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1. OVERVIEW'
PLANTAR FASCIITIS
Plantar fasciitis is a painful, debilitating condition involving the fibrous band of connective tissue that covers the bottom surface of the foot. Also referred to as painful heel
syndrome or runner's heel, plantar fasciitis is a common cause of heel pain and the
most common diagnosis in patients with a complaint of pain affecting the inferior heeL.
Plantar fasciitis is often self-limiting and it generally responds to a conservative
management program. However, early diagnosis is helpful since the time needed for
resolution of plantar fasciitis may increase when treatment initiation is delayed.1.2
EPIDEMIOLOGY
. Plantar fasciitis is estimated to account for 11%-15% of all foot disorders
leading adults to seek professional care.3
. At least 1 million Americans are treated for this condition annually.4
. Plantar fasciitis seems to be most prevalent in adults 40-60 years of
age.3 However, it can occur in persons of all ages and can be seen
commonly in younger adults with predisposing occupational or
recreational risk factors.3.
. The condition usually involves one foot only, but plantar fasciitis has been
reported to be bilateral in 15%-33% of cases.3.6.?
PATHOPHYSIOLOGY
The plantar fascia originates from the
Figure 1
medial calcaneal tuberosity and
Achilles
extends along the sole of the foot to
tendon
the toes (Figure 1 ).6
The cause of plantar fasciitis is not fully
understood. However, it is thought that
the pain is a result of injury to the plantar fascia arising from cumulative stress
overload.8 Repeated stretching of the
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plantar fascia, during physical activity
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or as a result of chronic excessive load,
leads to the development of microtears,
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which in turn causes an inflammatory
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response accompanied by tissue thick-
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ening and weakening.9.1o Exposed to ongoing i!ress, the plantar fascia is unable to
heaL. Histologically, the injured tissue exhibits degenerative changes with or without
chronic inflammatory changes and fibroblastic proliferation.9.11
The plantar fascia serves an important role in proper foot function (Table 1 ).3.5
Table 1
. Protects the bones, muscles, tendons, arteries, and nervès on the boltom of the foot
. Provides shock absorbency for the foot and leg during walking and running
during walking t
. Acts as a bowstring, supporting and raising the arch of the foot in the push-off phase
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RISK FACTORS
A variety of factors appear to increase the risk for plantar fasciitis (Table 2).6.7.12-14
Table 2
Age
. This association may be due to age-related anatomical changes, including
thinning of the fat pad in the heel and descent in the arch of the foot
Physical activity . Running, excessive walking, dancing, high-impact aerobics
Anatomical
features
Faulty footwear
. Flat foot, high-arched foot, shortened or tight Achilles tendon, excessive
pronation of the foot, reduced ankle dorsiflexion
. Shoes that fit too loosely or that have a thin sale, stiff sale, stilelto heel, or
poor arch support
Physical/medical' Diabetes, obesity, and pregnancy
conditions . Inflammatory disorders of the foot, e.g., arthritis
PROGNOSIS
The majority of cases of plantar fasciitis, 90%-95%, resolve within 12 months after
initiation of conservative interventions designed to minimize contributing factors and
enable healing.2 Only a small proportion of patients, about 5%, go on to surgery.3
However, without appropriate intervention and institution of preventive measures,
plantar fasciitis may become a chronic condition. Affected persons may find it necessary to limit their physical activities. They may also develop gait modifications that
can lead to other problems affecting the feet, knees, hips, and back.15
REFERENCES
1. Wolgin M, Cook C, Graham C, Mauldin D. Conservative treatment of plantar heel pain: long-term follow-up.
Foot Ankle. 1994;15:97-102.
2. American College of Foot and Ankle Surgeons Clinical Practice Guideline Heel Pain PaneL. The diagnosis and
treatment of heel pain. J Fool Ankle Surg. 2001 ;40:329-340.
3. Buchbinder R. Plantar fasciitis. N Engl J Med. 2004:350:2159-2166.
4. Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with
plantar fasciitis: a national study of doctors. Foot Ankle Int. 2004;25:303-310.
