OrthoNow/Upstate Orthopedics provides injury information

March 28, 2012 at 10:01 AM

19.jpgOrthoNow is the presenting sponsor of the 2012 Mountain Goat Training Runs and will be offering advice and explanations on various running injuries leading up to the Mountain Goat Run. 

This week's information was put together by Dr. Alan Zonno, Orthopedic Surgeon/Upstate Orthopedics, who will be on hand at the MOST before the run on Saturday. Feel free to talk with him about any running related injuries or concerns you may have.

What is plantar fasciitis?

Plantar fasciitis is inflammation of the thick tissue on the bottom of the foot. This thick tissue is the plantar fascia, which connects the heel bone (or calcaneus) to the toes.

What is the function of the plantar fascia?

The plantar fascia helps create and support the arch of the foot. It is believed that mechanical overload produces very small tears in the plantar fascia, which results in inflammation and pain.

How do I know if I have plantar fasciitis?  

Pain on the bottom of the foot, where the plantar fascia attaches to the heel, is the most common symptom. There is often no specific injury. Patients complain of "start-up" pain when getting out of bed in the morning or when getting up from a chair after sitting for a while. The first step out of bed in the morning is often described as the worst step of the day. The start-up pain improves with walking. However, patients also describe an achy pain at the end of the day or after a prolonged period of activity.

Who is at risk for developing plantar fasciitis?

Three factors can predispose an individual to develop plantar fasciitis: 1) standing for most of the workday, 2) contracture or tightness of the Achilles tendon and/or calf muscle, 3) being over-weight. Other factors that may contribute to the development of plantar fasciitis include older age, abnormal foot pressures, improper footwear, and isolated or repetitive trauma (for example, from running) to the bottom of the foot.

How is plantar fasciitis diagnosed?

For orthopedic foot and ankle surgeons, plantar fasciitis is a clinical diagnosis - meaning that no special tests are required to make the diagnosis. The diagnosis is made by asking the patient questions with regards to their symptoms and by physical examination. MRI, ultrasound, and nuclear bone scans may be used but are almost never necessary.

Can anything else cause pain on the bottom of the foot?

Yes. Two of the more common causes of heel pain (other than plantar fasciitis) include nerve entrapment syndromes and atrophy (or wearing away) of the fat pad under the heel. Runners and running athletes can also develop stress fractures of the calcaneus.

How is plantar fasciitis treated?

Plantar fasciitis is likely a self-limiting condition - meaning that if you do nothing at all it will eventually improve. The goal of treatment is to relieve the pain sooner. Nonsurgical management is successful in treating the vast majority of individuals with plantar fasciitis. However, there is no "magic bullet" and it may take up to one year (or even longer!). Treatment involves a combination of rest (avoiding aggravating or impact type activities for a short period of time, including running), nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen), night splints, stretching and massage exercises, physical therapy modalities (such as iontophoresis), and one or a combination of silicone heel cups, prefabricated insoles, and custom-made orthotics.

Does this mean that I need expensive custom orthotics?

Not necessarily. Less expensive, prefabricated inserts or simple silicone heel cups can work just as well, depending on your diagnosis and foot alignment.

I had this pain before and it got better after a steroid injection - can I have another one?

The short answer is no. Steroid injections can relieve symptoms quickly, but studies have shown no difference after several months, whether you receive the injection or not. I do not treat plantar fasciitis with steroid injections because of the potential side effects (which can be worse than the problem we are trying to fix); including premature wearing away of the fat pad under the heel and actual rupture of the plantar fascia.

It has been 4 months and nothing has worked - do I need surgery?

Surgery may be considered after 6 to 12 months of non-operative management. However, results are variable and not predictable from one patient to the next. My preference is to not to operate. Other potential treatments include high-energy shock wave therapy and platelet-rich plasma (PRP) injection. As with surgery - results are variable, but the risk of potential complications from high-energy shock wave therapy or PRP injection is low. Unfortunately, most insurance companies do not cover the cost of high-energy shock wave therapy or PRP injection.

I think my plantar fasciitis is returning, what should I do?

Start the routine over again, as soon as possible - including a period of rest, NSAIDs, night splinting, massage, stretching, heel cups, and potentially physical therapy. Even after plantar fasciitis resolves, it is wise to continue at least the stretching and massage exercises, which can be done at home without the help of a therapist. 


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