Plantar Fasciitis : Follow-Up
Follow-Up
Further Inpatient Care:
- Inpatient care is usually not necessary.
In/Out Patient Meds:
- NSAIDs and ice have been used for symptomatic treatment of plantar fasciitis, although no studies have been done to determine efficacy.
- Corticosteroid injections have been shown to improve symptoms at 1 month but not at 6 months. These injections have been shown to be associated with plantar fascia rupture and fat pad atrophy. These injections should be used conservatively and should probably be left to podiatrists for use, as NSAIDs would be proper first-line management in the ED.
- Extracorporeal shock-wave therapy (ESWT) has been used to treat plantar fasciitis. Although its efficacy is not definitively proven, it has been approved by the Food and Drug Administration for the treatment of plantar fasciitis and tennis elbow. The therapy bombards the tissue with high-pressure sound waves with its mechanism of action being to (1) stimulate blood flow for a beneficial immune response, (2) reinjure tissue to stimulate healing, and (3) shut down the neuronal pain pathways through the pulses hitting the affected nerves.
- Surgery for plantar release (open and endoscopic) has been used in extreme cases that are unresponsive to conservative treatments.
Deterrence/Prevention:
- The patient should decrease weightbearing activities (especially running), if possible.
- Shoes inserts (both custom-made orthotics and prefabricated insoles) have been used in conjunction with stretching. No definitive evidence exists that one type of insole is better than another.
- Night splints made to hold the ankle in dorsiflexion and the toe in extension have been used. One Cochrane review found limited evidence in the use of night splints in patients with pain lasting 6 months.
- Stretching is commonly used, but the exact benefits are unknown. One randomized control trial showed that there was greater improvement in pain with plantar fascia stretching as opposed to Achilles tendon stretching.
- Casts or splints holding the ankle in neutral to slight dorsiflexion have been investigated, although efficacy is controversial.
Complications:
- Risk of plantar fascia rupture and fat pad atrophy exists with steroid injections.
Prognosis:
- Eighty percent of cases resolve spontaneously by 12 months. Five percent of patients end up undergoing surgery for plantar fascia release because all conservative measures have failed.
Patient Education:
- Wear shoes with adequate arch support and cushioned heels. Discard old running shoes and wear new ones.
- Avoid long periods of standing.
- Lose weight.
- Stretch the plantar fascia and Achilles tendon, especially before participating in exercise.
- Use NSAIDs for pain.
- Do not exercise on hard surfaces.
- Avoid walking barefooted on hard surfaces.
- Avoid high-impact sports, such as aerobics and volleyball, which require a lot of jumping.
Miscellaneous
Medical/Legal Pitfalls:
- Misdiagnosis of other causes of heel pain, such as malignancy or infection, can be a cause of litigation.
- Plantar fascia rupture secondary to corticosteroid injection can cause chronic pain, which can motivate legal action.
Pictures
| Caption: Picture 1. Plantar fasciitis. Low-dye taping method. The following sketches illustrate the steps involved in low-dye taping, a technique that provides support for the planter fascia and helps reduce excessive pronation. | |
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| Caption: Picture 2. Plantar fasciitis. Example of an arch support with a cushioned heel. These are available in three-quarter or full lengths to fit in the shoe. | |
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| Caption: Picture 3. Plantar fasciitis. Example of a night splint. These are intended to prevent shortening of the Achilles tendon and plantar fascia at night. | |
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Bibliography
- Atkins D, Crawford F, Edwards J, Lambert M: A systematic review of treatments for the painful heel. Rheumatology (Oxford) 1999 Oct; 38(10): 968-73[Medline].
- Buchbinder R: Clinical practice. Plantar fasciitis. N Engl J Med 2004 May 20; 350(21): 2159-66[Medline].
- Cole C, Seto C, Gazewood J: Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician 2005 Dec 1; 72(11): 2237-42[Medline].
- Crawford F, Thomson C: Interventions for treating plantar heel pain. Cochrane Database Syst Rev 2003; CD000416[Medline].
- DiGiovanni BF, Nawoczenski DA, Lintal ME, et al: Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am 2003 Jul; 85-A(7): 1270-7[Medline].
- Hogan KA, Webb D, Shereff M: Endoscopic plantar fascia release. Foot Ankle Int 2004 Dec; 25(12): 875-81[Medline].
- Roxas M: Plantar fasciitis: diagnosis and therapeutic considerations. Altern Med Rev 2005 Jun; 10(2): 83-93[Medline].
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Synonyms And Related Keywords
plantar fasciitis, heel pain, jogger's heel, tennis heel, Policman's heel, bone spur, heel pain, pain on bottom of heel, exostosis, flat foot, highly-arched foot, excessively pronated foot, gait alteration, obesity, tight Achilles tendon, policeman's heel, pes planus, pes cavus
