PLANTAR FASCIITIS _heel spur syndrome_ What is it Plantar by Abbydoc


									PLANTAR FASCIITIS (heel spur syndrome)

What is it?

Plantar fasciitis is a condition
wherein the plantar fascia is pulling
on the periosteum at the calcaneus
therefore causing inflammation and

The plantar fascia is connective
tissue that acts as a stabilizer and
maintains the integrity of the arch of the foot. It originates at the plantar aspect of the
calcaneus and is attached to the metatarsal heads and continues forward to insert on
the proximal phalanges as well as forming the fibrous flexor sheath in each toe.

What are the common symptoms/complaints?

Patients complain of severe pain felt in the heel at the hindfoot (plantar surface of the
calcaneus) particularly when they take their first few steps of the day, or after they
have been off their feet for a prolonged period of time. Pain after rest!

How is it caused?

The plantar fascia is repeatedly over-torqued because the calcaneus in the hindfoot is
stable while the forefoot is over-pronating. This shearing force causes the Plantar
Fascia to become inflamed. Because the weakest part of the plantar fascia is the
attachment to the periosteum (fibrous membrane covering the bone) at the calcaneus.
When the plantar fascia is repeatedly twisted, it pulls the periosteum away from the
calcaneus and causes the pain and inflammation. If this happens often enough, the
calcaneus will eventually grow toward the plantar fascia in an effort to re-attach itself.
That bone growth is called a heel spur.

The pain is felt during the first few steps of the day because during the night, the
fibres of the fascia try to heal themselves by forming fragile new fibre, and when the
person puts weight on the foot, renewed tearing takes place and the pain becomes

How is it treated?

Since the problem is caused by over-pronation, the patient should be fitted with
orthotics and will likely experience pain relief within weeks and complete recovery
within months (generally 2 - 3 months).

When foot pain and tenderness occurs in the bottom of the heel, most
commonly the podiatry problem is related to an inflammation of the
Plantar Fascia. This discussion will focus on pain to the bottom of the
heel and not to the ankle joint or the rear of the heel.
           Besides plantar fasciitis, there are a few other conditions that
           need to be considered in diagnosing heel pain. These
           conditions include ruling out the presence of a calcaneal
           stress fracture, an entrapment of the nerve going to the inside
           or outside of the heel, radiating pain from sciatica from the
           hip or back and / or an nerve compression in the ankle called
           tarsal tunnel syndrome. In teenagers, there is also a common
           condition with the growth plate causing bottom of the heel
pain called Sever's Disease.

The Plantar Fascia is a strong inelastic band of fibers which begins at
the heel and extend into the toes. When the Plantar Fascia becomes
inflamed, the pain is mainly in the arch of the foot. Medically, this
condition is called Plantar Fasciitis. When the Plantar fascia becomes
inflamed and the pain is mainly in the heel, medically this condition is
called Heel Spur Syndrome. The usual cause of Plantar Fasciitis or Heel
Spur Syndrome is excessive pulling on the Plantar Fascia from either
excessive exercise, poor fitting shoe gear or poor foot alignment while
running or standing.

Plantar fascia pain usually begins as a mild pain to either the arch area
or the bottom of the heel. The discomfort in the foot is usually most
noticeable with the first step in the morning and seems to improve after
a period of "warming up" the foot. If untreated, the pain can become
intolerable. In some individuals, actual heel spur formation can occur at
the site of where the Plantar Fascia is connected to the heel. The heel
spur is actually a ridge of bone which forms to reinforce where the
Plantar Fascia attaches to the heel. The ridge of bone is not the main
problem unless a small nerve under the Plantar fascia becomes
entrapped. The Plantar Fascia is the primary pathological anatomical
structure that is causing pain to the patient. If the pulling on the plantar
fascia is corrected, it is important to understand that the heel spur that
formed from the pulling is not important and does not need to be
removed with surgery. There are many doctors who get the heel spur
confused and tell the patient that a heel spur is causing their pain when
in fact it is the injury to the Plantar Fascia that needs to be medically

Home care for either Plantar Fasciitis or Heel Spur Syndrome primarily
consists of resting the foot, applying ice to the affected area three times
a day for ten minutes, and using a supportive athletic shoe for most
activities during the day. Sometimes stretching the arch by rolling the
foot on an empty soft drink bottle in the morning helps relieve some of
the pain. In addition, using a heel pad or a padded insole can be helpful
in relieving the pain in the heel. If these home treatments do not relieve
the pain, treatment by a foot and ankle specialist is warranted.

In treating heel and arch related foot pain, an X-ray of the foot is usually
obtained to rule out a rare heel stress fracture and to document if a heel
spur has occurred. Once a diagnosis is made of either Heel Spur
Syndrome or Plantar Fasciitis, initial treatment usually consists of anti-
inflammatory medications, the use of a night splint and functional foot
orthotics. A night splint is required to hold the foot in the correct
position during sleep to allow the Plantar Fascia to heal in the correct
length as when standing and walking. A functional orthotic is required
to control the amount of pulling that is occurring in the Plantar Fascia
with weight bearing by controlling the position of the foot in the shoe.
 In some cases a cortisone shot is placed into the area of the origin of
the Plantar Fascia to rapidly reduce the amount of pain that is present.
 However, in many cases, a cortisone shot results in only a couple of
weeks of pain relief and the problem is back with the same intensity of
pain or even worse than before the cortisone shot.

Surgical intervention of either Heel Spur Syndrome or Plantar Fasciitis
is rarely indicated and should be considered only after use of the night
splint and / or the functional foot orthotic has failed. The surgery is
warranted if the Plantar Fascia band has become too short due to
repeated injury to where the Plantar Fascia or the nerve under the
Plantar Fascia has become entrapped. The surgery should only be
performed by an experienced surgeon. The primary purpose of the
operation is to lengthen the Plantar Fascia and remove the excessive
bone formation where the Plantar Fascia is anchored to the heel bone.
In many surgical cases, there is also a adventitious bursa that must be
excised. Over the last five years, a procedure has been advertised for
heel spur surgery using a scope with claims to have a better recovery
time and less associated pain compared to traditional procedures.
 However, to date this procedure has not demonstrated any better
advancement over traditional methods and has actually been associated
with a higher rate of complications than traditional procedures.

Because Heel Spur Syndrome and Plantar Fasciitis is an inflammatory
condition, early intervention is essential to stop the repeated scarring of
the Plantar Fascia that can lead to irreversible shortening of the Plantar
Fascia, nerve entrapment and the formation of a painful adventitious


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