• How to treat your plantar fasciitis?

    by Dr. Don Pelto
    on Aug 30th, 2018

In this video we will go over different aspects of how to quickly get rid of your plantar fasciitis. Postwire Link of Patient Information - https://www.postwire.com/page/53b2fad019eb384cd5027e52

https://youtu.be/IsMFT4tZpdQ

 

(Trascript Below)

Hello and welcome to healthy living I'm
Dr. Donald Pelto and today we're going
to talk about how you can get rid of
your plantar fasciitis to understand
this first we're going to look at what
is plantar fasciitis so if you can see
on this picture here that the plantar
fascia is a little ligament that
attaches to the heel of the foot and
it's intimately attached with the
Achilles tendon you see those two little
yellow lines the Achilles tendon is
pulling in one direction of the heel and
the fascia is pulling the other
direction on the bottom of the heel and
they're kind of playing tug-of-war in
what plantar fasciitis is it's an
inflammation of that fashio on the
bottom of the foot where it becomes
inflamed it becomes plain 'fl in many
people they had they start out with a
fasciitis and if the itis means
inflammation but if you have it for a
long enough period of time it can turn
into something called plantar fasciitis
which is more of a chronic condition of
the plantar fascia and the whole goal of
our treatment is to reduce that
inflammation and there's no one easy way
people tried a lot of different
treatments and one of the treatments
they try is they say doctor you know
I've tried I bought 10 or 15 different
pairs of shoes and none of them feel
good and when they say that and I tell
them you know it the problem probably it
isn't the shoe it's probably your foot
and and that's that's the issue you
can't try to change shoes give inserts
and all these things and if nothing
works you need some other treatment
options so let's go to look a little bit
more about the anatomy if you look at
the fashion on top or actually around
and underneath the fashio there's a
whole bunch of muscles so you see these
muscles that are on the bottom of this
foot and the muscle there that's in the
back of the leg the muscles all start in
the back of the leg and they insert into
the foot and if those muscles are tight
if they're not functioning well many
times the muscles since they're not
working well they caused the fashio to
get inflamed
let me kind of explain a little bit
easier the fashion is something we call
a secondary support structure on the
foot the fashion really isn't supposed
to do anything but it's the muscles that
start in the calf and they insert in the
foot and if those aren't working well
then the fashion can become inflamed
what do we typically see we see someone
that let's say they start working out
they work out a day everything is fine
the second day the third day everything
seems to be fine but usually after three
or four days their their heel starts to
hurt or if they go on a long walk or if
they go to someplace like Disney World
and they do a lot of walking in an
unsupportive shoe they start to develop
this condition a lot of times it's
because the muscles in the back of the
calf they'd become very tight they're
not working well and then all that
pressure needs to go through the plantar
fascia how do you determine if you have
plantar fasciitis you can try to kind of
push on the bottom of the foot that's a
good way usually it's right at the
bottom of the heel but there are some
other diagnostic exams that you can do
the first picture you're gonna see on
the top is a picture of an x-ray this
isn't the ideal x-ray because it's a non
weight-bearing x-ray we can tell that
because the foots pointed down you would
tend to want a weight-bearing x-ray and
you can see where there's that little
circle it's it's pointing to a spur now
the spur usually isn't the problem with
plantar fasciitis the spur is something
that happens over years of having
tightness of the plantar fascia to
explain it a little bit better there's
that there's a law called woofs law so
if you pull long enough on a bone in one
direction so for example that fashio is
pulling on the heel bone for a long time
that's gonna create bone in that
direction
and you're gonna have a spur but you'll
say well that spur needs to be treated
well if you get a hundred x-rays on
people with plantar fasciitis 50 of them
are gonna have Spurs and 50 of them
won't have Spurs so just because you
have a spur doesn't mean you have
plantar fasciitis and just because you
don't have a spur it doesn't mean that
you have plantar fasciitis the better
thing to look at is either an ultrasound
or an MRI
I have here as a picture of an
ultrasound and you can see the distance
here it says the right and the left
plantar fascia on the right there's a
shorter distance between the two letters
the two A's that you see and then on the
left one there's a larger distance
between the two letters that you see and
that largeness that little kind of dome
you're noticing that's actually the
bottom of the heel so the bottom of the
heel imagine that pitcher flipped upside
down of the x-ray flipped upside down
that's the bottom of the heel and on the
bottom of the heel that's where that
plantar fascial inserts and the bigger
problem isn't the spur the bigger
