Treatment of plantar fasciitis on the sole of the foot

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Treatment of plantar fasciitis in our clinic

Our clinic has been successfully treating plantar fasciitis with a holistic approach for many years. Plantar fasciitis manifests itself as pain in the lower area of the heel. Initially, the pain syndrome may vary locally, but over time it becomes concentrated on the medial surface of the calcaneal tuberosity. To relieve the pain, the affected person tries to relax the foot by standing on the outer edge and limping. The pain subsides after a few minutes of walking, but increases again after a period of rest.

When treating plantar fasciitis, we use both classic conservative approaches and new treatment methods. Therapy for plantar fasciitis includes plantar fascia relief and rest, use of NSAIDs, corticosteroid hormone injections, physical therapy, and massage. However, conservative treatment for plantar fasciitis is not always effective.

If conservative treatment is ineffective, resort to surgery. A fasciotomy is performed - the plantar fascia is cut away from the heel bone where it attaches.

Heel surgery is associated with complications and requires a long rehabilitation period. The medical community disagrees about glucocorticoid hormones.

The clinic has an impressive arsenal of rehabilitation methods for the treatment and management of acute and chronic pain: various physiotherapeutic methods, therapeutic massage, manual techniques and physical therapy, methods of regenerative medicine, various types of blockages, the dry needling method, medicinal botulinum and Pharmacotherapy is used.

Recently, we have successfully used shock wave therapy as one of the most effective methods to treat plantar fasciitis.

Treatment of plantar fasciitis with shock wave therapy

Our clinic has successfully used focused and radial shock wave therapy to treat plantar fasciitis. Numerous current scientific publications and our practice for plantar fasciitis and heel spurs have shown that UWT is an excellent treatment method compared to conservative methods.

A patient who comes to our clinic for the first time has an initial appointment with an orthopedic traumatologist. The diagnosis is made based on the symptoms and the clinical picture of the disease. To confirm the diagnosis, an ultrasound and MRI examination of the feet is carried out: a thickening of the fascia in the area of the heel bone of more than 4 mm and its heterogeneous structure are detected. A series of UHT treatments will be prescribed, usually 6 to 10 treatments at 4 to 7 day intervals. The treatment intervals are individual and can be shortened if no side effects occur and the treatment is well tolerated. The treatment lasts 15-30 minutes (or longer in individual cases).

Medical history

One woman associated pain with her work. About 5 years ago she took a job as a saleswoman and spent almost the entire working day standing. After six months of work, she felt pain in her heel for the first time.

During this time, she did not visit the hospital and self-medicated with various forms of anti-inflammatory drugs such as injections, ointments, dressings with Dimexide, medical bile, Kuznetsov applicator, massage mats and orthopedic insoles from various manufacturers. The patient felt better for a while, but the symptoms slowly progressed.

About 20 years ago, during a medical examination, she was diagnosed with grade I-II longitudinal flatfoot, but she did not consult her doctor. Her left foot was not injured.

diagnosis

• Focused Shock Wave Therapy (SWFT) in the area of greatest pain – 6 sessions, one every 4 days;
• Phonophoresis with hydrocortisone ointment on the entire heel area – 10 sessions, one every other day;
• Magneto-Laser Therapy – 10 sessions, one every other day;
• Paraffin ozokerite applications on the feet – daily for 10 days;
• Anti-inflammatory ointment on left heel – twice daily;
• Individual orthopedic insoles;
• Restriction of physical activity during the treatment period.

After the first UWTF session, the patient noticed that the pain increased, but after the second session it had already decreased. After the third UWTF session, she was fitted with custom-made insoles that allowed her to walk pain-free.

At the last UWTF session the pain was gone. She said she had no pain in the morning either. She was satisfied with the results of the treatment.

What medicines are prescribed for heel spurs?

Nonsteroidal anti-inflammatory drugs and glucocorticosteroids are effective for severe pain and inflammation. Non-narcotic analgesics, warming ointments and topical irritants have a general analgesic effect. Dietary supplements and vitamin complexes are taken to strengthen the immune system. Potassium and sodium chloride preparations help restore water-electrolyte and acid-base balance, which is important for the favorable course of heel spurs and prevents an increase in bone growth.

Non-steroidal anti-inflammatory drugs

A heel spur is accompanied by acute pain that requires analgesics. Nonsteroidal anti-inflammatory drugs (NSAIDs) are most commonly prescribed for this purpose. They have anti-inflammatory, pain-relieving and fever-reducing effects. The components belong to different chemical classes, so NSAIDs differ in the intensity of their analgesic and anti-inflammatory effects, the speed of their therapeutic action, the routes of administration into the body and the presence and nature of risk factors for adverse events. Nonsteroidal anti-inflammatory drugs (NSAIDs) are not safe, and their use can lead to gastrointestinal and cardiovascular complications in some cases. The most common illnesses resulting from uncontrolled overdose of NSAIDs are peptic ulcer, gastrointestinal bleeding, unstable angina, and myocardial infarction. It is recommended to take NSAID tablets in minimal but effective doses for at least 2-4 days. Non-steroidal anti-inflammatory drugs in the form of ointments, creams and gels are used for residual pain. Compared to tablet formulations, they are safer, well tolerated by patients and less likely to cause adverse allergic and toxic reactions. They are used as a supplement to systemically prescribed NSAIDs.

