What is Plantar Fasciitis?

Plantar Fasciitis

Topic Overview 

What is plantar fasciitis?

Plantar fasciitis (say "PLAN-ter fash-ee-EYE-tus") is the most common cause of heel pain. The plantar fascia  is the flat band of tissue (ligament) that connects your heel bone to your toes. It supports the arch of your foot. If you strain your plantar fascia, it gets weak, swollen, and irritated (inflamed). Then your heel or the bottom of your foot hurts when you stand or walk.

Plantar fasciitis is common in middle-aged people. It also occurs in younger people who are on their feet a lot, like athletes or soldiers. It can happen in one foot or both feet.

What causes plantar fasciitis?

Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling. This is more likely to happen if:

• Your feet roll inward too much when you walk (excessive pronation ).
• You have high arches or flat feet.
• You walk, stand, or run for long periods of time, especially on hard surfaces.
• You are overweight.
• You wear shoes that don't fit well or are worn out.
• You have tight Achilles tendons or calf muscles.

What are the symptoms?

Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time.

If you have foot pain at night, you may have a different problem, such as arthritis, or a nerve problem such as tarsal tunnel syndrome.

How is plantar fasciitis diagnosed?

Your doctor will check your feet and watch you stand and walk. He or she will also ask questions about:

• Your past health, including what illnesses or injuries you have had.
• Your symptoms, such as where the pain is and what time of day your foot hurts most.
• How active you are and what types of physical activity you do.

Your doctor may take an X-ray of your foot if he or she suspects a problem with the bones of your foot, such as a stress fracture.

How is it treated?

No single treatment works best for everyone with plantar fasciitis. But there are many things you can try to help your foot get better:

• Give your feet a rest. Cut back on activities that make your foot hurt. Try not to walk or run on hard surfaces.
• To reduce pain and swelling, try putting ice on your heel. Or take an over-the-counter pain reliever like ibuprofen (such as Advil or Motrin), naproxen (such as Aleve), or aspirin.
• Do toe stretches , calf stretches  and towel stretches  several times a day, especially when you first get up in the morning.
• Get a new pair of shoes. Pick shoes with good arch support and a cushioned sole. Or try heel cups or shoe inserts (orthotics ). Use them in both shoes, even if only one foot hurts. If these treatments do not help, your Podiatrist may give you splints that you wear at night, shots of steroid medicine in your heel, or other treatments. You probably will not need surgery. Podiatrists only suggest it for people who still have pain after trying other treatments for 6 to 12 months.

  How long will it take for the pain to go away?

  Plantar fasciitis most often occurs because of injuries that have happened over time. With treatment, you will have less pain within a few weeks. But it may take time for the pain to go away completely. It may take a few months to a year.
  Stay with your treatment. If you don't, you may have constant pain when you stand or walk. The sooner you start treatment, the sooner your feet will stop hurting.
  
  

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Care of the Diabetic Foot!

Care of the Diabetic Foot

General Care of the Diabetic Foot

Inspection

Shoe wear

Orthotics

Diabetic foot problems are a major health concern and are a common cause of hospitalization.

Most foot problems that people with diabetes face arise from two serious complications of the disease: nerve damage and poor circulation. The lack of feeling and poor blood flow can allow a small blister to progress to a serious infection in a matter of days. Chronic nerve damage (neuropathy) can cause dry and cracked skin, which provides an opportunity for bacteria to enter and cause infection.

The consequences can range from hospitalization for antibiotics to amputation of a toe or foot. For people with diabetes, careful, daily inspection of the feet is essential to overall health and the prevention of damaging foot problems.

General Care of the Diabetic Foot

• Never walk barefoot. The nerve damage decreases sensation so you may not notice that little pebbles or objects have gotten stuck in your foot. This can lead to a massive infection. Always wearing shoes or slippers reduces this risk.
• Wash your feet every day with mild soap and warm water. Test the water temperature with your hand first. Do not soak your feet. When drying them, pat each foot with a towel rather than rubbing vigorously. Be careful drying between your toes.
• Use lotion to keep the skin of your feet soft and moist. This prevents dry skin cracks and decreases the risk of infection. Do not put lotion between the toes.
• Trim your toe nails straight across. Avoid cutting the corners. Use a nail file or emery board. If you find an ingrown toenail, see your Podiatrist. Good medical care is important in preventing infections.
• Do not use antiseptic solutions, drugstore medications, heating pads, or sharp instruments on your feet. Do not put your feet on radiators or in front of the fireplace.
• Always keep your feet warm. Wear loose socks to bed. Do not get your feet wet in snow or rain. Wear warm socks and shoes in winter.
• Do NOT smoke. Smoking damages blood vessels and decreases the ability of the body to deliver oxygen. In combination with diabetes, it significantly increases your risk of amputation — not only of the feet, but can include the hands, as well.