5. Roxas M. Piantarfasciitis: diagnosis and therapeutic considerations. Altem Med Rev. 2005;10:83-93.
6. Cullen NP, Singh D. Plantar fasciitis: a review. Br J Hasp Med (Lond). 2006;67:72-76.
2, 2007.
7. Plantarfasciitis. Available at: http://ww.mayoclinic.comlealthfplantar-fasciilis/DS00508. Accessed April
8. Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam
Physician. 2005;72:2237-2242.
9. Leach RE, Seavey MS, Salter DK. Results of surgery in athletes with plantar fasciitis. Foot Ankle. 1986;7:156-161.
10. DeMaio M, Paine R, Mangine RE, Drez D Jr. Pla~tarfasciitis. Orthopaedics. 1993;16:1153-1163.
11. Lemont H, Ammirati KM, Usen N. Piantar fasciitis: a degenerative process (fasciosis) without infiammation.
J Am Pod/air Med Assoc. 2003;93:234-237.
12. Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study.
J Bone Joint Surg Am. 2003;85A:872-877.
2, 2007.
heel pain. Available at: htlp://familydoctor.org/140.xml. Accessed April
13. Plantarfasciitis: a common cause of
14. Martin JE, Hosch JC, Goforth WP, Murf RT, Lynch DM, Odom RD. Mechanical treatment of plantar fasciitis.
JAm Podiatr Med Assoc. 2001 ;91 :55-62.
15. Plantar fasclitls. Available at: http://orthoinfo.aaos.org/facl/thueport.cfm?ThreadJD=144&topcategory=Foot.
Accessed April 15, 2007.
mation for healthcare professionals. Readers are advised to consult
Provided as a
service by
manufacturers and specialists if questions arise about specific products,
treatments, or diseases. The publisher and editors do not assum'e liability for any errors or omissions.
&ALFaNioo
This MPR Fact PackI is produced as a basic reminder of important infor-
Copyright ig 2007 Prescribing Reference, Inc.
2. DIAGNOSIS'
The diagnosis of plantar fasciitis is usually based on the clinical features, including
the elements of the patient's history and findings on physical examination.
HISTORY
Certain features relating to the onset of pain, its nature, and location are characteristic
of plantar fasciitis.1-3 Patients with plantar fasciitis typically report:
. Pain is most severe with the first steps after
get- Figure 1
ting out of bed or following a period of inactivity
. Pain diminishes with ambulation, but may
Achiles tendon
increase over the day, especially if the plan-
tar fasciitis is related to prolonged standing
. Pain is maximal in the area of the proximal
plantar fascia, just distal to the weightbearing area of the heel (Figure 1), although
it may diffuse and extend along the full length
of the plantar fascia
Inflammation of
the plantar fascia
can cause heel pain
Patients generally describe the pain as a burning or stabbing sensation that may
cause them to limp with the heel off the ground when the condition has been more
long-standing.4.5 They usually note a gradual onset, although the development of plan-
tar fasciitis may be acute.4,5
PHYSICAL EXAMINATION
The physical examination aims to localize the pain and identify factors that precipitate
or relieve it. Findings of the physical examination that corroborate the diagnosis of
plantar fasciitis include:6-8
. With palpation, the area of greatest tenderness localizes over the antero-
medial aspect of the inferior heel
. Pain is induced by direct pressure on the fascia, stair climbing, standing
on tiptoe, passive dorsiflexion of the toes
. Pain is reduced by plantar flexion of the foot
. Absence of gross abnormalities other than occasional flat or high arches
IMAGING STUDIES
Imaging studies may be performed only if the diagnosis remains equivocal or another
condition is strongly suspected.
.
Table 1
TYPES OF IMAGING STUDIES4
A plain radiograph may be ordered to rule out calcaneal stress fracture. Heel spurs (calcifications) are common in patients with plantar fasciitis and may be seen on the x-ray. Heel
spurs are not a cause of plantar fasciitis and have no diagnostic significance.
