About Plantar Fasciitis or Heel Spur Syndrome

What is plantar fasciitis or heel spur syndrome?

Plantar fasciitis, also known as heel spur syndrome, is characterized by pain on the inferior surface of the heel. It is a common medical problem that can be associated with debilitating symptoms. Typically, aching or sharp heel pain is described by patients when first bearing weight upon arising in the morning, or following periods of sitting. In addition, pain can be significant following prolonged standing or walking.

Many factors can be associated with the onset of this condition. As an overuse syndrome, biomechanical abnormalities, obesity and prolonged periods of weight bearing can all play a role in this problem.

What are some causes of Plantar Fasciitis?

Plantar fasciitis occurs when the thick band of tissue on the bottom of the foot is overstretched or overused. This can be painful and make walking difficult. It is one of the most common orthopedic complaints relating to the foot.

Risk factors for plantar fasciitis include:

  • Foot arch problems (both flat feet and high arches)
  • Obesity or sudden weight gain
  • Long-distance running
  • Tight Achilles tendon
  • Shoes with poor support or soft soles

Plantar fasciitis is commonly thought of as being caused by a heel spur, but in most cases, the spur is a result of chronic plantar fasciitis. Furthermore, heel spurs can be seen in people without a history plantar fasciitis.

What are some of the common symptoms?

The most common complaint is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn.

The pain is usually worse:

  • In the morning when you take your first steps
  • After standing or sitting for a while
  • When climbing stairs
  • After intense activity

The pain may develop slowly over time, or suddenly after intense activity.

How is this problem diagnosed?

The diagnosis of plantar fasciitis is generally straightforward in nature. A thorough history will be taken in order to rule out various systemic arthritic conditions which may be associated with heel pain. A physical examination will also be performed. Diagnostic tests may include x-rays, diagnostic ultrasound and MRI.

What are appropriate conservative treatments prior to considering
  Extracorporeal Shock Wave Therapy?

Conservative treatment for plantar fasciitis generally includes both an anti-inflammatory and a mechanical approach. Oral anti-inflammatory medications (either over-the-counter or prescription) as well as injectible anti-inflammatory steroids are typically recommended. Physical therapy modalities may also be instituted. Mechanical treatment approaches to plantar fasciitis include use of appropriate shoegear, heel cushions, custom fabricated in-shoe orthoses and stretching exercises.

A patient who continues to have disabling pain following at least six months of treatment with these various modalities, may be a candidate for ESWT. This non-invasive procedure is highly recommended prior to considering surgical intervention.

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