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Treatment of Plantar Fasciitis

There are three components to plantar fasciitis:

1) inflammation:   This is a larger factor earlier in the process. This can be treated by anti-inflammatory drugs, ice massage, physical therapy modalitis such as ultrasound. Occasionally this is treated via a cortisone shot. Some patients beleive cortisone shots are always painful but that is only if poor technique is used in delivering the shots. First, the skin over the area to be injected should be numbed with a freezing spray like ethyl chloride. Then the area is to be injected from the side with lidocaine, a local anesthetic. Once the lidocaine has achieved numbness at the origin of the plantar fascia, the needle is left in place and the syringe changed to a syringe that includes a short acting cortisone (eg. dexamethasone phosphate), a medium acting cortisone (eg. celestone) and a long acting cortisone (eg. triamcinolone acetonide). The reason for using all three is to get the most complete effect possible. Keep in mind that cortisone does not cure plantar fasciitis (PF) but can calm things down considerably especially if it is early in the process and inflammation is the predominant process.

2) biomechanics This is the most important factor for most cases of plantar fasciitis particularly those that have been around for a while becasue this is treatment of the excess tension on the fascia. The professional, either a podiatrist (foot doctor) or a pedorthist (professional shoe fitter) takes a mold or image of the foot in the corrected position. The key is that the foot is molded in the corrected position; if one was to simply have on step in a foam box, one would capture the foot in the position the foot wants to go into. The professional watches the patient walk, takes a number  of measurments and then uses the corrected cast along with the collected data to order the prescritpion orthotic. Occasionally, heel pain caused by the excess plantar fascia tension can be helped by a change in shoegear or even an "off the shelf" orthotic. Be aware that there are non-professionals who attempt to sell non-custom made orthotics as the real thing. They are still around becasue occasionally such devices can work but use of such devices can be a trial and error process for heel pain releif.

3)tissue quality  This involves a degeneration of the fascia caused by long term, chronic inflammation of the fascia. Our bodies handle chronic inflammation very poorly so if the fascia has been inflamed for a very long time, it may not heal no matter what is done. Usually, when we treat the inflammation and correct the biomechanics, this takes care fo itself. If that does not happen, the common treatment used to be surgery, that is, cutting the fascia off the heel bone. Most such surgery has been replaced with extracorporeal shockwave therapy (ESWT)  in which repeated shockwaves are applied to the fascia. This converts the chronic inflammation to acute inflammation which the body handles very well by repairing the fascia, getting rid of scar tissue and bringing in new blood vessels (neovasuclarization). ESWT can be accomplished via one or two high energy session involving anesthesia or by low energy ESWT in which 3 low energy sessions are used in place of one high energy session and no anesthesia is needed. ESWT is successful 85 to 90 percent of the time when the plantar fascia does not repsond to conventional treatments. Surgical treatment as a treatment for heel pain caused by plantar fasciitis is rare. If a health professional mentions surgery before ESWT, look for the exit door to the office.


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J Orthop Sports Phys Ther. 2002 Apr;32(4):149-57. Related Articles, Links

The impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis.

Gross MT, Byers JM, Krafft JL, Lackey EJ, Melton KM.

Division of Physical Therapy, Program in Human Movement Science, University of North Carolina at Chapel Hill, 27599-7135, USA. mtgross@med.unc.edu

STUDY DESIGN: Single-group, pre-, and postintervention repeated measures design.

OBJECTIVE: To determine the impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis.

BACKGROUND: Few studies have examined the efficacy of foot orthotics for plantar fasciitis, and no single study has yet examined the effects of semirigid foot orthotics on an established quality-of-life instrument.

METHODS AND MEASURES: Eight men and 7 women (mean ages 44.7 +/- 9.0 years) who reported having plantar fasciitis symptoms for an average of 21.3 +/- 23.7 months participated in the study. Subjects were timed for a 100-m walk at a self-selected speed, then they rated the pain they experienced during the walk using a 10-cm visual analog scale. Subjects also completed the pain and disability subsections of the Foot Function Index questionnaire. All measures were acquired before the fabrication of custom semirigid foot orthotics and 12 to 17 days following onset of foot orthotic use.

RESULTS: Postorthotic 100-m walk times were not significantly different (t = 0.39, P = 0.70) than preorthotic values. Postorthotic pain ratings (mean = 0.7 +/- 0.7) for the 100-m walk were significantly less than (Wilcoxon t = 1, P < 0.005) preorthotic pain ratings (mean = 3.0 +/- 1.7). Postorthotic Foot Function Index pain subsection ratings (Wilcoxon t = 0, P < 0.005) were significantly less than preorthotic ratings, demonstrating a 66% reduction in pain ratings. Postorthotic Foot Function Index disability subsection ratings (Wilcoxon t = 0, P < 0.005) were significantly less than preorthotic ratings, demonstrating a 75% reduction in disability ratings.