What to do in case of side effects?

Undesirable side effects are possible with long-term use, especially when high doses are prescribed in the presence of risk factors. To minimize the risk of complications, it is important to use the medicine as prescribed and under medical supervision.

In case of overdose, gastric lavage and vomiting should be performed. In case of chronic dosage symptoms, it is recommended to reduce the dose and consult a specialist. Local reactions in the form of rash and itching require symptomatic treatment: antihistamines are administered orally, and antiallergic or steroid ointments are applied externally.

Side effects in the area of the gastrointestinal tract, the nervous system, the cardiovascular system, the musculoskeletal system and endocrine disorders force you to consult a doctor. Based on the examination results and the patient's complaints, the doctor adjusts the dose and medication regimen or prescribes another medication.

Diagnosis and treatment of fasciitis

At the stage of inflammation, the diagnosis is made based on the patient's complaints and examination of the foot. If osteophytes have already formed, an X-ray examination is recommended.

Basic measures

No therapy is effective without reducing the pressure on the fascia. Various orthopedic aids are used for this purpose:

• A special heel pad with a recess that absorbs shock loads;
• Custom-made orthoses that relieve the arch of the foot and cushion the heel;
• an orthosis – a splint for the foot at a right angle that prevents the fascia from shortening;

The orthosis is worn when going to bed. Do not walk barefoot in the morning as this will increase pain. Taping (Wearing taping in the morning is performed after physical therapy. The load on the painful foot should be reduced to a minimum. Wearing flip-flops, high-heeled shoes or tight shoes should be avoided.

Conservative treatment

Conservative treatment of heel spurs should be comprehensive. It includes:

• Physiotherapy – shockwave, laser and vibroacoustic treatment, magnetic therapy and electrophoresis;
• Radiation therapy (treatment with targeted X-rays);

Treatment is done at home but requires a prescription.

Medication.

To relieve pain, anti-inflammatory drugs are prescribed - including. ibuprofen, aspirin, Naproxen. If the inflammatory process worsens, a blockade is performed using hormonal drugs in combination with painkillers.

Diagnosis and treatment of fasciitis

Relax. Try to limit activities associated with movement problems, as this can prolong the common cause of pig's foot pain. It is a good idea to relieve the tightness in the upper part of the foot.

– Let your feet pass normally, without an extended one of the most or plastic fresh

that plantar fasciitis plantar fasciitis. Plantar fasciitis is in front of you with vegetable oil.

Quiet. Not standing, running and crying, becoming weak, swollen or sore. Such a condition is called

Apply grated garlic to the foot, keeping the foot straight

– Take adequate breaks during exercise. Fascia can cause painful heels – Wrap a towel and walk barefoot. Possible problems, X-ray is recommended or

Conservative treatment

or plantar fasciitis before bed.

Buttless, high-heeled shoes, sandals, flip-flops and do not walk. In some cases, to rule out others

Being comfortable when exerting yourself).

– Wear footwear that supports the foot. Do not wear shoes while standing Figure 1: Plantar fascia

– Sit on the floor for a minute.

prevention

To avoid the occurrence of plantar fasciitis, simple rules should be followed daily. Steps to prevent plantar fasciitis include:

• Right nutrition;
• wearing comfortable footwear;
• Adequate physical activity;
• maintaining a healthy body weight;
• Stretching before sports training to prepare all muscle groups for the upcoming stress.

Anyone can get plantar fasciitis. It is not possible to protect yourself 100 % against this unpleasant phenomenon, but if you follow the prevention recommendations and avoid most of the possible causes of the disease, you can reduce the risk of its occurrence.

The most important thing is to carefully monitor the condition of the skeletal system and pay attention to the body's signals. This allows you to prevent destructive processes and get rid of the disease from the very beginning. Preventing plantar fasciitis is always easier than treating it

Causes of Plantar Fasciitis

Some causes of plantar fasciitis are:

• Stiff calf muscles or Achilles tendon (the dense tissue that connects the calf muscles to the heel bone);
• Prolonged walking, standing, or running, especially on hard surfaces;
• wearing shoes that don't fit properly;
• wearing shoes that do not provide the foot with the necessary support;
• Weakening of foot tissues with age;
• Flat feet, high instep or uneven gait;
• overweight;
• pregnancy or hormonal changes; Under the influence of hormones, ligaments and tissues can become more mobile than usual.

