Dr. Nick Smith - 08/25/09

Plantar fasciitis demystified

Plantar fasciitis (PLAN-ter fashee EYE tis) is a very common cause of bottom-of-the-foot and heel pain. It occurs when the large thick band of tissue spanning from the heel to the toes becomes inflamed and irritated. This tissue functions like a suspension bridge and gives the bottom of the foot the ability for slight elasticity and rebound. It can occur in both feet but usually affects only one. Usually it is caused by repetitive activities that place excessive stress on the heel, foot and associated structures.

Activities such as running, excessive walking, and other impactful exercise may contribute to its onset. Usually sufferers feel the most pain first thing in the morning when rising. Also these symptoms may flare when rising from a seated position, climbing stairs, standing on the toes, etc.

The plantar fascia is a ligament that connects the heel bone to the toes and forms the major arch in the foot. Our feet actually have a total of three arches, but most of us refer to this one in conversation.

Not only is this condition quite painful but it can also contribute to the development of other foot problems, most notably heel spurs. The abnormal load on the plantar fascia stimulates abnormal bony formation resulting in the heel spur. These are very painful and can require surgery.

Risk factors include: abnormal arches, excessive weight, long periods of standing and tight calves or Achilles tendons. Poorly fitted or worn-out shoes are a culprit, as they alter the motion of the many joints of the foot. Women are more likely to have it than men, and 40 to 60 years is the most common age group

Before seeing a doctor, there are home interventions that may help. Rest and discontinue activities that cause pain. Forget the saying ";no pain no gain." Pain is a signal that we are hurting ourselves and it needs to be acknowledged. Try icing the affected area for up to 20 minutes.

Change to a different kind of shoe that has good arch support and is well padded. Try arch supports or heel cups.

Don't walk around barefoot, as this stresses the offending ligament and slows healing. Stretching the calf may be helpful.

There are many treatment options, and in my opinion it is better to start with the conservative ones. Most plantar fasciitis cases -- 95 percent -- do not require surgery, so don't start there.

In the worst-case scenario when conservative care doesn't work, moving on to more invasive procedures is the next step. Drug therapy may be prescribed to diminish swelling. A night splint is also common; this sling is placed on the lower leg and foot to keep it in a toes-back position to stretch the fascia and calf.

For worse cases, a rigid cast may be prescribed but requires more rehabilitation after having the foot totally immobilized.

For cases that do not respond in six to 12 months, surgery to release the fascia may be recommended. The good news is that with some conservative care from your chiropractor, therapist or physician, your statistical prognosis is very good.

Dr. Nick Smith is a chiropractor at Active Life Chiropractic Center in Helena and is Montana's only certified Biomechanics of Posture practitioner. Reach him at 443-3965 or www.activelifemt.com.