CONCLUSION: Custom semirigid foot orthotics may significantly reduce pain experienced during walking and may reduce more global measures of pain and disability for patients with chronic plantar fasciitis.

Orthotics

Orthotics - Heel Pain - Plantar Fasciitis

What are Orthotics?

Orthotics are shoe inserts that are intended to correct an abnormal, or irregular, walking pattern. Orthotics are not truly or solely “arch supports,” although some people use those words to describe them, and they perhaps can best be understood with those words in mind. They perform functions that make standing, walking, and running more comfortable and efficient by altering slightly the angles at which the foot strikes a walking or running surface.

Doctors of podiatric medicine prescribe orthotics as a conservative approach to many foot problems or as a method of control after certain types of foot surgery; their use is a highly successful, practical treatment form.

Orthotics take various forms and are constructed of various materials. All are concerned with improving foot function and minimizing stress forces that could ultimately cause foot deformity and pain.

Foot orthotics fall into three broad categories: those that primarily attempt to change foot function, those that are primarily protective in nature, and those that combine functional control and protection.

Rigid Orthotics The so-called rigid orthotic device, designed to control function, may be made of a firm material such as plastic or carbon fiber and is used primarily for walking or dress shoes. It is generally fabricated from a plaster of paris mold of the individual foot. The finished device normally extends along the sole of the heel to the ball or toes of the foot. It is worn mostly in closed shoes with a heel height under two inches. Because of the nature of the materials involved, very little alteration in shoe size is necessary.

Rigid orthotics are chiefly designed to control motion in two major foot joints, which lie directly below the ankle joint. These devices are long lasting, do not change shape, and are usually difficult to break. Strains, aches, and pains in the legs, thighs, and lower back may be due to abnormal function of the foot, or a slight difference in the length of the legs. In such cases, orthotics may improve or eliminate these symptoms, which may seem only remotely connected to foot function.

Soft Orthotics The second, or soft, orthotic device helps to absorb shock, increase balance, and take pressure off uncomfortable or sore spots. It is usually constructed of soft, compressible materials, and may be molded by the action of the foot in walking or fashioned over a plaster impression of the foot. Also worn against the sole of the foot, it usually extends from the heel past the ball of the foot to include the toes.

The advantage of any soft orthotic device is that it may be easily adjusted to changing weight-bearing forces. The disadvantage is that it must be periodically replaced or refurbished. It is particularly effective for arthritic and grossly deformed feet where there is a loss of protective fatty tissue on the side of the foot. It is also widely used in the care of the diabetic foot. Because it is compressible, the soft orthotic is usually bulkier and may well require extra room in shoes or prescription footwear.

Semirigid Orthotics The third type of orthotic device (semirigid) provides for dynamic balance of the foot while walking or participating in sports. This orthotic is not a crutch, but an aid to the athlete. Each sport has its own demands and each sport orthotic needs to be constructed appropriately with the sport and the athlete taken into consideration. This functional dynamic orthotic helps guide the foot through proper functions, allowing the muscles and tendons to perform more efficiently. The classic, semirigid orthotic is constructed of layers of soft material, reinforced with more rigid materials.

Orthotics for Children Orthotic devices are effective in the treatment of children with foot deformities. Most podiatric physicians recommend that children with such deformities be placed in orthotics soon after they start walking, to stabilize the foot. The devices can be placed directly into a standard shoe or an athletic shoe.

Usually, the orthotics need to be replaced when the child’s foot has grown two sizes. Different types of orthotics may be needed as the child’s foot develops and changes shape.

The length of time a child needs orthotics varies considerably, depending on the seriousness of the deformity and how soon correction is addressed.

Other Types of Orthotics Various other orthotics may be used for multidirectional sports or edge-control sports by casting the foot within the ski boot, ice skate boot, or inline skate boot. Combinations of semiflexible material and soft material to accommodate painful areas are utilized for specific problems.

Research has shown that back problems frequently can be traced to a foot imbalance. It’s important for your podiatric physician to evaluate the lower extremity as a whole to provide for appropriate orthotic control for foot problems.

Orthotic Tips Wear shoes that work well with your orthotics.

  • Bring your orthotics with you whenever you purchase a new pair of shoes.
  • Wear socks or stockings similar to those that you plan on wearing when you shop for new shoes.
  • Return as directed for follow-up evaluation of the functioning of your orthotics. This is important for making certain that your feet and orthotics are functioning properly together.
  •  
    Your podiatric physician/surgeon has been trained specifically and extensively in the diagnosis and treatment of all manner of foot conditions. This training encompasses all of the intricately related systems and structures of the foot and lower leg including neurological, circulatory, skin, and the musculoskeletal system, which includes bones, joints, ligaments, tendons, muscles, and nerves.


    heel pain plantar fasciitis
    heel pain plantar fasciitis