Plantar fasciitis
From Wikipedia, the free encyclopedia
| Plantar fasciitis Classification and external resources |
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|---|---|
| Location of pain from an online survey of 2655 people.[1] | |
| ICD-10 | M72.2 |
| ICD-9 | 728.71 |
| DiseasesDB | 10114 |
| MedlinePlus | 007021 |
| eMedicine | pmr/107 |
Plantar fasciitis, formerly called "a dog's heel" in the United Kingdom, sometimes known as "flip-flop disease" among US podiatrists, is a painful inflammatory condition caused by excessive wear to the plantar fascia of the foot or biomechanical faults that cause abnormal pronation of the foot.[1] 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 or sudden changes in weight bearing or activity. 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.[1]
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[edit] Treatment
Many different treatments have been effective, and although it typically takes six to eighteen months to find a favorable resolution,[2] plantar fasciitis has a generally good long-term prognosis. The mainstays of treatment are stretching the Achilles tendon and plantar fascia, resting, keeping off the foot as much as possible, discontinuing aggravating activity, cold compression therapy, contrast bath therapy, weight loss, arch support and heel lifts, and taping. Care should be taken to wear supportive and stable shoes. Patients should avoid open-back shoes, sandals, "flip-flops", and any shoes without a raised heel. To relieve pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are often used but are of limited benefit.[3]. Diclofenac is sometimes prescribed for ongoing problems. Patients should be encouraged to lessen activities which place more pressure on the balls of their feet because it increases tension in the plantar fascia. This is counter-intuitive because the pain is in the heel, and the heel is often sensitive to pressure which causes some patients to walk on the balls of their feet.
Local injection of corticosteroids often gives temporary or permanent relief, but may be painful, especially if not combined with a local anesthetic and injected slowly with a small-diameter needle.[4] Recurrence rates may be lower if injection is performed under ultrasound guidance.[5] Repeated steroid injections may result in rupture of the plantar fascia. This may actually improve pain initially, but has deleterious long-term consequences.
In cases of chronic plantar fasciitis of at least 10 months duration, one recent study has shown high success rates with a stretch of the plantar fascia.[6]
Pain with first steps of the day can be markedly reduced by stretching the plantar fascia and Achilles tendon before getting out of bed. 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. These have many different designs, some of which may be hard and may press on the origin of the plantar fascia. Softer, custom devices, of plastizote, poron, or leather, may be more helpful. Orthoses should always be broken in slowly.
Therapeutic ultrasound has been shown in a controlled study to be ineffective as a treatment for plantar fasciitis.[7] More recently, however, extracorporeal shockwave therapy (ESWT) has been used with some success in patients with symptoms lasting more than 6 months.[8] The treatment is a nonsurgical procedure, but is painful, and ideally should be done either under sedation, or local anaesthesia either with or without intravenous sedation (twilight sedation). Local anaesthesia by injection of drugs into the area can also be painful, and may incur the risks of neuritis, bleeding, and infection. ESWT 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.
Most patients should improve within one year of beginning non-surgical treatment, without any long-term problems. A few patients, however, will require surgery. Over 95% will then be relieved of their heel pain.
[edit] Surgery
Surgery carries the risk of nerve injury, infection, rupture of the plantar fascia, and failure of the pain to improve. [9] Surgical procedures, 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.[10] An ultrasound guided needle fasciotomy can be used as a minimally invasive surgical intervention for Plantar Fasciitis. A needle is inserted into the Plantar Fascia and moved back and forwards to disrupt the fibrous tissue.[11]
[edit] References
- ^ a b Barrett, Stephen L.; Robert O'Malley (1999). "Plantar fasciitis and other causes of heel pain". American Family Physician 59 (8): 2200-6. PMID 10221305.
- ^ Young, Craig C.; Rutherford, Darin S. and Mark W. Niedfeldt (2001). "Treatment of Plantar Fasciitis". American Family Physician 63 (3): 467-74,477-8.
- ^ 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.
- ^ Genc, Hakan; Meryem Saracoglu, Bans Nacir, Hatice Rana Erdem and Mahmut Kacar (2005). "Long-term ultrasonographic follow-up of plantar fasciitis patients treated with steroid injection". Joint Bone Spine 72 (1): 61-5. PMID 15681250.
- ^ Tsai, Wen-Chung; Chih-Chin Hsu, Carl P. C. Chen, Max J. L. Chen, Tung-Yang Yu, Ying-Jen Chen (2006). "Plantar fasciitis treated with local steroid injection: comparison between sonographic and palpation guidance". Journal of Clinical Ultrasound 34 (1): 12-16. PMID 16353228.
- ^ Digiovanni, Benedict F.; Deborah A. Nawoczenski, Daniel P. Malay, Petra A. Graci, Taryn T. Williams, Gregory E. Wilding, and Judith F. Baumhauer (2006). "Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up". The Journal of bone and joint surgery (American) 88 (8): 1775-81. PMID 16882901.
- ^ Crawford, F (2004). "Plantar heel pain and fasciitis". Clinical Evidence (11): 1589–602. PMID 15652071.
- ^ Norris, Donald M.; Kimberly M. Eickmeier and Bruce R. Werber (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.
- ^ Kauffman, Jeffrey (2006-09-21). Plantar fasciitis. MedlinePlus Medical Encyclopedia. National Institutes of Health.
- ^ Endoscopic Plantar Fasciotomies / Heel Pain. FootLaw.com.
- ^ Treatment of recalcitrant plantar fasciitis by sonographically-guided needle fasciotomy. Am College of Foot and Ankle Surgeons.
