Plantar Fasciitis - A Heel of a Pain
As we age we are more prone to injury that comes from things we used to do when younger with no consequences. All readers know that our joints, bones, and tendons are not what they use to be. Thus one of the consequences of use in some people is a problem with the tendons that stretch from the heel to the toes. This tendon is called the plantar fascia and it becomes a very common new problem for about two million Americans a year. The actual peak incidence is in middle age, but it can and does afflict older people, especially if it has not been treated when it first appears.
Cause of Plantar Fasciitis
If the plantar fascia is overly used and becomes inflamed the result is plantar fasciitis. There is evidence that small tears occur in the tendon, that it becomes inflamed and that swelling in and around the fascia occurs. If allowed to persist the tension on the fascia can cause a bone spur to occur in the heel, aggravating the situation. The inflammation is a result of repeated wear and tear on the fascia that can be caused by walking, running, or standing that stresses and stretches the fascia.
Risk Factors and Prevention
The first risk factor is age--it is a disease most prevalent in middle age. Other factors shows to be related to plantar fasciitis are repetitive use (weight bearing), excessive body weight, "flat feet," exercising or standing on hard surfaces, and shoes that do not offer appropriate arch support (old shoes). Obviously to prevent this problem, the correctable factors are to stretch frequently during the day, stay at a normal weight, wear shoes with cushioned heel and arch support, do no wear worn out flat shoes, and do not go barefoot. It is important to vary exercises that affect the foot; rather than doing one thing only like walking or running, alternate between them or with swimming. Avoid prolonged standing on a hard surface--consider placing a cushioned mat where a great deal of time is spent standing (like in the kitchen).
Diagnosis and Treatment
Plantar fasciitis is generally diagnosed by you or you and your physician together by simply reviewing your activities and doing a physical exam. The heel and area in front of the heel on the bottom of the foot will be tender to pressure and to walking or running. Imaging is not used to make the diagnosis since tendons don't show well on x-ray and MRI is not required either. It is important to make the diagnosis as early as possible, like the first time that one feels a new and severe pain in the bottom of the foot. The earlier the treatment, the shorter the duration of the problem will be.
The treatment involves immediate rest. Do not repeat the activity that caused the problem. Apply ice to the bottom of the foot and keep the foot elevated. Sometimes alternating cold (ice) and heat may be used, but cold is much superior since it reduces the inflammatory response while heat increases that. Stretching exercises (Achilles and towel around toes) and sometimes splints that raise the toes may be used to treat the problem. At early diagnosis some medicines are useful to treat the pain and inflammation such as ibuprofen (Advil, Motrin), naproxen (Aleve), or aspirin. These medicines SHOULD NOT be used to continue the exercise or activity that caused the problem--rest from that is essential. This is one of those problems where toughing it out is really bad for you--stay off your feet. Additional treatment is the use of shoe inserts that protect the heel and elevate the arch. These conservative methods are almost always able to return the foot to its normal state, but it takes time--sometimes as long as a year. There are other treatments in the late stages of the diseases such as steroid injections and very rarely surgery. These should be undertaken as last resorts and under the supervision of an expert in foot problems. The tendonitis or fasciitis will heal over time in most people.
The bottom line is plantar fasciitis is a very common problem that affects about 10 percent of the population at one time or another in their life. It can cause severe pain that seems slow to respond to the appropriate treatment. However, this is one problem of aging that can be prevented or minimized if the preventive measures mentioned above are taken and if diagnosis and treatment are quickly made when it does occur.
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