Issue link: http://viewer.e-digitaledition.com/i/915948
PLANTAR FASCIITIS PROTECTION When 29-year-old Marvin started running road races two years ago, he never imagined that inflammation would trip him up. MARVIN PURCHASED new running shoes every six months to give his feet support. In spite of this, he developed a foot injury from overuse that is common among runners as well as among people who stand on their feet all day—heel pain due to plantar fasciitis, which occurs when the tissue connecting the heel bone to the toes becomes inflamed. "The plantar fascia tissue, when inflamed, causes heel pain during your first steps in the morning or when standing after a period of prolonged sitting," says Ronald Soave, D.P.M., podiatrist at NewYork-Presbyterian Brooklyn Methodist Hospital. "Common risk factors for developing the condition include running on hard, uneven surfaces, having unusually tight calf muscles and low arches, standing for extended periods of time, and being overweight." Runners increase their risk of developing plantar fasciitis by running along the same path without varying their route and going for long distance runs too soon in their training. Alternating running paths and following an incremental running plan like the ten percent run duration-increase guideline can reduce the risk. "Shoe support and stretching are equally essential," says Ernest Megdanis, D.P.M., assistant chief of podiatry at NYP Brooklyn Methodist. "I recommend stretching for 20 to 30 minutes before and after running or standing for a long time." HEALING THE HEEL When runners or those who stand for hours notice pain along their heel, they should consult with a podiatrist, who typically diagnoses the problem based on the patient's personal medical history and an exam to check for areas of tenderness. In some cases, the doctor may recommend an x-ray to rule out an orthopedic issue and confirm plantar fasciitis. "The first line of treatment for plantar fasciitis includes issuing patients over-the-counter or custom orthotics (insole cushions) to place in their shoes coupled with stretching the feet before and after exercise or using a tension band to bring their foot up toward their nose," Dr. Soave says. "Another suggestion is to roll a frozen bottle of water under the soles of their feet to release tension after running or standing." Other nonsurgical treatments for patients living with plantar fasciitis involve taking nonsteroidal anti-inflammatory drugs, wearing devices like splints, braces, casts or boots while sleeping to gently stretch the plantar fascia, reducing activities that cause pain, or receiving cortisone injection therapy and physical therapy. It can take from two to 12 months for these treatments to resolve the painful condition. LAST STOP: SURGERY "After exhausting nonsurgical options and finding no relief from pain, we turn to other, more invasive procedures," Dr. Soave says. "One is radiofrequency, in which we insert a probe into the fascia at multiple sites to create a reaction that allows for healing to occur." "As a last resort, in only about ten percent of patients, we perform a 15-minute minimally invasive outpatient procedure called plantar fasciitis release, which lengthens the tissue causing the pain," Dr. Megdanis says. "We typically try other methods for six to 12 months before recommending this procedure. Patients see improvements with endoscopic plantar fascia release, but they must take off up to six weeks from activities following surgery." WINTER 2018 W W W.N Y P.O RG / BRO OKLY N 12 A N A T O M Y I N S I D E R 12