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Saturday, January 4, 2014

Plantar Fasciitis: Down to the nitty gritty by Mirylsa Colon-Martinez, MD


The following message below was written by Mirylsa Colón-Martínez , MD Orthopaedic Surgeon. Currently, Dr. Colón-Martínez offers her expertise in Puerto Rico. The excerpt appeared as guest writership in the 3rd edition of the 2013 Yuletide Mania Video Series as seen in HAHPN. 


December 12, 2013
Plantar Fasciitis
Down to the nitty gritty 

Heel Pain. Most people experience it during their lifetime. Among the many causes of heel pain, probably the most common is plantar fasciitis, an inflammatory process of the plantar fascia, characterized by plantar heel pain that is usually worse in the morning, upon taking the first steps out of bed, on startup (that means when you've been sitting for a while, then you stand up... pain is worse in those first few steps you take), and after standing for long periods of time. 

Why!? It is most common in middle age, overweight, people who stand or walk a lot, and in athletes, due to overuse. 

What is the plantar fascia? It is a fibrous band of connective tissue that originates from the plantar aspect of the heel bone, and runs along the sole of the foot all the way down to the toes. It functions in maintaining the arch and improves propulsion during gait. Radiologic studies usually show thickening of the plantar fascia fibers at the origin in the calcaneus or heel bone, and surrounding edema. Now, not all plantar fasciitis is manifested by heel pain. There is also mid-substance or non-insertional plantar fasciitis, with similar features, but pain along the arch of the foot. 

What can you do?! It has been my experience, that the mainstay of treatment is Achilles and plantar fascia specific stretching exercises (hold position for 1 minute, repeat 6 times a day...although there are many protocols). Oral non-steroidal anti-inflammatory medications are also helpful, as well as a night splint, gel insoles and lifestyle modifications such as weight loss. It is the combination of all these, what makes the difference. Other therapies include steroid injections (with a modest risk of plantar fascia rupture), platelet-rich plasma injections, electro-shock wave therapy, and surgery. According to the foot and ankle literature, surgery is indicated after 6-12 months of failed non-operative management. Surgery would remove a part of the plantar fascia (open or endoscopic), although recent studies have shown pain relief with a lengthening of the Achilles tendon /gastrocnemius fascia.

The most important thing, in my experience, is to stretch.