While Brett Farve was leading his new team against the Green Bay Packers, Eli Manning was being diagnosed with a common problem called Plantar Fasciitis. This diagnosis may keep him from playing in an upcoming football game, but what is it and how do you keep it from stopping you? Plantar Fasciitis is an inflammation of a tissue or ligament (the plantar fascia) that extends from the bottom of the heel to the toes. It shares an insertion at the heel with the achilles tendon and will often be aggravated from normal activities, even walking. When we walk, the ground perssures require us to have at least 10 degrees of motion at the ankle. If the achilles tendon is too tight and limits this motion, the plantar fascia is stretched and will become inflammed or torn at the heel where the plantar fascia inserts. This pain then is recurrently aggravated each time someone walks on the foot. How Will It Present? Typically it will present as pain to the bottom of the heel that hurts significantly first step in the morning (after sleeping) or after sitting for a period of time. After several steps, it usually improves and then worsens again throughout the day. It can be severe pain that limits the ability to walk or run, or as Eli Manning is finding participate in sports that you love. How Is It Diagnosed? The plantar fascia is a soft tissue, and therefore can not be seen under x-ray. Often an x-ray will be taken to ensure no bone related problem is causing the pain. If a bone spur is seen in the heel, it is a confirmation of plantar fasciitis, because the spur forms as a symptom of the problem. The body is trying to protect the plantar fascia from tearing by creating extra bone. Since it is a symptom, not the cause, however, the spur rarely needs to be removed to alleviate the pain. The best diagnostic tool, however, is ultrasound as it will show the thickening of the plantar fascia and allow visualization of any tears if seen. This tool will also allow visualization of heel spurs and allow the physician to discuss how inflammed your plantar fascia has become. How Do I Keep Plantar Fascia From Stopping Me? To keep from being stopped by plantar fascia, I recommend you start with some of these common treatments: 1. Ice the foot to alleviate the inflammation. The easiest way to ice the bottom of the foot is by freezing a water bottle and rolling the foot across it. This will decrease the inflammation and massage the area. 2. Stretch agressively the achilles tendon. Since the achilles tendon is the cause of the inflammation, stretching this tendon will alleviate the stress across the plantar fascia long term. 3. Anti-inflammatory medications can help. Taking an anti-inflammatory medication as simple as ibuprofen can decrease the swelling in the tissues and alleviate some of the pain. 4. It is also recommended that you undergo evaluation by a physician specialized in the foot and ankle to provide additional care and recommendations. Some additional treatments may include orthotics, cortisone shots, ultrasound treatment, cold laser treatments, topaz radiocoblation therapy, platelet rich plasma injections, shockwave therapy, or surgical intervention. Eli Manning may be limited by his plantar fasciitis. My recommendation is that you get treatment early so it doesn't keep you from doing what you enjoy. Copyright (c) 2009 Mountain West Foot & Ankle Institute
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