Plantar Fasciitis, Seattle

Illustration of the Plantar Fascia

Plantar fasciitis is a painful inflammation of the main structural ligament that runs along the bottom of the foot from the heel to the base of the toes. The function of the plantar fascia ligament is to change the shape and biomechanics of the foot with each step taken. Because of this repetitive use, inflammation at the bottom of the heel, where the ligament connects to the bone, is not uncommon. It usually results from a hyperpronated arch and is often complicated by a short Achilles tendon.


Diagnosis is made by taking a careful history and doing a thorough physical exam. Sometimes an X-ray aids in the diagnosis and will show a heel spur on the bottom of the calcaneus. There is a characteristic pattern of First Thing in the Morning pain during the first few steps out of bed. This is Stage I and is a warning of foot biomechanics that are overstressed or beginning to change. In Stage II the pain occurs during the first few steps each day but also recurs late in the day. In Stage III the pain remains all day long and can even begin to ache at night. The same biomechanics and activity that can lead to plantar fasciitis can also lead to a stress fracture of the heel or pain at the Achilles tendon's attachment at the back of the heel.


Treatment is aimed at correcting faulty mechanics usually with the use of an orthotic arch support which is made by taking plaster impressions of both feet and sending them to a lab for fabrication. The lab will use the models of your feet and your podiatrist's instructions to custom mold an orthotic that will meet your needs. Other treatments can include stretching, a short course of non-steroidal anti-inflammatory medication like Advil, or a splint worn for thirty minutes in the evenings called a night splint. The night splint gives a very gentle stretch on the plantar fascia ligament, the underlying muscles and the Achilles tendon. It must be worn with the knee straight to keep light tension on the Achilles.

After the biomechanical causes are corrected with orthotics, a night splint and/or perhaps immobilization, if pain persists a single cortisone shot can be very helpful in cases of longstanding pain where there has been a build up of scar tissue. The inside of the heel is treated with a very cold spray followed by a numbing injection with a tiny needle. Once the painful area is numb, ultrasound visualization is used to direct the cortisone to the exact spot where the plantar fascia ligament attaches to the heel bone. A rapid decrease in pain and inflammation should be noted between day four and day ten following injection.

We provide treatment for plantar fasciitis in our Seattle and Edmonds clinics. Call today for your free consultation!

Posted by Mark A. Kuzel, DPM, FACFAS on March 16, 2010

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