Re: Website CMT - Plantar Fasciitis

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<< Plantar Faciitis >>

Here are a couple of explanations with suggestions.

I did not write any of it, but I have had plantar fasciitis and it is

excruciatingly painful.

http://www.ultranet.com/~smith/CMTnet.html

Introduction to Plantar Fasciitis

I am not a doctor. Follow my advice at your own risk.

These pages and links are directed more towards plantar fasciitis than heel

spurs. However, it is hard to distinguish between a heel spur and plantar

fasciitis. Here is a picture of the plantar fascia.

If you have heel pain in the front of your heel, especially if it's in the

morning, then you may have plantar fasciitis. The pain can be where the

fascia attaches to the heel, or it can be over the entire bottom area of the

foot. Causes of plantar fasciitis include a sudden increase in physical

activities (especially running uphill or aerobics), lack of flexibility in

the calf muscles, or weight gain. A lot depends on the patient in order to

cure plantar fasciitis. Rest, stretching the calf muscles, heel lifts, night

splints or the Strassburg sock, good shoe inserts, aggressive massage, foot

muscle strengthening, ice after activities (or whenever it hurts), Ibuprofen

(or other anti-inflammatory medication such as NSAIDs or steroids from the

doctor), and losing weight (if needed) can be used to cure it. Ultrasound,

orthotics, injections, and, as a last resort, surgery are also used. Plantar

fasciitis can become debilitating and last for years. There are other

conditions such as tarsal tunnel syndrome, stress fracture, arthritis, heel

bursitis, Reiter's Syndrome, and even AIDS that can mimic plantar fasciitis

and may be worsened by PF treatment. See your doctor.

Rest and stretching the calf muscles without re-injuring the fascia are often

the cure for plantar fasciitis. Tape and hard heel lifts can help take the

tension out of the fascia, allowing it to rest. If a heel lift (or 3/4 " of

carefully folded paper under the heel) provides immediate relief, then a

stretching program (3 times per day) for increasing the flexibility in the

calf muscles can begin. You may need to apply tape properly (as described in

my detailed comments page) before stretching. Night splints and the

Strassburg Sock are tools that can help increase the flexibility in the calf

muscles. I apply tape to take the tension out of the fascia when using these

products (see the products page). Be careful; over-stretching can cause

Achilles tendonitis. Ibuprofen (800 mg, 3 times per day), or medication from

your doctor such as Daypro (an NSAID) or Prednisone (a steroid), can reduce

the inflammation, giving more relief and allowing the fascia to heal.

Some podiatrists have had a lot of success with steroid injections. I have

had many people complain that they hurt " like hell " , and may have made their

condition worse.

HEEL PAIN

PAIN ON THE PLANTAR SURFACE OF THE HEEL

Calcaneal Spur Syndrome

http://www.merck.com/!!u4gZg25Gdu4gc72ROv/pubs/mmanual/html/hjllhgji.htm

The spur is a bony exostosis (well defined on x-ray) that originates at the

inner weight-bearing tuberosity of the calcaneus and extends forward

horizontally toward the plantar fascia. Spurs result probably from an

excessive pulling or stretching of the calcaneal periosteum by the plantar

fascia. Excessive stretching may result in pain along the inner border of the

plantar fascia (plantar fasciitis). Disorders associated with an increase in

plantar fascial tension may include flatfeet and contracted heel cords.

Symptoms, signs, and diagnosis: An inferior calcaneal spur tends to be

painful during its early development, when little or no x-ray evidence is

present. As the spur enlarges, pain often diminishes, possibly due to

adaptive changes in the foot. Thus, a well-developed spur found on x-ray may

be asymptomatic. Conversely, a spur may develop pain spontaneously after

periods of being asymptomatic or following local trauma (e.g., sports injury

--see also Chapter 270 SPORTS MEDICINE). Occasionally, an adventitious bursa

will develop in the area and become inflamed (inferior calcaneal bursitis);

the pain then takes on a throbbing quality. Upon physical examination, firm

thumb pressure applied directly to the center of the heel will elicit further

pain. While the demonstration of a heel spur on x-ray confirms the diagnosis,

a negative x-ray cannot rule out the early onset of a heel spur. To confirm

the presence of associated plantar fasciitis, pain should be demonstrated

along the inner border of the fascia. This is best elicited by applying very

firm digital pressure along the entire inner border of the fascia while the

ankle is dorsiflexed. Infrequently, calcaneal spurs may appear ill-defined on

x-ray, exhibiting fluffy new bone formation. When this is observed, the

possibility of seronegative or HLA-B27 arthropathy should be considered.

Treatment: Symptoms can be controlled with a mixture of insoluble and soluble

steroids (1 mL of dexamethasone phosphate [4 mg/mL] mixed with * mL

triamcinolone acetonide [40 mg/mL] and 1.5 mL of 2% lidocaine in 1:100,000

epinephrine) given perpendicular to the medial border of the heel pointing

toward the painful trigger point located at the central portion of the heel.

Strapping alleviates tension along the plantar fascia; orthotic devices

control abnormal elongation of the foot.