problem is the thickness of the fashio
when the fashion becomes really thick so
so for example instead of four
millimeters like it should normally be
it's six or eight millimeters that
thickness doesn't allow the fashio to
move or to adapt as well and it becomes
painful for people so it's important to
do an ultrasound to evaluate the actual
thickness of the fashio in the other
diagnostic exam that can be done is
something called an MRI and an MRI will
show you if there's some inflammation
down there it will show you if there's a
spur down there it's a little bit
challenging to measure the thickness of
the fascia because if you think about
the cuts of an MRI they're usually two
millimeters in thickness so it might be
a little bit more challenging to measure
things and to see everything that's down
there so let's go into the treatment
process how do you treat plantar
fasciitis if you look in the Internet
there's hundreds of treatments and
that's where many times it gets
confusing we're gonna go over some of
the basics okay I like to categorize
things in the basics of reducing
inflammation reducing tightness and then
stabilizing the heal those are the the
main things that we focus on when we're
treating plantar fasciitis let's first
start to look at how do you reduce the
inflammation one of the ways to start is
to use ice there's a couple of ways you
can do this you can see in this picture
here on the left
someone put a bottle of water in the
freezer and they're rubbing that on the
bottom of the heel they're rolling that
on the bottom of the heel that can help
reduce some of the inflammation and
other ways to take a little cup of ice
and put it in the freezer and then you
kind of rip around the edges of that cup
of the ice and that massaging motion you
can massage you can on the bottom of the
heel and that's gonna freeze the area
and that's gonna reduce some
inflammation now if you have a very mild
case icing alone may be helpful but for
most people
icing is in conjunction with other
things the icing isn't enough for most
people to get rid of all their symptoms
basically because the ice isn't able to
penetrate deep enough into the foot to
resolve the issue another way to reduce
the inflammation are using if your
doctor will allow you anti-inflammatory
medications there are many different
types there's motrin there's ibuprofen
there's naproxen there are many
different types of anti-inflammatories
and where I find people make a few
mistakes using anti-inflammatories is
that they only take them when they have
pain if you're taking them only when you
have pain you have a really hard time to
get that true pain reduction and
anti-inflammatory effect in the foot
what I find works a little bit better is
to be consistent so for example if
you're taking motrin three hundred three
times a day you take it three times a
day for a couple of weeks once again
take it with food you know under the
direction of your doctor or naproxen
this twice a day that's why I like
naproxen a little bit more or a leave
because you just have to take it twice a
day and most people forget the third
dosage but to be consistent with it for
a period of time of a couple of weeks
you're gonna determine if you're able to
get that anti-inflammatory effect on the
bottom of the heel there are other ways
or other medications that you can take
for example a prednisone like a medrol
dose pack if you're in a lot of pain
that can help reduce the inflammation
and there are numerous other medications
that your doctor may prescribe for you
what I find works most effectively when
someone comes in most people have tried
the icing and they've tried the
anti-inflammatory and they're limping
quite a bit the the best way to reduce
the inflammation I find is utilizing a
cortisone injection and everyone maybe
listening they're saying you know I
don't want a cortisone a cortisone
hertzel
well if you imagine if you're coming in
limping and you're having a lot of pain
and if you could possibly leave without
pain it would be worth it it would be
worth it a cortisone injection can be
made up of a concoction of a number of
medications usually it involves some
type of anesthetic and an anesthetic is
used to numb up the area and then you
put different types of of cortisone in
there we tend to use a short-acting
cortisone that that starts working
within a day or two and then we also put
a portion of a long-acting steroid as
well that may take a week or so before
it starts working but it has a longer
lifespan and a couple of the questions
we always get about cortisone is first
how long is it going to last well for
some people it may last a couple of days
a couple of weeks a couple of months or
if it's able to reduce the inflammation
and you do the other treatments then it
could totally resolve the condition with
cortisone if you can see here in this
picture on the bottom the two of them
you can see it usually goes on the side
of the foot even though your pain is on
the bottom we normally put the cortisone
through the side of the foot unless you
have a different condition or something
called a bursa on the bottom of the foot
it could go through straight through the
bottom but usually go on the side you
Author Dr. Don Pelto

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