Heel Pain / Plantar Fasciitis

What is plantar fasciitis?

Plantar fasciitis is an inflammation of the band of tissue that connects the toes to the heels called the plantar fascia. The initial stage comprises of a painful inflammation and irritation of the fascia. As the problem persists a scarring of the tissue in and around the facia is noted, which can result in an increased pain.  

Causes

Plantar fasciitis is most commonly caused by underlying biomechanical issues. Flat feet, high arches, and overpronation (an excessive turning inwards of the foot while walking) are usually the primary factors that lead to plantar fasciitis. 

Unsupportive shoes and extended periods of standing or walking on hard surfaces can also contribute to plantar fasciitis. Obesity and overuse as well have been noted as possible contributing factors. 

Symptoms

Symptoms that occur in patients suffering from plantar fasciitis include: 

  • Pain - at the heel or in the arch. Pain can increase when standing, but may dissipate during continued activity. Pain can worsen over weeks and months if left untreated. 

  • Swelling at the bottom of the heel that may be tender to the touch. 

Treatments

Many different treatments exist for plantar fasciitis. You podiatrist will suggest one of the following treatments, depending on the severity of the plantar fasciitis:​

  • Shoes - wearing shoes that support the arch can often reduce strain on the plantar fascia. 

  • Padding/Strapping/Taping - adding padding can soften the shoe while walking and standing. Strapping and taping aim to support the arch and reduce strain on the plantar fascia.

  • Limit Activities - limiting activities, such as long periods of walking or standing can reduce stress to the plantar fascia. 

  • Ice - the use of ice packs can help to reduce inflammation. An ice pack can be wrapped in a towel and applied to the area (never apply ice directly to the skin) for periods of no greater than 20 minutes. 

  • Oral Medications - Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, may be used to reduce inflammation and pain.

  • Orthotic Inserts - a custom orthotic device is frequently prescribed to support the arch and control the motion of the foot to prevent overpronation. 

  • Injection therapy - corticosteroid injections are sometimes used to ease pain and inflammation. 

  • Walking Cast/Boot - a walking cast or boot may be prescribed to immobilize the foot, giving the fascia time to heal. 

  • Night Splint - a piece of medical equipment designed to keep the plantar fascia stretched during periods of sleep.

  • Platelet Rich Plasma Therapy - PRP therapy is a new treatment by which the blood is drawn from the patient and subjected to a centrifuge, separating the bloods platelets. This platelet rich plasma is usually mixed with an anaesthetic and injected into the plantar fascia. This allows for accelerated healing. 

  • Ultrasound Therapy - sometimes referred to as Extracorporeal Pulse Activation Therapy (EPAT), Extracorporeal Sound Wave Therapy (ESWT) or Shockwave Therapy, this treatment aims to increase the rate of healing in soft tissue with the use of soundwaves. 

  • Topaz Procedure - a minimally invasive treatment using radio frequencies. 

  • Surgical Correction - while most patients experience positive results with non-invasive treatments, your podiatrist may suggest surgical intervention if these other treatments produce no results. 

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