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Posts for: November, 2014

November 23, 2014
Category: F.Y.I.
Tags: ankle   foot   plantar fasciitis  

Plantar Fasciitis is one of the most common conditions that affects the foot.  Years ago, this was referred to as HEEL SPUR SYNDROME because a bone spur on the bottom of the heel is often seen with the condition we now refer to as plantar fasciitis.  Actually, the presence or absence of a "spur" on the bottom of the heel has little, if anything, to do with the pain one gets with this condition.

 Plantar fasciitis is a mechanical thightening that occurs, usually just in front of the bottom of the heel bone, at the attachment of the plantar fascia.  The plantar fascia is a thick, tough, ligamentous band that runs from the heel, through the arch and ends near the ball of the foot at the toes.  A number of things can cause this to become tight and cause pain, often when first putting pressure on the heel in the morning or after a period of rest.  BUT, the idea of INFLAMMATION in this ligament is simply not the case.

 While oral anti-inflammatory agents (also known as NSAIDs) such as Ibuprofen, Naproxen, and many others)  and steroid injections often reduce, and in some cases eliminate the pain, WHERE IS THE INFLAMMATION?????   Rarely does one see swelling, redness, or heat in the area on the bottom of the heel.  In fact, surgical removal of portions of the fascia, when sent for microscopic examination rarely show signs of inflammation.

 For this reason, there is a movement to change the name of this dreaded condition to PLANTAR FASCIOSIS or even PLANTAR FASCIOPATHY.  This name implies deformity or diseased areas within the plantar fascis rather than actual inflammation.  There are also cases where removing small parts of the plantar fascia that appear abnormal on ultrasound exams of the fascia, and "needling" the remaining fascia, or injecting stem cells and/or platelets that are separated from the patient's own blood can cause the body to "heal itself."

 Shockwave therapy, something we will go into more detail on later, can also cause the fascia to "heal" on its own.  These points seem to suggest that INCREASING the inflammation in and around the ligament is actually a good thing, and can lead to reduced pain, and in some cases, complete resolution of symptoms.  No matter what one calls it, plantar fascitiis is a condition that affects many people, and can be treated in a variety of ways.  

Dr. Richard S. Eby