ARTICLE ON PLASTAR FASCITIS OR FOOT AND HEEL PAINS

BY SUNNDEEP CHOPRA:

Plantar fasciitis (medical condition primarily responsible for causing heel and arch pains) is the most common or widespread cause of foot pains or aches in adults between the ages of 40-60. The same has also been frequently spotted amongst the younger generation namely those who are either professionally involved or then making a living from such diverse professions such as: running, aerobic exercise routines and dancing, and ballet dancing. The pain more often than not originates or makes it’s presence felt either at or then in close proximity to the site of the conjunction of the plantar fascia with/to the media tuberosity of the calcaneus.

The plantar fascia is a thick fibrous band that extends distally (remote; farthest from any point of reference) ,further sub-dividing into five strips that insert or then fit themselves into each metatarsal head (four fingers and thumb of the foot). The primary or then sole function of the same is to tighten and elevate the longitudinal arch as well as to invert the hind or rear foot during the push-off or arising from a seated position phase of the gait.

Repeated instances of stress or then loads being exerted on the plantar fascia during such everyday activities such as walking, running, climbing and so on over a prolonged period of time or a number of years results in micro traumas or then minor Injuries to the plantar fascia thereby causing or resulting in inflammation and/or pain. The patient commonly complains of pain manifesting itself in the sole of the heel and the same being relieved or alleviated when the load is taken off the affected part.

The initiation of a clinical examination would illuminate the fact that there will be resulting tenderness in and around/over the medial side of the calcaneum. The same condition is characterized or then recognized by pain at the insertion of the planter fascia and also commonly seen in gout and other inflammatory conditions. Another characteristic or distinguishing feature of this kind of pain is that it is normally at it’s worst early in the mornings and shows signs of abating as the day wears on.

TREATMENT: Conservative or then age old methods of treatment include the ingestion of non steroidal anti inflammatory drugs, local steroids and making the desired changes in the style and shapes of footwear worn by the patient. Surgical release or then relieving the plantar fascia from the burdens being extended on it through the help of or then taking recourse to a proximal medial longitudinal arch incision is actively considered nay contemplated if the conservative forms of treatment fail to provide the patient with the desired relief.

Other/additional forms or methods of treatment could include the inclusion of shoe inserts/heel cups. The resultant rate of success or failure with each modality or method is differing or variable, but as the condition has been found to self limiting and containing over a 18 month long period, one of the additional methods of treatment taken recourse to could end up relieving the patient of his misery.

Initial or then early treatment always includes the use of ice packs, or other ice treatments, keeping the affected surface warm and exposing it to additional sources of heat and stretching of the affected muscles, tendons. Stretching exercises or techniques of the plantar fascia and calf muscles are commonplace and most commonly employed and more often than not prove to be a blessing in disguise for the affected patient. Orthotics or then orthopaedic aids such as cushions or insoles, caps and so on provide the much needed medial arch support and thereby go along way in relieving the affected patient of his aches and pains.

A miniscule number of patients may also benefit from strapping up or taping up the affected area while others repose their confidence in the good old night splint which enables the patient to keep his ankle in a neutral position throughout the night or then for as long as the same is worn. Short term or then limited period ingestion of non steroidal ant inflammatory drugs can be actively considered as a course of treatment in cases where the benefits far outweigh the demerits or resultant side effects. Local glucocorticoid injections to the affected area are also widely recognized as the most efficacious or effective form of treatment but also carry the resultant threat or risk of a rupture of the plantar fascia.

Plantar fasciotomy (minimally invasive surgical intervention for plantar fasciitis) is normally the last course of treatment and almost exclusively reserved for those patients who fail to show any signs of either recovery or improvement even after 6-12 months of intensive treatment.