Denton County Living Well Magazine May/June 2016 | Page 13
Plantar Fasciitis
P
lantar fasciitis is a painful inflammatory process of the
plantar fascia. Longstanding cases of plantar fasciitis often demonstrate more degenerative hanges than inflammatory changes, in which case they are termed plantar
fasciosis. The plantar fascia is a thick fibrous band of
connective tissue on the bottom surface of the calcaneus (heel
bone) and extending along the sole of the foot towards the toes.
It is associated with long periods of weight bearing.
The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom
is that the sufferer has difficulty bending the foot, so
that the toes are brought toward the shin (decreased
dorsiflexion of the ankle). A symptom recognized
among sufferers of plantar fasciitis is increased
probability of knee pains.
Diagnosis
The diagnosis of plantar fasciitis, is
usually made by clinical examination. The examination may include
checking the patient’s feet and
watching the patient stand and
walk. The examination will take
under consideration a patient’s
medical history, physical activity,
foot pain symptoms and more.
The doctor may decide to use imaging studies.
A finding associated with this condition is a heel spur, a small bony calcification, on the calcaneus heel bone, in
which case it is the underlying condition,
and not the spur itself, which produces the
pain. The condition is responsible for the
creation of the spur, the plantar fasciitis is
not caused by the spur.
Sometimes ball-of-foot pain is mistakenly
assumed to be derived from plantar
fasciitis. A dull pain or numbness in the
metatarsal region of the foot could instead be metatarsalgia, also called capsulitis.
TREATMENT
Medical
Orthotics, i.e., foot supports, are the only non-surgical therapy to
have been supported by studies rated by the Center for EvidenceBased Medicine as being of high quality. Landorf et al. performed
By Dr. Reza Mobarak
a single-blind experiment in which patients were randomly assigned
to receive off-the-shelf orthotics, personally customized orthotics, or
sham orthotics made of a soft, thin foam. Patients receiving real orthotics showed significant short-term improvements in functionality
compared to those receiving the sham treatment.
Pain with the first steps of the day can be 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 pain on waking.
To relieve pain and inflammation, nonsteroidal anti-inflammatory
drugs, such as aspirin and ibuprofen, are often used.
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.
Surgery
There is a new treatment
of plantar fasciitis which is
non-surgically based, very
effective, and usually done
within the clinical setting.
This is called the PRP treatment. Plasma is what’s
left when blood cells are
separated from the liquid
component of human whole
blood. The plasma portion contains numerous biologic factors
that have been shown to enhance
healing in studies.
Surgery carries the risk of nerve injury, infection,
rupture of the plantar fascia, and failure to improve the pain. Traditional 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 superolateral side of the foot due to compression of
the cuboid bone. This will allow decompression of the nearby FDB muscle belly that is
inflamed, yet doesn’t fix the underlying problem. This basically allows more space for the
inflamed muscle belly, thus, relieving pain/pressure. Ultrasound
guided needle fasciotomy can be used as a minimally invasive
surgical intervention for plantar fasciitis.
Coblation surgery (aka Topaz procedure) has been used successfully
in the treatment of recalcitrant plantar fasciitis. This procedure utilizes
radiofrequency ablation and is a minimally invasive procedure.
Dr. Reza Mobarak heads the Southwest Foot and Ankle Center with offices in
Plano, Lewisville and Irving. He may be reached at 972-316-0902.
DENTON COUNTY Living Well Magazine | MAY/JUNE 2016
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