A radionucleotide bone scan may be ordered if a stress fracture is suspected, but the
plain radiograph appears normaL. In patients with plantar fasciitis, a bone scan typically
shows findings consistent with local inflammation.
Magnetic resonance imaging (MRI) is the preferred study to rule out calcaneal stress
fractures not evident on plain radiography. In plantar fasciitis, the MRI shows fascial thickening, inflammatory changes, signs of edema, and intrasubstance microtears.
,
Ultrasound in patients with plantar fasciitis also reveals an increase in plantar fascia thickness along with inflammatory changes.
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LABORATORY STUDIES
Laboratory studies are indicated only if the patient is suspected to have an underly-
ing seronegative spondyloarthropathy or other systemic disease.9
DIFFERENTIAL DIAGNOSIS
Inferior heel pain is a feature of a variety of disorders involving the plantar fascia,
bone, nerves, or soft tissues of the foot (Table 2).
Table 2
Site
Plantar fascia
Possible Diagnosis
Bone
Calcaneal stress fracture, Paget's disease, primary or metastatic tumors,
infection, bone bruise
Plantar fasciitis, rupture, other enthesopathies
Soft tissues
Fat pad atrophy, heel bruise, bursitis, tumors
Nerves
Tarsal tunnel syndrome, abductor digiti quinti nerve entrapment, sciatica
radiculopathy
Features of the pain (location, onset, diurnal variation, factors that incite or relieve it)
and associated findings may suggest an alternate diagnosis or an underlying spondyloarthropathy and indicate that additional evaluation is warranted (Table 3).10
Table 3
Feature
Excessive exercise
Possible Diagnosis
Excessive swellng, warmth
Plantar fascia rupture, infection
Increased pain with walking
Calcaneal stress fracture, nerve entrapment
Bilateral pain
Spondyloarthropathy
Positive percussion (Tinel's sign)
Nerve entrapment, tarsal tunnel syndrome
Bruising
Plantar fascia rupture
Calcaneal stress fracture, bone bruise
REFERENCES:
1. American College of Foot and Ankle Surgeons Clinical Practice Guideline Heel Pain PaneL. The diagnosis and
treatment of heel pain. J Foot Ankle Surg. 2001 ;40:329-340.
2. Cole C, Seto C, Gazewood J. Plantar fasciilis: evidence-based review of diagnosis and therapy. Am Fam
Physician. 2005;72:2237-2242.
3. Roxas M. Piantar fasciitis: diagnosis and therapeutic considerations. Altem Med Rev. 2005;10:83-93.
4. Buchbinder R. Plantar fasciitis. N Engl J Med. 2004:350:2159-2166.
2007. April
5. Plantarfasciitis. Available at: http://w.mayoclinic.com/healthfplantar-fasciitisiDS00508.2,Accssed
6. Jenkin WM. Approach to the patient with ankle & foot pain. In: Imboden JB, Heilmann DB, Stone JH, eds.
Current Rheumatology Diagnosis & Treatment. 2nd edition. The McGraw-Hil Companies, Inc. 2007.
7. Young CC, Rutherford DS, Niedfeldt MW. Treatment
of
plantarfasciilis. Am Fam Physician. 2001 ;63:467-474,477-478.
8. Pribut SM. Current approaches to the management of plantar heel pain syndrome, including the role of ,
injectable corticosteroids. JAm Podiatr Med Assoc. 2007;97:68-74.
9. Foye PM, Stitik TP. Plantar fasciitis. Available at: htlp://ww.emediclne.comlpmr/topic107.htm. Accssed April
17,2007.
10. Cuilen NP, Singh D. Piantar fasciitis: a review. Br J Hosp Med (Land). 2006;67:72-76.
This MPR Fact PackI is produced as a basic reminder of important infor-
mation for healthcare professionals. Readers are advised to consult
manufacturers and specialists if questions arise about specific products,
treatments, or diseases. The publisher and editors do not assume liability for any errors or omissions.
Copyright (§ 2007 Prescribing Reference, Inc.
