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Plantar Fasciitis

Plantar refers to the sole of the foot. The plantar fascia is flat fibrous band of tissue on the sole of the foot. It attaches to the toes in front, and the heel in the back. If the arch of the foot is thought of as a bow, then the plantar fascia may be considered the bowstring. It functions to support the arch and provide stability and protection to the foot.

If the plantar fascia becomes inflamed, then the condition is called plantar fasciitis (‘itis’ refers to something that is inflamed (like appendicitis). Over time, x-rays may show a spur-like growth of calcium where the plantar fascia attaches to the heel bone, sometimes called a heel spur. This is a result of plantar fasciitis, and not the cause of the pain.

Plantar fasciitis may be due to shoes with poor arch support, flat feet, overuse, obesity, or new vigorous running or jumping sports. Weight gain from pregnancy may lead to heel pain from plantar fasciitis. If the calf muscles and Achilles tendon are too tight, it is easier to develop plantar fasciitis pain.

Pain from plantar fasciitis is a sharp or stabbing pain felt on the bottom of the heel. In severe cases the entire sole of the foot is painful. Usually the pain is worst first thing when stepping on the floor in the morning, especially in bare feet. There may be tenderness with pressing on the heel, and a tight cord may be felt on the bottom of the foot.

The diagnosis of plantar fasciitis is made from the type of pain, its location and an examination of the foot and lower leg. X-rays may be done to exclude any bone or joint abnormalities, but they will not show the plantar fascia itself.

The pain from plantar fasciitis may take weeks or months to resolve completely. Physical therapy with specific stretching exercises is very important in the treatment of plantar fasciitis. Arch support in shoes helps to take tension off the plantar fascia, and weight reduction may be useful. A rest from sporting activities may be recommended, or the condition may become chronic and much more difficult to treat. Although in the past, cortisone shots frequently were used, these are less popular now due to concerns about weakening the plantar fascia and the possibility that a tear could occur. Local use of ice and medications called non-steroidal anti-inflammatory medications (NSAIDs for short) are used to stop the pain and inflammation. Some of the more commonly prescribed of these include medications such as Ibuprofen, Naprosyn, Indocin and Celebrex. Plantar fasciitis splints which keep the foot in a flexed position are worn at night and often provide excellent results. In resistant cases, and as a last resort, various surgical procedures may be necessary.

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Plantar fasciitis
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