Understanding Plantar Fasciitis -- Diagnosis and Treatment
How Do I Know If I Have Plantar Fasciitis?
Most cases of plantar fasciitis are diagnosed by a health care provider based on your symptoms and by a physical exam in which he or she will press on the bottom of your feet -- the area most likely to be painful in plantar fasciitis, inflammation of the thick, fibrous band of tissue (''fascia'') that reaches from the heel to the toes and supports the muscles and arch of the foot. He or she may suggest that you have an X-ray of your foot to verify that there is no stress fracture causing your pain.
What Are the Treatments for Plantar Fasciitis?
Most health care providers agree that initial treatment for plantar fasciitis should be quite conservative. You'll probably be advised to avoid exercise that is making your pain worse. Your doctor may also advise one or more of these treatment options:
A Heel Pad
A heel pad is sometimes used to cushion the painful heel if you spend a great deal of time on your feet on hard surfaces.
Also, over-the-counter or custom-made orthotics, which fit inside your shoes, may be constructed to address specific imbalances you may have with foot placement or gait.
Stretching exercises performed three to five times a day can help elongate the heel cord and the ligaments on the bottom of the foot.
You may be advised to apply ice packs to your heel or to use an ice block to massage the plantar fascia before going to bed each night.
Simple over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in decreasing inflammation and pain. To avoid stomach discomfort, NSAIDs should be taken with meals. If you can't tolerate such drugs, ask your health care provider about an alternative.
A Night Splint
A night splint is sometimes used to hold your foot at a specific angle, which prevents the plantar fascia from contracting during sleep.
Ultrasound physical therapy can be performed to decrease inflammation and promote healing.
Anti-inflammatory steroid injections directly into the tissue around your heel may be helpful. However, if these injections are used too many times, you may suffer other complications, such as shrinking of the fat pad of your heel, which you need for insulation and cushioning. Loss of the fat pad could actually increase your pain -- or could even rupture the plantar fascia in rare cases.
If your plantar fasciitis is unresponsive to typical treatments, your doctor may recommend that you wear a short walking cast for about three weeks. This ensures that your foot is held in a position that allows the plantar fascia to heal in a stretched, rather than shortened, position.
Shock Wave Therapy
Extracorporeal shock wave therapy is a procedure that may be performed prior to considering open surgery, if your symptoms have persisted for more than six months. This surgery does not involve any actual incisions being made; rather, it uses a high intensity shock wave to stimulate healing of the plantar fascia.