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.
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
Dr. Kuzel has been in practice since 1992 and has been board certified since 1998.