ANKLE & FOOT
Plantar fasciitis is a very common issue across all age groups. It affects the young, the old, the active, and the not-so-active. The onset is usually gradual, with worsening pain in the heel and/or bottom of the foot, particularly the first few steps in the morning. It is mostly unilateral, but can affect both feet simultaneously. There are many risk factors for plantar fasciitis including running, prolonged standing, obesity, and flat foot deformities.
The plantar fascia is a band-like tissue on the bottom, or plantar surface, of the foot. It spans from the heel to base of the toes. It is a very durable tissue, sort of like a tarp. Plantar fasciitis is when that tarp-like material gets small tears in it near the heel. The pain is worse with the first few steps in the morning or after sitting for a period of time. This is a telltale symptom of plantar fasciitis. What happens is the body starts to repair the micro tears as soon as it gets a chance to do so, i.e. when it is resting. This is great... but it repairs the tears when the plantar fascia is shortened. When we stand up, the plantar fascia stretches and we tear all of the repairs that were made while the plantar fascia was resting… in a shortened position.
One of the main treatments is a night splint, which keeps the foot in a 90 degree angle while at rest. This allows the plantar fascia to heal in a lengthened position, which is compatible with walking. Although worn over night, the night splint does not resolve the issue in one night. A night splint coupled with physical therapy is one of the mainstays of treatment. A tight Achilles’ is most often seen along with plantar fasciitis, so Achilles’ stretching is a big part of physical therapy. The tears in plantar fasciitis cause inflammation. Reducing the inflammation can reduce the pain. Rolling a frozen water bottle along the bottom of the foot helps. Taking anti-inflammatories as needed can help with both inflammation and the pain it causes. If these treatments don’t work, your orthopedic provider may suggest a cortisone injection. Yes they can be painful, but a brief moment of pain for a long duration of relief can be a good tradeoff! Another type of injection is PRP, or platelet rich plasma, injections. Long-term studies are pre-mature, but regenerative medicine can be an option for some (with great results!). Orthotics are rarely advised, but would address other underlying pathologies of the foot causing the plantar fasciitis. Surgical intervention is recommended in cases that are refractory to conservative management.