Regional
(2008-03-10)
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BRUSH, CO
(KUNC) -
Aching Feet and Flying Buttrests
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by Marc Ringel, M.D.
KUNC March 10, 2008
I'll bet that lots of you have had plantar fasciitis. I'd like to help you understand what it is.
For starters, here's an analysis of the words in the name. Plantar is an adjective that derives from planta the Latin noun that means sole of the foot. Fasciitis comes from the Latin word fascia for band, plus the suffix -itis, meaning inflammation of. So, plantar fasciitis is inflammation of a band that runs along the sole of the foot.
The human foot is constructed in the form of an arch that runs front-to-back, from the heel to the ball. The arch is built of bones that are held together by elastic ligaments.
If pressure is applied to the peak of an arch, the transmitted forces will tend to spread the bases. That's why Gothic architects employed flying buttresses, structures built at right angles to the external walls of large cathedrals to keep the them from buckling outward under the downward force transmitted from the weighty roof. (These structures are sometimes improperly referred to flying buttrests because of their presumed function as places where angels could rest their weary bones.)
You can also restrain the lateral forces on an arch by tying its bases together. That's what the plantar fascia does. It runs between the bases of the foot arch, anchored on one end at the heel bone and on the other at the bones that underlie the ball of the foot. This fibrous band is somewhat stretchy. When the weight of the body applies pressure from above the arch spreads and stretches the plantar fascia. That's the main shock absorber of the foot.
Apply too much stress on the plantar fascia too often and you can get fasciitis, which manifests as pain where the band is anchored into the heel bone. If the inflammation goes on for too long, the fascia may calcify, producing a shadow on foot x-ray, called a heel spur.
Early in the course of the problem the treatment is pretty simple. As an overuse syndrome the first step, of course, is to reduce the stress. Patients are encouraged to stay off their feet and to lose weight.
Shoe inserts, in the form of arch supports and/or heel cups (soft appliances that cushion and cradle the heel end of the plantar fascia), can help. So can gentle Achilles stretching of the sort that runners do, leaning toward a wall with one foot back, heel on the floor.
When conservative measures don't work, the doctor may try injecting the sore end of the plantar fascia with a dose of anti-inflammatory steroid. A new therapy, in which bright lights are applied directly to the skin of the sole, shows some promise. Nobody knows quite how this treatment works.
That's about as much as I know how to do. If my patient is still suffering, I refer her to a podiatrist who may build a custom arch support, tape the foot to reduce stress on the fascia or, in extreme cases, surgically remove some of the inflamed tissue.
Here's how to tell if you have plantar fasciitis. You have pain and tenderness toward the heel end of the sole of your foot. We don't know why, but the pain does tend to be worst when you first get up in the morning.
If you suspect you have plantar fasciitis, get it taken care of right away. The earlier it's addressed, the easier it is to fix. Remember even angels appreciate having a flying buttrest to take the load off.
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