Plantar fasciitis is the term commonly used to refer to heel and arch pain traced to an inflammation on the bottom of the foot. More specifically, plantar fasciitis is an inflammation of the connective tissue, called plantar fascia, that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Overpronation is the most common cause of plantar fasciitis. As the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes inflammation.
Also known as heel spur syndrome, the condition is often successfully treated with conservative measures, such as the use of anti-inflammatory medications, ice packs, stretching exercises, orthotic devices, and physical therapy. Note: Please consult your physician before taking any medications. In persistent cases, Extracorporeal Shock Wave Treatment (ESWT) may be used to treat the heel pain.
Extracorporeal Shock Wave Therapy (ESWT) is used to treat chronic heel pain (plantar fasciitis). "Extracorporeal" means "outside of the body." During this noninvasive procedure, sonic waves are directed at the area of pain using a device similar to that currently used in nonsurgical treatment of kidney stones.
Extracorporeal Shock Wave Therapy is prescribed for patients who have experienced plantar fasciitis for an extended period of time -- six months or more -- and have not benefited from other conservative treatments. The brief procedure lasts about 30 minutes and is performed under local anesthesia and/or "twilight" anesthesia. Strong sound waves are directed at and penetrate the heel area to stimulate a healing response by the body. ESWT is performed on an outpatient basis. Although there are no bandages, someone will need to drive the patient home.
People who are not candidates for ESWT include pregnant women and individuals with neurological foot disease, vascular foot disease, pacemakers, or people taking medications that interfere with blood clotting (such as Coumadin).
This therapy is a safe and effective alternative treatment for heel pain and only requires a short recovery time. Clinical studies show a 70 percent success rate for treatment of plantar fasciitis using Extracorporeal Shock Wave Therapy.
What should you look for to make sure your feet are healthy? Here are some general guidelines:
- Balance. A good test for balance involves standing on one foot, with your arms out to the side and your eyes closed. If you are less than 30 years old, you should be able to balance for 15 seconds, 30 to 40 years old for 12 seconds, 40 to 50 years old for 10 seconds and over 50 years old for seven seconds. This can be improved with exercises.
- Circulation. Look at the color of your toes. Do they look like a normal nail color or are they leaning towards red, white, purple, or blue? Press down on the nail of your big toe until the color blanches. Now let go and allow the blood flow to return to your toe. The return of normal color should take 2 to 5 seconds in a person with average circulation.
- Flexibility. How flexible are your toes? Try to pick up a marble or a small dish towel with your toes. To test your ankle flexibility, hang your heel off of a stair. Now let the heel go below the level of the stair. If this causes pain, stop the test. If your heel goes below the level of the stair without causing strain in your calf, that is a good sign. If there is some strain, this can be improved with flexibility exercises.
- Pain. A healthy foot does not produce any pain.
- Sensation. Take a pencil eraser and lightly run it on the top, bottom, and both sides of your feet. The sensation should feel equal in all quadrants. It may tickle on the bottom of the feet. That is normal.
- Skin. Check your skin for calluses, blisters, or areas of irritation. Stand next to your shoes. Are they shaped like your feet or are they causing areas of constriction that may result in irritation? Put your hand inside your shoe. Are there seams, tacks, or rough places in the shoe that correspond to calluses or blisters on your feet?