Diagnosis of plantar fasciitis

Your doctor can diagnose plantar fasciitis during a physical exam. He or she will examine your foot and observe how you stand and walk. In some cases, an x-ray or laboratory test will be ordered to rule out other possible problems.

Although plantar fasciitis usually resolves on its own without causing long-term problems, it can take six to 18 months to resolve.

You may need to take medication to relieve pain and reduce swelling. Your doctor will tell you which of these medications are best for you. Always take your medication as prescribed by your doctor.

The most commonly taken medications are nonsteroidal anti-inflammatory drugs (NSAIDs). Examples of drugs from the NSAID group:

NSAIDs should be taken with food. Talk to your doctor before taking NSAIDs if:

• you have ever seen a doctor for gastrointestinal, liver or kidney problems;
• have ever seen a doctor for blood clotting problems;
• taking aspirin or another medication that affects blood clotting;
• Taking corticosteroids – steroid hormones produced by the adrenal cortex (the outer part of the adrenal glands).

Your doctor may also suggest wrapping the arch of your foot with tape or fitting your shoes with special products such as heel inserts, orthotic devices (such as braces or bandages), and spinal inserts to give you extra support. Physiotherapy may also be required.

If these treatments do not help, you should see your doctor. Other methods such as corticosteroid injections (syringes) or surgery may also be considered.

Symptoms of a heel spur

Leaning on your heel causes pain. It is felt more strongly when the heel spur enlarges and radiates from the inside of the heel into the deep part of the foot. The pain is sharp and burning and feels like a 'nail in the heel'. It becomes lighter as you run.

No symptoms are evident on visual inspection. In rare cases, slight swelling is noted. Palpation of the heel confirms the pain. The size of the spur does not affect the intensity of the pain.

Pathogenesis of heel spurs

Constant trauma to the tendon predisposes to the disease. This leads to the formation of small cracks that favor the development of an aseptic inflammatory process. The body reacts to the pathological changes by forming a bony outgrowth. This takes the shape of a thorn. His pressure on the soft tissues causes initial pain.

Classification and stages of heel spurs

According to the classification of disease groups, heel spurs are a pathology of the musculoskeletal system.

• Exposure to a traumatic event with development of lesions in the plantar fascia.
• Aseptic inflammation of the fascia.
• Formation of a spur.

Complications of heel spurs

A heel spur affects the quality of life because pain makes it difficult to walk and perform everyday activities. Constant discomfort in the heel area causes irritability and anxiety. For fear of stepping on the painful foot, posture and gait are impaired.

Very rarely, complications such as a fascial tear and an abscess occur.

The operation takes up to 20 minutes and no rehabilitation is required. We have a day clinic where we will solve your problem today. Please request a free consultation with our medical coordinator.

Treatment of subacromial fibromatosis

To reduce the strain and pain on the fascia, you should take shorter steps and avoid walking barefoot. Activities that put strain on the foot, such as: B. running should be avoided. The most effective treatments for plantar fasciitis include exercises to stretch the calf and plantar fascia muscles and using orthotics to stretch the lower leg and plantar fascia muscles while you sleep. Orthotics can also reduce fascia stress and pain. In addition, movement correction, weight reduction in obese patients, nonsteroidal anti-inflammatory drugs (NSAIDs), cooling massage and sometimes glucocorticoid injections are used. However, administration of corticosteroids can worsen degenerative changes in the plantar fascia, which is why many clinicians limit their use (see Guidelines on the Use of Corticosteroid Injections Use of Glucocorticoid Injections).

In refractory cases, physical therapy, oral glucocorticoids, and immobilization may be recommended before surgical treatment is considered. The newest form of treatment for unresponsive plantar fasciitis is extracorporeal shock wave therapy (ECWT), which uses a hand-held applicator to deliver low-frequency pulsed waves to the painful area. Pulsed pressure wave is a safe, non-invasive method that stimulates metabolism and increases blood circulation while repairing damaged tissue and accelerating healing. EUVT is used in large medical centers (1 The reference treatment for plantar fasciitis is characterized by pain at the attachment of the longitudinal fascia to the heel bone (heel enthesopathy), which may radiate along the medial edge of the longitudinal bone. Read more ).

Highlights

Various syndromes that cause pain localized in the sole of the foot are indications of plantar fasciitis.

Various illnesses and an unfavorable lifestyle increase the risk of shortening of the calf muscles and fascia.

Pain in the lower part of the heel increases when the foot is put under strain, especially when the heel is pushed back while walking and generally during the day.

The diagnosis is confirmed by pain caused by pressure on the heel with the thumb in a flexed position.

Initial treatment includes wearing shoes with cushioned soles, exercises to stretch the calf muscles, and using immobilization splints during sleep.

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