SPORTS MEDICINE

Dr. Steve Badolato

Plantar fasciitis (PF) is a painful inflammation of the bottom of the heel of the foot.

There are many causes of plantar fasciitis including:

• Weight gain,
• Excessive standing and walking ,
• Stair climbing,
• Wearing high heels,
• Runners who increase mileage or frequency of workouts,
• Biomechanical foot conditions such as flat footed or high arches,
• Pregnancy as a result of weight gain,
• Improper shoes with poor arch support,
• Arthritis of the foot.

These and many other causes of PF can cause the tough tissue on the bottom of the foot, which is tendon-like and covered by fascia, to become shorter.   Pain occurs when this shortened fascia is stretched.  This classically occurs in the morning when you first wake up and walk barefoot. These first few steps can cause severe heel pain, which typically improves as you continue to walk.

PLANTAR FASCIITIS was formerly called “a dog’s heel” in the United Kingdom. It is sometimes known as “flip-flop disease” among US podiatrists. The condition often results in a heel spur on the calcaneus, in which case it is the underlying condition, and not the spur itself, which produces the pain.

• Sharp pain in the inside part of the bottom of the heel bone (calcaneous bone),
• Heel pain after exercise,
• Pain after standing a long time or getting up from a seated position,
• Commonly heel pain first thing in the morning with your first few steps.

Plantar fasciitis usually occurs gradually overtime with increasing pain as the condition worsens. For example, an individual who just started a jogging exercise routine may experience some heel discomfort upon awaking in the morning. After increasing the amount of running distance and/or frequency he or she may then begin to experience a knife-like sensation in the heel in the morning, frequently throughout the day, and at the beginning and end of their runs.

How is PF Diagnosed?
Typically the diagnosis is easily made based on the patient's history and physical findings.  A history of heel pain with weight bearing, especially upon awakening, tenderness at the medial (inside) aspect of the bottom of the heel bone, and pain elicited by stretching the bottom of the foot, are typical findings of this condition.

Commonly, a foot X-ray is performed which may show a bone spur of the bottom of the heel (calcaneous) bone which projects forward.  In the past, and still on occasion now, these bone spurs may be blamed for the heel pain and unnecessarily operated on to correct the problem.  The symptoms are actually the result of inflammation of the tissue attached to the spur and the muscles fascia of the foot, not from the bone spur itself.  Therefore, surgery to remove these bone spurs should rarely if ever be performed.

How is PF treated?

• Anti-inflammatory medication as directed by your physician
• Proper shoes with attention to good arch supports and heel cushions
• Stretching and icing the bottom of foot first thing in morning, which is best accomplished with a frozen bottle of water, placing your foot on it and rolling it on the ground
• Night splints keep the foot and ankle in a neutral position at night allowing for a constant stretch of the fascia while sleeping
• Physical therapy is sometimes required with the goal of stretching the plantar fascia and strengthening the muscles of the lower leg to support the heel
• Injection of cortisone into the inflamed tissue of the heel is sometimes necessary to treat severe inflammation
• Very rarely is surgery necessary.

PF may take a couple of weeks, up to months to treat, and resolution depends on the duration and severity of symptoms prior to seeking medical consultation.

How is PF prevented?
The best way to prevent PF is to maintain a healthy weight, and wear proper shoes with arch supports and heel cushions if needed. Avoid repeated pounding to the heel if PF symptoms are present.  Thorough stretching, and a focus on maintaining flexibility and strength of the muscles of the foot and ankle are critical to preventing plantar fascia shortening. Prompt treatment by a physician can prevent long debilitation from PF and help to ensure a speedy return to pain-free activity and exercise.

A Florida native, Dr. Badolato received his medical degree from the University of South Florida School of Medicine and did his residency training at St. Vincents' Medical Center in Jacksonville. Dr. Badolato is Board Certified and has fellowship training in sports Medicine with a specialization in non-operative musculaskeletal medicine. Formerly a team physicians at Ohio State University, he was also the medical director for the world-renowned IMG Bollettieri Sports Academy in Bradenton, Florida. You can reach Dr. Badolato at 321-253-2169 or log on to Premierurgentcare.com

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