Provided as a
service by
6rÕjj~
3. TREATMENT
i
Early initiation (within 6 weeks of symptom onset) of a multi
modal treatment approach
combining conservative, complementary interventions may favor a faster resolution.1
The American College of Foot and Ankle Surgeons has issued a set of expert opinion-based guidelines for management of heel pain associated with plantar fasciitis
(Table 1).2 The recommendations are stratified into three phases beginning with
patient-initiated measures and other conservative, inexpensive interventions and progressing in stepwise fashion to incorporate more costly or aggressive modalities.
Table 1
Phase
2
Strategies
Comments
Nonsteroidal anti-inflammatory drugs, padding
and strapping the foot, corticosteroid injections
(selected individuals), regular stretching of the
calf muscles, proper footwear, ice application.
prefabricated arch supports and heel cushions,
limit activities
A 6-week trial is
recommended. If
improvement occurs,
Refer patient to a foot and ankle specialist.
Evaluate response
after a 2- to 3-month
triaL. If no improvement,
advance to phase 3.
Continue initial therapy. Recommend weight
loss if appropriate. Add custom orthotic devices,
night splints, immobilization of the foot with
casting or other devices for 4 to 6 weeks.
3
continue unti complete
resolution. If not,
advance to phase 2.
Continue existing therapy. Add cast immobilization if not tried previously. Consider surgery
or extracorporeal shock wave therapy.
PHARMACOLOGIC TREATMENTS
NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)
NSAIDs are recommended to relieve pain associated with plantar fasciitis. The table
below lists some NSAIDs that are commonly used for analgesia. An agent offering a
more rapid onset of action and shorter duration (half-life) may be preferred for managing pain associated with more minor musculoskeletal injuries.3
Table 2
I
~
Generic
(trade name)
Onset of
Half-life
Fenoprofen (NalfoniI 200) 15-30 minutes
Recommended adult
dose for analgesia
action
2 hours
200 mg Q4 to 6 hours
Naproxen (NaprosyniI)
60 minutes
14 hours
250 mg QID or 500 mg BID
Celecoxib (CelebrexiI)
60 minutes
6-12 hours
400 mg initially, followed by
an additional 200 mg dose
if needed on the first day
and 200 mg BID as needed
on subse'quent days
NSAIDs are generally safe and well-toleràted when used as directed in appropriately selected patients. The individual patient's risk of GI bleeding, cardiovascular or cerebrovascuiar complications should be taken into account
when choosing an appropriate NSAID.7 Long-term or high-dose therapy with non-COX-ztselective NSAIDs are
associated with increased risk of GI bieeding. The scientific evidence to date indicates that NSAIDs with COX-2
selectivity are associated with increased risk of cardiovascular or cerebrovascular complications.'
4 l: .. ..
NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (contd)
If a physician has decided to use an NSAID for a patient with known cardiovascular
disease or risk factors for ischemic heart disease, the American Heart Association
recommends using non-COX-2 selective NSAIDs before NSAIDs with some COX-2
activity or COX-2 selective NSAIDs.7
CORTICOSTEROID INJECTIONS
Corticosteroids, administered alone or mixed with a local anesthetic, provide antiinflammatory and analgesic effects. Any benefit in treating plantar fasciitis may be
short-term as one study comparing injection with a corticosteroid plus anesthetic versus an anesthetic alone found a significant difference in patient pain ratings favoring
the combination at 1 month, but not at 3 months.8
Corticosteroid injections are uncomfortable and are associated with a number of
potential complications, including plantar fascia rupture, infection, skin pigmentation changes, peripheral nerve dysfunction, muscle damage, and atrophy of the
heel fat pad.9
PREVENTIVE STRATEGIES10
A NUMBER OF STRATEGIES CAN BE SUGGESTED TO PATIENTS TO
PREVENT A RECURRENCE OF PLANTAR FASCIITIS
. Continue stretching exercises
. Maintain a healthy weight
. Choose proper footwear
. Avoid going barefoot, especially on hard surfaces
. Change athletic shoes before they are worn out and lose their support and
cushioning functions
REFERENCES
1. Buchbinder R. Plantar Fasciitis. N Engl J Med. 2004;350:2159-2166.
2. American College of Foot and Ankle Surgeons Clinical Practice Guideline Heel Pain PaneL. The diagnosis
and treatment of heel pain. J Foot Ankle Surg. 2001 ;40:329-346.
