Patient Education

 
 

Plantar Fasciitis – Part 2

Decreasing the inflammation at the plantar fascia can be achieved with the use of ice, non steroidal anti inflammatories like ibuprofen and the possible use of a cortisone injection. Ice can be applied twice daily for 5-10 minutes by rolling a frozen water bottle over the painful region. Non steroidal antinflammatories like ibuprofen or Naproxen can be used for short periods of time in therapeutic doses. Typically three over the counter tablets of Advil (Ibuprofen) can be taken three to four times daily or over the counter Aleve (naproxen) two tablets twice daily. If you take these ant inflammatory medications be aware of potential adverse effects and consult your physician.

Cortisone injections can be a very helpful tool in decreasing inflammation at the plantar fascia.  One up to three cortisone injections can be instrumental in reducing the inflammation and pain in the heel region. Complications associated with cortisone include thinning of the protective fatty tissue on the bottom of the foot. Outside of discomfort associated with the cortisone injection complications is rarely seen. 

The balance between biomechanically controlling pronation stress on the plantar fascia as well as aggressive use of anti-inflammatory therapy should effectively decrease pain to the heel region. Typically 70-80% overall improvement should be noted after the first three weeks of therapy.

Activity modification is an essential part of recovery. Many patients who are being treated for plantar fasciitis lead active lifestyles that include physical weight bearing activity including walking and running. It is imperative to continue cardiovascular conditioning during your recovery period but modify it to include only low to non impact activity including biking or swimming.

If minimal pain relief is experienced after the first visit secondary therapy often includes the use of night splints, physical therapy, cast immobilization, custom foot orthotics and a possible secondary cortisone injection.

A night splint is a rigid brace that worn during the night maintains the foot at a ninety degree angle to the leg. The night splint by maintaining an extension stress on the plantar fascia during the night can help reduce the pain related to plantar fasciitis. The night splint as a single therapy has been shown to be helpful with reduction of the pain associated with plantar fascitis.

Formal physical therapy including often times including the application of electrical current, topical cortisone delivered through ultrasound and additional therapeutic tools to help reduce inflammation to the region.

Custom orthotic therapy can be utilized if conservative shoe, store purchased arch supports and anti-inflammatory therapy have failed. A custom orthotic is a custom contoured arch support that controls the abnormal foot pronation mechanics. Increase foot pronation is a causative factor that increases the likelihood of the development of plantar fascitis.

A majority of patients who experience symptoms associated with plantar fasciitis fully recover. A small percentage of patients despite all conservative attempts do not respond to conservative care and pursue surgical options for pain relief.

The surgical care of plantar fasciitis includes a minor outpatient surgical procedure to cut the plantar fascia at the level of its attachment to the heel bone. The surgical release of the plantar fascia decompresses the region and creates a plane of scar tissue related to the relative lengthening of the ligament from its insertional region.  Recovery after surgical repair is on average around ten weeks with the tenth week being the period at which patients should fully resume normal activity.

Chris Byrne, DPM

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