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The Dreaded Plantar Fasciitis By Dr. Michael M. Cohen, DPM, FACFAS
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he plantar fascia is a they may actually mask telltale symptoms. Patients PRP (Platelet Rich Plasma) tight band of connec- with stomach ulcers or blood thinners should avoid PRP or platelet rich plasma has been used tive tissue which links nonsteroidal anti-inflammatories. Occasionally to manage dermatologic and oral maxillofacial the ball of the foot to the in severe cases, a physician may elect to inject a conditions since 1950. More recently interest has base of the heel. You can steroid into the heel to reduce inflammation and grown exponentially in the use of this technique visualize the structure in your improve symptoms. This is done with the caveat for orthopedic applications such as plantar fasciitis. arch by holding the foot 90° that chronic use of these agents may predispose Media attention to this treatment modality has been to the leg and bending the great toe backwards. the plantar fascia to rupture. Over-the-counter reported due to its popularity with professional Imagine this structure as being a cable which orthotics are usually very beneficial, but more athletes. With this technique, a patient’s own maintains the integrity of the arch. Plantar fasciitis complex foot type may require a molded orthotic. blood is separated using a technique referred is an inflammation of this connective tissue usually Yet most agree that the crux of treatment and to as plasmapheresis into white blood cells, red located at its weakest link, at the bottom of the prevention of plantar fasciitis requires appropriate, blood cells, plasma and platelets. The technique heel. Debate continues regarding its exact cause, focused and consistent static stretching exercises extracts healing proteins such as platelet derived but some researchers feel that it is a result of aimed at relaxing the calf muscle. This enhances growth factor, vascular endothelial cell growth factor, some type of overuse mechanism such as a repair of damaged collagen in the plantar fascia. and basic fibroblasts which can be detected in sudden change in shoe gear, ambulating barefoot There are several adjunctive devices on the market high concentrations. Consequently, investigators especially on hard surfaces, females who are which are quite effective at accomplishing this, theorized that PRP may be beneficial in conditions postpartum or runners increasing their training including the Prostretch wheel, various types of that require tissue healing. PRP is injected into the intensity too rapidly. Several studies have pointed nightsplints or adjustable dorsiflexion stockings plantar fascia guided with ultrasound or fluoroscopy. at a common thread between patients who have such as the Strasburg sock. Vigorous stretching A series of three injections scheduled weekly are this problem, and that is a shortened or tight calf is to be avoided in the acutely painful heel. In usually used. muscle. Plantar Fasciitis may be particularly notable these instances, immobilization or at best very light in females who wear or work in high heel shoes. passive stretching and range of motion techniques EPF (Endoscopic Plantar Fascial Release) Regrettably, a very small percentage of patients After several hours of standing in high heels, the are employed while sports activity is discontinwith plantar fasciitis will not respond to six to eight hamstring and calf muscles become acclimated ued temporarily. Beware; a small percentage of to a shortened position. Upon returning home heel pain unresponsive to traditional treatment months of conservative treatment. For these the shoes are often traded for a flat heel at which may be a result of misdiagnosed stress fractures, patients, some may opt for a more definitive form time the person may walk, exercise or run without inflammatory arthritis, nerve problems or even of treatment which uses a procedure referred to as a good warm-up or stretch. Symptoms will often partial or complete tears of the plantar fascia. A an endoscopic plantar fascial release (EPF). In this present as a dull aching pain in the arch and in later proper history and MRI study is indicated to fully procedure approximately 33 to 50% of the plantar stages progress to acute pain in the heel. This is evaluate these recalcitrant cases. Other treatment fascia is released from its connection to the heel the point at which the plantar fascia attaches to adjuncts include wearing supportive shoes with using microincisions. They are allowed to walk the bone. Pain may become debilitating and not adequate heel cushioning. I prefer the Hoka One/ in a healing boot for four weeks and transition to only experienced during walking or running but One, or one of the New Balance Fresh Foam series a running shoe to allow the plantar fascia to heal especially during the first few steps out of bed with a stiffer midsole. One should avoid walking properly. The plantar fascia serves an important in the morning or when rising out of a chair. It is barefoot on hard surfaces such as tile or hardwood function during walking and running and its release often likened to a nail being driven through the floors. The OOFOS, Hoka or Fit Flop sandals work may result in temporary residual side effects which center of the heel forcing patients to walk with a particularly well and should be used at home when are eventually overcome. For this reason, surgery is to be considered as a last resort but in most limp or even resort to using a cane. Plantar fasciitis not wearing shoes. cases, if performed correctly may provide gratifying is a very common condition seen in both athletes and sedentary people. Studies show that rapid ESWT (Extracorporeal Shock Wave Therapy) results with reported satisfaction rates of 80- 90% Patients who are unresponsive to the initial aggressive treatment in the initial stages yields the best outcome. Unfortunately, studies also treatment of plantar fasciitis may be candidates Michael M Cohen, DPM, is a Board-Certified Foot show that a successful response to conservative for extracorporeal shock wave therapy (ESWT). and Ankle Surgeon and Diplomate of the Amertreatment diminishes after a period of 6-8 months. ESWT or lithotripsy was initially used to fracture ican Board of Foot and Ankle Surgery. He is a painful kidney stones which allow them to pass Fellow of the American Board of Foot and Ankle Initial Treatment through the ureter. Within the past several years Surgeons and Board Certified and Diplomat of Unfortunately, there is no quick solution to this ESWT has been implemented in several orthopedic the American Board of Podiatric Medicine. He problem, and overcoming plantar fasciitis requires conditions such as chronic plantar fasciitis with very practices with the Foot, Ankle and Leg Specialists some homework. The initial phase of treatment positive results. Literature suggests that it may be of South Florida specializing in lower leg injuries revolves around eliminating the symptoms. Athletes an effective nonsurgical modality for the treatment and reconstructive surgery of the foot and anmay apply heat prior to exercising then switching to of patients with recalcitrant chronic plantar fasciitis. kle. The practice includes Carlo Messina DPM, Al ice massage after the activity. If pain is particularly ESWT focuses controlled shock waves at the DeSimone MD, Alexander Bertot MD, David Sheacute then impact-related exercises such as running area of maximal tenderness. It is speculated that nassa MD, Franz Jones DO, John Goodner DPM or jumping should be discontinued for a few weeks. shockwaves may induce an inflammatory mediated and Warren Windram DPM. The South Florida At times the foot is immobilized to reduce the healing response. ESWT allows immediate return to Institute of Sports Medicine in Weston is located inflammation until pain can be controlled. I have activity with the exception of running and jumping at 1600 Town Center Blvd., Suite C, (954) 389found that the stairmaster may aggravate the sports for a few weeks. Generally, 4-5 weekly 5900 and in Pembroke Pines at 17842 NW 2nd condition as well. Nonsteroidal anti-inflammatories sessions are required. Street, (954) 430-9901. Our practice website is such Alleve, or Motrin can be used initially but www.southfloridasportsmedicine.org chronic use of these agents is to be avoided as
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30 / Our City Davie / February 2022 / OurCityMedia.com
