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Policeman's Heel

Plantar fasciitis

• is a painful inflammatory process of the plantar fascia, the connective tissue on the sole (bottom surface) of the foot.

• caused by overuse of the plantar fascia or arch tendon of the foot.

• common condition and can be difficult to treat

Plantar Fasciitis• plantar fascia is a thick fibrous

band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes.

• It has been reported that plantar fasciitis occurs in two million Americans a year and in 10% of the U.S. population over a lifetime.

Plantar Fasciitis• It is commonly associated with long

periods of weight bearing.

• Among non-athletic populations, it is associated with a high body mass index.

• The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day.

• Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle).

Plantar Fasciosis.

• Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes

• The suffix "osis" implies a pathology of chronic degeneration without inflammation.

• Since tendons and ligaments do not contain blood vessels, they do not actually become inflamed.

• usually the result of an accumulation over time of microscopic tears at the cellular level.

Diagnosis

• The diagnosis of plantar fasciitis is usually made by clinical examination alone.

Plantar fasciitis• commonly causes stabbing

pain that usually occurs with your very first steps in the morning.

• Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.

Plantar fasciitis – at risk

• Runners

• Overweight people

• Pregnant women

• wear shoes with inadequate support

Plantar Fasciitis• Develops gradually

• Affects just one foot, although it can occur in both feet at the same time

• Is triggered by — and is worst with — the first few steps after awakening,

• although it can also be triggered by long periods of standing or getting up from a seated position

• Feels like a stab in the heel of your foot

Causes

• normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot.

• If tension on that bowstring becomes too great, it can create small tears in the fascia.

• Repetitive stretching and tearing can cause the fascia to become irritated or

Risk Factors• Age. Plantar fasciitis is most common between the ages of 40 and 60.

• Sex. Women are more likely than are men to develop plantar fasciitis.

• Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing and dance aerobics — can contribute to an earlier onset of plantar fasciitis.

• Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you're standing and put added stress on the plantar fascia.

Risk Factors• Obesity. Excess pounds put extra stress on your plantar fascia.

• Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.

• Improper shoes. Avoid loose, thin-soled shoes, as well as shoes without enough arch support or flexible padding to absorb shock.

• If you regularly wear high heels, your Achilles tendon — which is attached to your heel — can contract and shorten, causing strain on the tissue around your heel.

Imaging tests

• an X-ray or magnetic resonance imaging (MRI) to rule out another problem, such as a stress fracture

• Sometimes, an X-ray shows a spur of bone projecting forward from the heel bone.

Heel Spur

• An incidental finding associated with this condition is a heel spur, a small bony calcification on the calcaneus heel bone,

• it is the underlying plantar fasciitis that produces the pain, and not the spur.

• The condition is responsible for the creation of the spur; the plantar fasciitis is not caused by the spur.

Flexor Digitorum Brevis• ball-of-foot pain is mistakenly assumed

to be derived from plantar fasciitis.

• A dull pain or numbness in the metatarsal region of the foot could instead be metatarsalgia,

• Some current studies suggest that plantar fasciitis is not actually inflamed plantar fascia, but merely an inflamed flexor digitorum brevis muscle (FDB) belly.

• Ultrasound evidence illustrates fluid within the FDB muscle belly, not the plantar fascia.

Treatment • Rest,• Massage therapy, • Stretching,• Night splints, • Physical therapy, • Cold therapy,• Heat therapy, • Orthotics,• Anti-inflammatory medications,• Corticosteroid (Botox) Injections -

US guided• Surgery in refractory cases.

Treatment

• Add arch supports to your shoes. Inexpensive over-the-counter arch supports take the tension off the plantar fascia and help absorb shock.

• Stretch your arches. Simple exercises using household objects can stretch your plantar fascia, Achilles tendon and calf muscles.

Therapies

• Stretching and strengthening exercises or use of specialized devices may provide symptom relief.

• exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel.

• A therapist may also teach you to apply athletic taping to support the bottom of your foot.

• Night splints. Your physical therapist or doctor may recommend wearing a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and facilitates stretching.

• Orthotics. Your doctor may prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.

Taping

Foot Orthoses

Night Splints

Treatment• Put your feet up. Stay off your feet for several days when the pain is

severe.

• Apply ice. Hold a cloth-covered ice pack over the area of pain for ice massage. Freeze a water-filled paper cup and roll it over the site of discomfort for about five to seven minutes.

• Decrease your miles, but it's a good idea to cover shorter distances until pain subsides.

• Take up a no- or low-impact exercise. Swap swimming or bicycling in for walking or jogging.

Non-Impact Activities

Alternative Medicine

• Although some over-the-counter arch supports contain magnets, no reliable evidence indicates that arch supports with magnets relieve heel pain any better than do arch supports without magnets.

Surgery

• Risk of nerve injury• Infection,• Rupture of the plantar fascia, and • Failure to improve the pain.• Traditional surgical procedures, such as

plantar fascia release, are a last resort

Coblation Surgery

• (aka Topaz procedure) has been used successfully in the treatment of recalcitrant plantar fasciitis. This procedure utilizes radiofrequency ablation and is a minimally invasive procedure.

Extracorporeal shockwave therapy (ESWT)

• One review found that the preponderance of evidence supports the use of ESWT, but only after several months of treatment with more accepted and proven therapies have failed, as a possible alternative to surgical intervention.

Extracorporeal Shockwave Therapy

• The American Academy of Orthopaedic Surgeons notes that ESWT is sometimes tried before surgery due to minimal risk involved, but due to lack of consistent results it is not commonly performed.