PLANTAR FASCIITIS - heel pain

Patients often come to me complaining of heel pain,  the usual story being that they have pain in the heel right after getting out of bed or after taking the first few steps in the morning. The pain will ease somewhat, but tend to be progressively worse throughout the day when they are constantly on their feet.

Now there are many causes of heel pain but PLANTAR FASCIITIS ( interpreted as inflammation of the PLANTAR FASCIA - this is a misnomer, as I would explain later) remains the most common cause of heel pain.

The PLANTAR FASCIA is a thickened fibrous band of tissue that stretches from the heel (calcaneum bone) to the head of the metatarsals of the foot. Likened to a bowstring, it acts to maintain the arch of the foot and also helps in shock absorption when the foot strikes the ground.

The Plantar Fascia

It was thought that inflammatory changes was the cause of this pain; however we now know it is mainly due to degenerative changes in the fascia, especially at the interface where the fascia attaches to the bone, hence the misnomer in the "fasciitis" as I informed earlier.

Causes

Tight heel cord ie the gastrocnemeus, soleus and the Achilles tendon, high arch feet, flat feet are some of the incriminating causes of plantar fasciitis, as is obesity, occupations requiring prolonged standing and weight-bearing, and heel spurs. Talking about heel spurs, one does not necessarily have plantar fasciitis if the heel spurs are present on x rays.

Seeking relief from the pain

There are a variety of measures that one can do to alleviate this problem:

Stretching your plantar fascia

• usage of a well fitting shoe, with adequate arch support and well cushioned heel
• adding insole into the shoe - the soft silicone ones applied to the heel area are the best 
• stretching exercises - this can be done first thing in the morning or anytime before starting any prolonged activity
• ice helps to soothe the pain after a painful episode

Seeing the doctor

This condition is typically self-limiting with the majority of patients having resolution of symptoms with simple measures described above.
If the problems still persist, your friendly orthopedic surgeon can rule out other causes of heel pain and maybe order some imaging studies to help in making a diagnosis.
Along with the measures above, the good doctor could try any of these modalities to help you along:

• Anti-inflammatory medications (NSAIDS)
• Splints and orthoses - typically to be used at night
• Physiotherapy
• Steroid /  platelet rich plasma (PRP) injection
• Extra-corporeal shock wave therapy (ESWT)
• Radiofrequency (RF) microdebridement (TOPAZ)- a relatively new technique in which a wand like instrument is inserted percutaneously under the heel and a bipolar radiofrequency pulse applied to the plantar fascia

Whew. Now that's a lot of choice innit? Do contact your orthopedic surgeon if you have any more questions or need to know more about this or any foot-related problems.

You know how to contact me:

Dr Saiful Akhtar Shamsuddin

Columbia Asia Hospital - Bukit Rimau

No3, Persiaran Anggerik Eria, Bukit Rimau, Seksyen 32

40460 Shah Alam, Selangor Darul Ehsan

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Tel: 603-51259999  Fax: 603-51259998


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