Inspection

• Inspect your feet every day.
• Look for puncture wounds, bruises, pressure areas, redness, warmth, blisters, ulcers, scratches, cuts, and nail problems.
• Get someone to help you, or use a mirror if you are unable to do it alone. You may not feel that damage has occurred to the skin. Inspecting for skin breakdown is crucial.
• Look at and feel each foot for swelling. Swelling in one of the feet and not the other is an early sign that you may be experiencing early stages of Charcot (pronounced "sharko") foot. This is a unique problem that can occur in people with nerve damage. It can destroy the bones and joints.
• Examine the bottoms of your feet and toes. Check the six major locations on the bottom of each foot:
• The tip of the big toe
• The base of the little toes
• The base of the middle toes
• The heel
• The outside edge of the foot
• Across the ball of the foot

Shoe wear

Choose and wear your shoes carefully. A poor fitting shoe can cause an ulcer and lead to an infection.

• Buy new shoes late in the day when your feet are larger. Buy shoes that are comfortable without a "breaking in" period.
• Check how your shoe fits in width, length, back, bottom of heel, and sole. Have your feet measured every time you buy new shoes. Your foot will change shape over the years and you may not be the same shoe size you were 5 years ago.
• Avoid pointed-toe styles and high heels. Try to get shoes made with leather upper material and deep toe boxes.
• Wear new shoes for only 2 hours or less at a time. Do not wear the same pair every day.
• Inspect the inside of each shoe before putting it on. Do not lace your shoes too tightly or loosely.
• Avoid long walks without taking a break, removing your shoes and socks and checking for signs of pressure (redness) or ulcers.

Orthotics

Insurance companies frequently will cover the cost of orthotics for people with diabetes. They understand how important it is to minimize the risk of a pressure sore in these patients. Discuss this with your Podiatrist.

An accommodative orthotic made from a soft material called plastizote is commonly prescribed. The orthotics should not be hard, as this will increase the risk of a pressure ulcer. The orthotic can be transferred from shoe to shoe and should be used at all times when standing or walking.

Stress Fractures of the Foot and Ankle

Stress Fractures of the Foot and Ankle

Description

Cause

Symptoms

Doctor Examination

Treatment

Recovery

Prevention

A stress fracture is a small crack in a bone. Stress fractures often develop from overuse, such as from high-impact sports like distance running or basketball.

Most stress fractures occur in the weight-bearing bones of the foot and lower leg. Studies show that athletes participating in tennis, track and field, gymnastics, dance, and basketball are at high risk for stress fractures. In all of these sports, the repeated stress of the foot striking the ground can cause problems.

Rest is the key element to recovery from a stress fracture.

Description

A stress fracture is an overuse injury. When muscles are overtired, they are no longer able to lessen the shock of repeated impacts. When this happens, the muscles transfer the stress to the bones. This can create small cracks or fractures.

The most common sites of stress fractures are the second and third metatarsals of the foot. Stress fractures are also common in the heel (calcaneus), the outer bone of the lower leg (fibula), and the navicular, a bone on the top of the midfoot.

The most common sites for stress fractures in the foot are the metatarsal bones.

Cause

Stress fractures usually occur when you increase your high-impact activity by:

• Frequency (how often you exercise)
• Duration (how long you exercise)
• Intensity (your level of exertion)

People who do not exercise can also have stress fractures. If osteoporosis or other disease has weakened bones, normal daily activities may result in a stress fracture. This is called bone insufficiency. It is one of many factors that can increase your risk for stress fracture.

Conditioning

Doing too much too soon is a common cause of stress fractures. For example, runners who are confined indoors for the winter may want to pick up where they left off at the end of the previous season. Instead of starting slowly, they try to match their previous mileage. Because of the lower level of conditioning, muscles become fatigued faster. The result could be a stress fracture in the foot or ankle.

Those who are new to exercise and try to do too much too soon are also at risk.

Equipment and Environment

Improper sports equipment, such as shoes that are too worn or stiff, can contribute to stress fractures.

A change of surface, such as going from a grass tennis court to one of clay, or a change from an indoor to an outdoor running track, can also increase the risk.

Technique

Errors in training or technique are another cause of stress fractures. Anything that alters the mechanics of how the foot absorbs impact when it strikes the ground may increase your risk for a stress fracture. For example, a blister, bunion, or tendonitis can affect how you put your weight on your foot, and may require a bony area to handle more load than usual.

