None — Plantar Fasciitis
Fascia is a strong band of tissue that binds other tissue/structures together. In the foot, the plantar fascia is a long, thin ligament that runs along the sole and connects the heel to the front of the foot. The structure supports the foot's arch and acts as a shock absorber for the bottom of the foot.
Sometimes excessive pressure or stress on the foot can cause tiny tears or damage to the plantar fascia. This can cause plantar fasciitis, characterized by inflammation, pain and stiffness. The pain, felt in the heel, is described as sharp and stabbing. It's most pronounced when taking the first steps out of bed in the morning or after a long rest. Generally, the pain subsides after walking for a while.
According to the American Academy of Orthopaedic Surgeons (AAOS), about 2 million Americans are treated for plantar fasciitis annually. Obesity, having a very high arch, repetitive stress injury (like from running), tight calf muscles and new or sudden increase in activity can increase the risk for developing the condition. Some patients also develop a heel spur from chronic pulling on the plantar fascia.
Treating Plantar Fasciitis
Plantar fasciitis can be acute (sudden onset) or chronic (long-lasting). For acute symptoms, doctors may recommend rest (including staying away from activities that cause pain), ice, nonsteroidal anti-inflammatory medication, cortisone injections, orthotics (shoe inserts), thick-soled, padded shoes and night splints.
Exercise is also important for treating plantar fasciitis. The AAOS recommends two stretching activities – the calf stretch (performed while standing and leaning against a wall) and the plantar fascia stretch (performed while sitting).
Patients with severe symptoms, and those who don't respond to traditional therapy, may be candidates for surgery. One procedure is a gastrocnemius recession, or surgical lengthening of the calf muscles. It's usually only done after a patient has tried calf stretches for at least a year. In a plantar fascia release, the fascia is partially cut to release the tension and stress. If a bone spur is present, it may be surgically removed as well.
EPAT® for Plantar Fasciitis
Another treatment for plantar fasciitis is shockwave therapy, or Extracorporeal Pulse Activation Treatment (EPAT®). EPAT delivers pulses of acoustic (sound) waves to the site of inflammation. The wave pressure causes microtrauma to the target site, improving circulation and initiating a healing response. It can also break up fibrotic or calcified tissue.
To perform the treatment, a special gel is applied to the surface of the skin on the bottom of the foot (around the heel). The EPAT applicator is then placed on the skin and, as the sound waves are emitted, moved in a circular direction.
The treatment takes only about 15 minutes. Gabriel Maislos, D.P.M., Podiatric Surgeon with Houston Foot and Ankle Care in Houston, TX, says it's a virtually pain-free procedure and patients are able to walk out of the office after it's done. Typically, a total of three once-a-week treatments are needed. It takes about 12 weeks to reach maximum benefit. Stretching exercises are also recommended and some patients require orthotics.
Maislos says EPAT is not generally covered by health insurance. Each treatment costs about $200, so a series of three treatments would be about $600. Recent research shows shockwave therapy is best for patients with chronic plantar fasciitis. Patients with acute symptoms generally fare better with stretching exercises as a first line of treatment.
For information about EPAT®, click here.
For general information about plantar fasciitis:
American Academy of Orthopaedic Surgeons American Orthopaedic Foot and Ankle Society