Plantar fasciitis

From Wikipedia, the free encyclopedia

**Plantar fasciitis**
*Classifications and external resources*
ICD-10	M 72.2
ICD-9	728.71
DiseasesDB	10114
MedlinePlus	007021
eMedicine	pmr/107

Plantar fasciitis is a painful inflammatory condition caused by excessive wear to the plantar fascia of the foot. The pain usually is felt on the underside of the heel, and is often most intense with the first steps of the day. It is commonly associated with long periods of weight bearing. Obesity, weight gain, jobs that require a lot of walking on hard surfaces, shoes with little or no arch support, and inactivity are also associated with the condition. This condition often results in a heel spur on the calcaneus, in which case it is the underlying condition, and not the spur itself, which produces the pain.

[edit] Treatment

Many different types of treatment have been effective, and though slow to respond plantar fasciitis has a generally good prognosis. The mainstays of treatment are stretching the Achilles tendon and plantar fascia, rest, icing with a compression wrap (cold compression therapy), losing weight, arch support, and taping. To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of very limited benefit.<ref name="JAPMA1998-Lynch">Lynch, D., Goforth, W., Martin, J., Odom, R., Preece, C., & Kottor M. (1998). "Conservative treatment of plantar fasciitis. A prospective study". Journal of the American Podiatric Medical Association 88 (8): 375-380. PMID 9735623.</ref>

Care should be taken to wear supportive and stable shoes. Patients should avoid open-back shoes, sandals, and flip-flops.

Local injection of corticosteroids often gives temporary or permanent relief, but may be painful, if not combined with a local anesthetic and injected slowly with a small-diameter needle.<ref name="JointBoneSpine2005-Genc">Genc H, Saracoglu M, Nacir B, Erdem HR, Kacar M (2005). "Long-term ultrasonographic follow-up of plantar fasciitis patients treated with steroid injection". Joint Bone Spine 72 (1): 61-5. PMID 15681250.</ref> Recurrence rates may be lower if injection is performed under ultrasound guidance.<ref name="JClinUltrasound2006-Tsai">Tsai WC, Hsu CC, Chen CP, Chen MJ, Yu TY, Chen YJ (2006). "Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance". J Clin Ultrasound 34 (1): 12-6. PMID 16353228.</ref>

Night splints can be used to keep the foot in a dorsi-flexed position during sleep to improve calf muscle flexibility and decrease morning pain. Patients should be encouraged to lessen activities which place more pressure on the balls of the feet. Weight on the heel does not cause plantar fasciitis. Over-the-counter insole arch support may help. Prescription orthotics are often used for this condition too. They can be made of many different materials, some of which may be hard and may press on the origin of the plantar fascia. Softer custom devices may also be used, of plastizote, poron, or leather. Orthotics may be expensive, and should be broken in slowly.

Therapeutic ultrasound, with or without iontophoresis, and more recently, extracorporeal shockwave therapy (ESWT) have been used with some success in patients with symptoms lasting more than 6 months.<ref name="JAPMA2005-Norris">Norris,DM, Eickmeier,KM and Werber B (2005). "Effectiveness of Extracorporeal Shockwave Treatment in 353 Patients with Chronic Plantar Fasciitis". Journal of the American Podiatric Medical Association 95 (6): 517-524. PMID 16291842.</ref> The treatment is a nonsurgical procedure, but must be done either under local anaesthesia either with or without intravenous sedation (twilight sedation). The basic premise behind ESWT is that in chronic pain (over six months) the brain no longer perceives the pain (even though the patient feels pain) and so no longer is sending signals to fight the pain. ESWT basically re-inflames the area and in doing so increases blood flow to the area as a means to heal the area. It can take as long as six months following the procedure to see results. Like any procedure there are varying degrees of success.<ref>Marc Mitnick. (ESWT) Extracorporeal Shock Wave Therapy for heel pain. Foot Pain Explained. Retrieved on 2006-10-09.</ref>

Surgical treatments, such as plantar fascia release, are a last resort, and often lead to further complications such as a lowering of the arch and pain in the supero-lateral side of the foot due to compression of the cuboid bone.^{[citation needed]}