Bone Insufficiency

Insufficiency stress fractures result when the bone itself is weak. Conditions like osteoporosis reduce bone strength and density. This increases the risk of fracture.

Anyone with a medical problem or taking medication that decreases bone density is susceptible to stress fractures.

Female athletes who experience irregular or absent menstrual periods may also have decreased bone density. Studies show that female athletes are more prone to stress fractures than their male counterparts are. Many doctors attribute this to "female athletic triad." This three-sided condition includes eating disorders, irregular menstrual cycle, and osteoporosis. As a woman's bone mass decreases, her chances for getting a stress fracture increase.

Symptoms

• Pain that develops gradually, increases with weight-bearing activity, and diminishes with rest
• Pain that becomes more severe and occurs during normal, daily activities
• Swelling on the top of the foot or the outside of the ankle
• Tenderness to touch at the site of the fracture
• Possible bruising

Doctor Examination

Medical History and Physical Examination

During the first visit, your Podiatrist will ask you about your work, your activities, and any medications you take. It is important that your Podiatrist understands what your risk factors for stress fractures are.

After discussing your symptoms and medical history, your Podiatrist will examine your foot and ankle.

Imaging Tests

Imaging tests may help your doctor confirm your diagnosis.

Stress fractures are difficult to see on X-rays until they have actually started to heal. Your Podiatrist may recommend a bone scan or a magnetic resonance imaging (MRI) scan, which are more sensitive than an X-ray and can detect stress fractures early.

Treatment

First Aid

If you suspect a stress fracture in your foot or ankle, stop the activity and rest. Ignoring the pain can have serious consequences. The bone may break completely.

Apply an ice pack and elevate your foot above the level of your heart. Nonsteroidal anti-inflammatory medicines like ibuprofen or naproxen may help relieve pain and swelling, but may inhibit bone healing. Try not to put weight on your foot until after you see a Podiatrist.

Nonsurgical Treatment

Treatment will vary depending on the location of your stress fracture and its severity.

The goal of any treatment is to help you return to all the activities you enjoy. Following your doctor's treatment plan will restore your abilities faster, and help you prevent further problems in the future.

Rest. Take a break from the activity that caused the stress fracture. It typically takes 6 to 8 weeks for a stress fracture to heal. During that time, switch to aerobic activities that place less stress on your foot and leg. Swimming and cycling are good alternative activities. Remember, however, that you should not do any physical activity on the involved foot or ankle until you consult a doctor.

Protective footwear. To reduce stress on your foot and leg, your Podiatrist may recommend wearing protective footwear. This may be a stiff-soled shoe, a wooden-soled sandal, or a removable short-leg fracture brace shoe.

Casts. Stress fractures in the fifth metatarsal bone (on the outer side of the foot) or in the navicular or talus bones take longer to heal. Your doctor may apply a cast to your foot to keep your bones in a fixed position and to remove the stress on your involved leg. Casts are a type of external fixation. To keep weight off your foot and leg, your doctor may recommend that you use crutches until the bone heals.

Surgical Treatment

Some stress fractures require surgery to heal properly. In most cases, this involves supporting the bones by inserting a type of fastener. This is called internal fixation. Pins, screws, and/or plates are most often used to hold the small bones of the foot and ankle together during the healing process.

Recovery

Once your stress fracture has healed and you are pain-free, your Podiatrist will allow a gradual return to activity.

Slow pace. During the early phase of rehabilitation, your Podiatrist may recommend to alternate days of activity with days of rest. You should slowly increase the frequency, duration, and intensity of your exercise. If the activity that caused the stress fracture is resumed too quickly, larger, harder-to-heal stress fractures can develop. Reinjury could lead to chronic problems, and the stress fracture might never heal properly.

Cross-training. Varying the types of aerobic exercise you do may help you avoid repeated stress on your foot and ankle.

Prevention

These guidelines can help you prevent stress fractures.

• Maintain a healthful diet. Eat calcium and vitamin D-rich foods to help build bone strength.
• Use proper sports equipment. Don't wear old or worn running shoes.
• Alternate your activities. For example, you can alternate jogging with swimming or cycling.
• Start any new sports activity slowly. Gradually increase time, speed, and distance; a 10% increase per week is fine.
• Strength training can help prevent early muscle fatigue and prevent the loss of bone density that comes with aging.
• If pain or swelling returns, stop the activity. Rest for a few days. If pain continues, see your doctor.