3. Burke A, Smyth E, Fitzgerald GA. Analgesic-antipyretic agents; pharmacotherapy of gout. In: Brunton L,
Lazo J, Parker K, eds. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 11th ed. New
York: McGraw-Hili 2006. Accessed online April 2, 2006.
4. Naprosyn (package insert). Nutley, NJ: Roche Laboratories Inc.; 2007.
5. Celebrex (package insert). New York, NY: Pfizer; 2007.
6. American Society of Health-System Pharmacists. Nonsteroidal anti-infiammatory agents. In: McEvoy GK,
ed. AHFS Drug Information 2007. Bethesda, MD: American Society of Health-System Pharmacists, Inc.
Accessed online April 16, 2007. .
7. Antman EM, Bennett JS, Daugherty A, Furberg C, Roberts H, Taubert KA. Use of nonsteroidal antiinfiam-
matory drugs: an update for clinicians, a scientific statement from the American Heart Association.
2007;115:1634-1642.
Circulation.
8. Crawford F, Thomson C. Interventions for treating piantar heel pain. Cochrane Database Syst Rev.
2003;3:CD000416.
9. Crawford F. Piantar heei pain and fasciitis. Clin Evid. 2005;June(13):1533-1545.
10. Plantar fasciílis. Available at: http://ww.mayoclinic.com/health/plantar-fasciitis/DS00508. Accessed April
2,2007.
mation for healthcare professionals. Readers are advised to consult
Provided as a
service by
manufacturers and specialists if questions arise about specific produ¡;ts,
treatments, or diseases. The publisher and editors do not assume liability for any errors or omissions.
aõ¡¡¡:Õ!Jioo
This MPR Fact PackI is produced as a basic reminder of important infor-
Copyright i&2007 Prescribing Reference, Inc.
4. CASE STUDY.
PATIENT PRESENTATION
A 45-year-old female optician presents complaining of a piercing pain in her left inferior heel when she gets out of bed in the morning or up from her chair at work. She
first noticed the pain about 4 weeks ago. She reports that she joined a health club
when she turned 40 and began running on an inside track for 30 minutes twice a
week. About 3 months ago she decided to begin training for a marathon and she
started running outdoors, changed to a new type of shoe, and increased the intensity of her regimen. The patient has been taking acetaminophen to try to relieve the
pain, but it has been minimally effective and she is concerned that her running has
caused a permanently disabling injury.
PATIENT AND FAMILY HISTORY
The patient is 5'4" tall and weighs 118 pounds. She does not recall sustaining any
acute trauma to her foot prior to the onset of the pain, and her medical history is
unremarkable. Her temperature is normal, she has no other joint symptoms, and has
no family history of seronegative spondyloarthropathies. Other than the acetaminophen, the only medication she takes is a daily multivitamin tablet.
PHYSICAL EXAMINATION
Examination of the left foot reveals a normal appearance other than mild swelling around the heel on the
plantar surface. A maximal area of tenderness local-
izes over the anteromedial aspect of the calcaneus
with palpation of the bottom of the foot. There is no
pain of the posterior heeL. Passive dorsiflexion of the
toes exacerbates the pain. The patient has limited
dorsiflexion at the ankle. Her arch appears normaL.
The right foot is normal and pain-free.
DIAGNOSIS
Palpation of the medial calcaneal
tubercle usually elicits pain in patients
presenting with plantar fasciltis
The history and physical examination findings in this patient are typical of plantar
fasciitis. Plantar fasciitis most often affects persons 40-60 years 01d.1 It is common in
runners and can develop after the individual changes footwear or begins running
more intensively, especially on a hard surface. The location of the pain, onset with
weight-bearing activity, and maximal tenderness over the anteromedial aspect of the
inferior heel are also consistent with a diagnosis of plantar fasciitis.1 Limited ankle
dorsiflexion indicates Achiles tendon t,ghtness, which can predispose to plantar
fasciitis.1 The patient has no findings that strongly suggest another cause for her heel
pain. Therefore, any additional work-up with imaging studies or laboratory evaluation
does not appear to be warranted at this time.
