How to treat your plantar fasciitis?

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. Donald Pelto Dr. Donald Pelto is a Podiatrist at Central Massachusetts Podiatry, in Worcester and Westborough. Author of several books on foot health, he also speaks Portuguese and Spanish. He likes to go on family hikes and loves learning and talking about health related topics and healthy life hacks. Watch some of his interviews about health and video lectures on youtube.com/drpelto.

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