for plantar fasciitis
In a sports medicine or foot and ankle surgeon’s office, a thorough history and physical examination is performed. Physical exam findings usually reveal pain at the insertion of the plantar fascia into the base of the calcaneus (heel bone). Typically the plantar fascia is tight with dorsiflexion of the ankle. There are usually no other areas of tenderness. Sometimes limited range of motion of the ankle and hindfoot are noted. X-rays are usually obtained, although they are often negative. While there will sometimes be a heel spur noted, it is usually an incidental finding. Further tests, such as MRI’s, are rarely ordered.
Treatment for plantar fasciitis
Treatment is typically nonsurgical. The vast majority of patients get better with simple measures such as wearing a night splint for sleeping and stretching exercises and/or physical therapy. Other treatments include heel cups and orthotics, although I think those are better second-line treatments. For people with symptoms that are not improving, wearing a walking boot or even a cast for several weeks can be tried. Newer attempts to try to get the plantar fascia to heal include platelet-rich plasma injections.
I try to refrain from using cortisone injections into the plantar fascia. There is a concern that the plantar fascia can rupture due to the cortisone weakening the tissue. A common misperception of plantar fasciitis is that it’s an inflammation of this tissue when in reality it’s an intrinsic degeneration of the fascia. If you took a biopsy of this tissue, there would be few, if any, inflammatory cells. So in theory, while cortisone might make the pain better for a short period of time, it is actually not treating the underlying problem.
If symptoms continue to be debilitating and prevent exercise and activities of daily living, surgical treatment occasionally can be attempted. It is rare, but surgery usually entails partial or complete release of the plantar fascia. Unfortunately this surgery is very debilitating, and return to sports is often difficult. Due to the potential morbidity of the surgery, many surgeons try to avoid it.
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