TREATMENT OPTIONS
A conservative treatment program can help to reduce pain while enabling mobility
and healing with minimal risk of causing adverse events.
ACTIVITY LIMITATION
. The patient should stop or reduce her running, depending on the severity
of her pain. In order to maintain finess, she can switch to a non-weightbearing activity, such as bicycle riding or swimming.
l.
PATIENT-INITIATED MEASURES
. A heel pad and/or arch support for her
shoes can be purchased over-the-counter
for cushioning and to reduce strain on the
plantar fascia.
. Application of an ice pack to the affected
area for 15 to 20 minutes,
3 or 4 times a day for 10-14 days
can help relieve pain and swellng. Plantar fascia-specific stretch
. Stretching exercises, focusing on the muscles of the lower leg and the
plantar fascia, can increase flexibiliy and relieve tightness.
. Wearing shoes with good support and a low heel may be beneficiaL.
PHARMACOLOGIC TREATMENTS
. The patient did not achieve sufficient pain relief using acetaminophen. A
nonsteroidal anti-inflammatory drug (NSAID) can provide more potent pain
relief and also reduce any inflammation that is present. The patient is
given a prescription for NALFONIB 200 mg with instructions to begin taking
one capsule up to four times daily as needed for pain relief. The patient is
advised to schedule a return visit after 6 weeks.
ANALYSIS
Plantar fasciitis is a painful and potentially debilitating condition. Early recognition and
intervention seem to favor a faster recovery. Patient education is imperative. Patients
should understand the etiology of their pain and learn about home therapy that may
relieve their discomfort.
Not all patients improve with initial conservative measures. After observing the
response to initial therapy with NALFON 200, the dose and frequency should be
adjusted to suit an individual patient's needs. Daily dosage should not exceed
3200 mg.2 Persons who do not experience satisfactory improvement should consult
a podiatric physician if they had not seen one initially and should be evaluated for
additional therapeutic strategies, including corticosteroid injection, custom-made
orthotics, a night splint, or a walking cast. Surgery or extracorporeal shock-wave
therapy is generally reserved for the small minority of patients who do not respond
successfully to these other measures.
OUTCOMES
At her follow-up visit, the patient reports much improvement after 6 weeks of
NALFON 200 treatment and stretching exercises. She has also purchased appropriate
athletic shoes with a significant medial arch. During the preceding week, she found
that she could reduce the frequency of NALFON 200 administration and stil remain
comfortable. Based on her positive response, the patient is advised to discontinue
NALFON 200 and continue with the same conservative measures (a less strenuous
exercise regimen, stretching) and she will eventually be able to return to running.
REFERENCES:
1. Buchbinder R. Plantar fasciitis. N Eng/ J Med. 2004;350:2159-2166.
2006.
Inc.;
2. Nalfon (package insert). Farmingdale, NY: Pedinol Pharmacal
This MPR Fact PackI is produced as a basic reminder of important infor-
mation for healthcare professionals. Readers are advised to consult
manufacturers and specialists if questions arise about specifc products,
treatments, or diseases. The publisher and editors do not assume liability for any errors or omissions.
Copyright (§ 2007 Prescribing Reference, Inc.
Provided as a
service by
iNA-LFÕJj¿""
5.' PATIENT INFORMATION
PLANTAR FASCIITIS: A COMMON CAUSE OF HEEL PAIN
WHAT IS PLANTAR FASCIITIS?
Plantar fasciitis (PLAN-tur fas-e-I-tis) is a painful condition caused by inflammation of
the plantar fascia - the tissue along the bottom of your foot that connects your heel
bone to your toes. A pad of fat in your heel covers the plantar fascia to help absorb
the shock of walking, thus supporting the arch in your foot. Damage to the plantar fascia can be a cause of heel pain.
