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Plantar Fasciitis This common condition is also known as HEEL SPUR SYNDROME, however this is not really correct. The presence of a spur (or boney outgrowth) on the bottom of the heel bone does not produce the pain. This condition is usually treated without direct treatment of the spur and will usually resolve in time. The spur remains, but the pain will have been eliminated. Plantar fasciitis is actually an inflammation of the plantar fascia or ligament on the bottom of the foot beginning behind the toes and attaching into the heel bone. This ligament functions to support the arch, among other things.
The main reasons why heel pain develops are: 1) an injury to the bottom of the foot, 2)associated with arthritic conditions, and occasionally 3)medication induced. By far, the most common cause for this condition is a mechanical change within the foot. This can result from normal aging when the foot rolls in or tilts (pronation) at the joint just below the ankle. Also, changes in the arch may cause the foot to either flatten or increase in height and may, at times, produce a slight twist or torque in the ligament. This mechanical change may lead to inflammation and the development of symptoms typical of plantar fasciitis. It is often associated with the development of a bursitis in the bottom of the heel. This same motion change may cause compression of the small nerve near the ligament. If this occurs, one would experience shooting or burning pain. Plantar fasciitis classically produces swelling as a function of the inflammatory response. When there is no pressure on the bottom of the foot (off weight-bearing), the soft tissue under the heel will swell slightly.
Therefore, the first step will cause a great deal of pain which improves as body weight reduces the swelling and the ligament stretches out. The pain usually occurs again when a person sits for a period of time and then begins to walk. As the condition progresses, pain will be present throughout the day and is most severe at the end of the day.
Treatment needs to be individualized for each patient. In general, treatment may include anti-inflammatory medications, a change in mechanics of the foot and specific stretching programs for the ligament and associated muscles. At times, in-shoe devices such as heel cushions, arch supports, or custom orthotics (which align the foot in its best functioning position) are required. Injections of anti-inflammatory medication usually reduces pain immediately.
If the condition fails to respond to conservative treatment (10% of cases), we have found the best treatment is lengthening the ligament with a new surgical technique called endoscopic plantar fasciotomy. This procedure is performed through two 1/4 inch incisions, and the ligament is visualized through an endoscope before a precise cut is made. This procedure is done on an out-patient basis, and the patient may walk immediately. Most people return to work in two or three days and may resume athletics in two or three weeks. In our experience the procedure cure rate is 95%. It should be stressed that adequate conservative treatment must be attempted prior to surgical consideration.
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