Plantar Fasciitis

THE CLINICAL SYNDROME

Plantar fasciitis is characterized by pain and tenderness over the plantar surface of the calcaneus. Occurring twice as commonly in women, plantar fasciitis is thought to be caused by an inflammation of the plantar fascia. This inflammation can occur alone or can be part of a systemic inflammatory condition such as rheumatoid arthritis, Reiter’s syndrome, or gout. Obesity also seems to predispose to the development of plantar fasciitis, as does going barefoot or wearing house slippers for prolonged periods. High-impact aerobic exercise has also been implicated.

The pain of plantar fasciitis is often localized to the hindfoot and can cause significant functional disability.

SIGNS AND SYMPTOMS

The pain of plantar fasciitis is most severe on first walking after non-weight bearing and is made worse by prolonged standing or walking. Characterized radiographic changes are lacking in plantar fasciitis, but radionuclide bone scanning may show increased uptake at the point of attachment of the plantar fascia to the medial calcaneal tuberocity.

On physical examination, the patient will exhibit point tenderness over the plantar medial calcaneal tuberocity. The patient may also experience tenderness along the plantar fascia as it moves anteriorly. Pain will be increased by dorsiflexing the toes, which pulls the plantar fascia taut, and then palpating along the fascial from the heel to the forefoot.

TREATMENT

Initial treatment of the pain and functional disability associated with plantar fasciitis should include a combination of the nonsteroidal anti-inflammatory drugs or cyclooxygense-2 inhibitors and physical therapy. The local application of heat and cold may also be beneficial. Avoidance of repetitive activities that aggravate the patient’s symptomatology, as well as avoidance of walking barefoot or with shoes that do not provide good support, combined with short-term immobilization of the affected foot may also provide relief. For patients who do not respond to these treatment modalities, the following injection technique with local anesthetic and steroid may be a reasonable next step. To inject plantar fasciitis, the patient is placed in the supine position. The medial aspect of the heel is identified by palpation.

The use of physical modalities including local heat as well as gently stretching exercises should be introduced several days after the patient undergoes the is injection technique. Vigorous exercises should be avoided because they will exacerbate the patient’s symptomatology. Heel pads or molded orthotic devices may also be of value. Simple analgesics, nonsteroidal anti-inflammatory drugs, and antimyotonic agents such as tizanidine may be used concurrently with this injection technique.

This injection technique is extremely effective in the treatment of plantar fasciitis. This technique is a safe procedure if careful attention is paid to the clinically relevant anatomy in the areas to be injected. Care must be taken to use sterile technique to avoid infection and to use universal precautions to avoid risk to the operator. Most side effects of this injection technique are related to needle-induced trauma to the injection site and underlying tissues.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue. Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.