WHAT CAUSES THE HEEL PAIN?
As you age, the pad of fat in your heel becomes thinner and its shock-absorbing abilities weaken. The extra shock damages the plantar fascia and may cause it to swell,
tear, or bruise.
Other risk factors include:
Achiles
tendon
. Overweight and obesity
. Diabetes
. Physical activity overload (e.g.,
spending most of the day on
your feet, long-distance runners,
ballet dancing, aerobics)
. Being flat-footed or having a
high arch
. Improper shoes (thin-soled,
loose, or lacking arch support)
HOW DO I KNOW IF I HAVE PLANTAR FASCIITIS?
Do your first steps out of bed in the morning cause severe pain in your heel? Does
your heel hurt after jogging or playing tennis? If you've answered yes, you may have
plantar fasciitis.
Some signs to watch out for include;
. Sharp pain in the inside part of the bottom of your heel, which may feel
like a knife or pin sticking into the bottom of the foot
. Heel pain that worsens with the first steps of the day, when climbing stairs,
or when standing on tiptoe
. Heel pain after long periods of standing or after getting up from a seated
position ·
. Heel pain after, but not usually during, exercise
. Mild swellng in your heel
However, heel pain can result from many different causes. If the pain persists despite
self-care measures, such as stretching or changing your activities, seek the advice
of your foot doctor (podiatrist). If you have diabetes or another condition that may
cause poor circulation, see your doctor for an early evaluation.
ARE THERE COMPLICATIONS ASSOCIATED WITH PLANTAR FASCIITIS?
Ignoring plantar fasciitis may result in a chronic condition that hampers your regular
activities. You may also develop foot, knee, hip, or back problems because of the way
plantar fasciitis changes your walking motion.
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HOW IS PLANTAR FASCIITIS TREATED?
Initial treatment aims to:
. Minimize stress on the plantar fascia with rest and shoe inserts (heel
pads, arch supports)
. Reduce pain and any associated inflammation with application of ice and
use of oral nonsteroidal anti-inflammatory medications (NSAIDs)
. Stretch the Achiles tendon, calf muscles, and plantar fascia with simple
exercises
MY DOCTOR PRESCRIBED AN ANTI-INFLAMMATORY - HOW SHOULD I
TAKE IT?
A number of different anti-inflammatory medications are available and they vary in
their recommended dose, time to onset of action, and duration. Be sure to take your
medication as prescribed by your doctor to relieve the pain associated with plantar
fasciitis. Take your medication with a full glass of water. You may take it with food,
milk, or antacids to try and prevent an upset stomach. Ask your doctor or pharmacist
before taking other drugs or over-the-counter products. Avoid drinking alcohoL.
HOW SOON SHOULD I SEE IMPROVEMENT?
Most people respond to treatment within 6 to 8 weeks. If you have not improved,
other strategies may be added, including taping of the foot, corticosteroid injections,
a walking cast, or a night splint. Surgery may be considered for a small proportion of
patients, but only after there is no response with other measures.
IS THERE ANYTHING I CAN DO TO PREVENT THE HEEL PAIN FROM
RETURNING?
Yes, there are simple steps you can take now to prevent painful steps later:
. Maintain a healthy weight
. Select supportive shoes
. Don't wear worn-out athletic shoes
. Start sports activities slowly
. Wake up with a stretch - Before you get out of bed in the morning, stretch
your calf muscles, arch, and Achilles tendon by reaching for your toes and
gently flexing your foot.
ONLINE RESOURCES
American Podiatric Medical Association
Medline Plus
ww.apma.org
http://www.nlm.nih.gov/medlineplus
Health A to Z
Pedinol Pharmacal, Inc
www.pedinol.com
www.nalfon200.com
ww.healthatoz.com
MayoClinic.com
http://ww.mayoclinic.com
Provided as a resource for patients by Pedinol Pharmacal, Inc.
Provided as a
service by
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