martes, 8 de enero de 2013

Plantar fasciitis

Last reviewed: March 1, 2012.

Plantar fasciitis is inflammation of the thick tissue on the bottom of the foot. This tissue is called the plantar fascia. It connects the heel bone to the toes and creates the arch of the foot.

Causes, incidence, and risk factors

Plantar fasciitis occurs when the thick band of tissue on the bottom of the foot is overstretched or overused. This can be painful and make walking more difficult.

You are more likely to get plantar fasciitis if you have:

Foot arch problems (both flat feet and high arches)
Long-distance running, especially running downhill or on uneven surfaces
Sudden weight gain or obesity
Tight Achilles tendon (the tendon connecting the calf muscles to the heel)
Shoes with poor arch support or soft soles

Plantar fasciitis is seen in both men and women. However, it most often affects active men ages 40 - 70. It is one of the most common orthopedic complaints relating to the foot.

Plantar fasciitis is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On x-ray, heel spurs are seen in people with and without plantar fasciitis.

Symptoms

The most common complaint is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn.

The pain is usually worse:

In the morning when you take your first steps
After standing or sitting for a while
When climbing stairs
After intense activity

The pain may develop slowly over time, or suddenly after intense activity.

Signs and tests

The health care provider will perform a physical exam. This may show:

Tenderness on the bottom of your foot
Flat feet or high arches
Mild foot swelling or redness
Stiffness or tightness of the arch in the bottom of your foot.

X-rays may be taken to rule out other problems.

Treatment

Your health care provider will usually first recommend:

Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation
Heel and foot stretching exercises
Night splints to wear while sleeping to stretch the foot
Resting as much as possible for at least a week
Wearing shoes with good support and cushions

Other steps to relieve pain include:

Apply ice to the painful area. Do this at least twice a day for 10 - 15 minutes, more often in the first couple of days.
Try wearing a heel cup, felt pads in the heel area, or shoe inserts.
Use night splints to stretch the injured fascia and allow it to heal.

If these treatments do not work, your health care provider may recommend:

Wearing a boot cast, which looks like a ski boot, for 3-6 weeks. It can be removed for bathing.
Custom-made shoe inserts (orthotics)
Steroid shots or injections into the heel

Sometimes, foot surgery is needed.

Expectations (prognosis)

Nonsurgical treatments almost always improve the pain. Treatment can last from several months to 2 years before symptoms get better. Most patients feel better in 9 months. Some people need surgery to relieve the pain.

Complications

Pain may continue despite treatment. Some people may need surgery. Surgery has its own risks. Talk to your doctor about the risks of surgery.

Calling your health care provider

Contact your health care provider if you have symptoms of plantar fasciitis.

Prevention

Making sure your ankle, Achilles tendon, and calf muscles are flexible can help prevent plantar fasciitis.

References

Wapner KL, Parekh SG. Heel pain. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine.3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:section F.
Abu-Laban RV, Ho K. Ankle and foot. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 55.
Silverstein JA, Moeller JL, Hutchinson MR.Common issues in orthopedics. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 30.

: Review Date: 3/1/2012.

Reviewed by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.