Plantar Fasciitis: Causes and Treatments

yeah why does it hurt so much we're going to answer that my name is Dr Paul zalzow I'm Dr Brad weenie Dr Danny Aurora nice to have me welcome to talking with docs uh where we talk with docs who developed a patented way wait no not pens to humor and mess we've copyrighted a way to make humor and alerts it's not copyrighted okay on the back of a napkin we wrote this idea down to write sort of uh medical humor mixed in with medical information that's what we're gonna do plantar fasciitis what's the plantar fascia yeah good question so uh planner fascia essentially a thick fascial band or thick band on the bottom and the sole of the foot everyone has it you have two feets you have two plantar fascists okay so in plantar fasciitis that is inflammation of that plantar fashion exactly and what is that characterized by yeah so a lot of times it's pain on the bottom of the heel a lot of times the classic symptoms are you know first steps coming out of the bed people say they step down they can't even walk they're crawling to the bathroom sometimes it can happen after sitting for long periods of time if you're driving and getting out of the car if you're at the office and you're on the computer or at the desk a lot and you get up sometimes I can that could be the the classic presentation of symptoms it can sometimes happen after activity prolonged activity and that could exacerbate this is the symptoms as well okay who gets it yeah it can happen to anybody I don't think there's necessarily age I mean I see a lot of times in middle age you know um you know 40 to 60 uh age range is probably the most common presentation I do see it but I've seen it in younger patients as well I've seen it in athletes as well so I think it pretty much could you know touch everybody okay it's a very common problem leave a comment if you've had it or you're thinking of getting it it is very common and it hurts a lot and can be very debilitating because it hurts with every step you take and sometimes it seems the people that I think we don't they don't come to me for this but they talk about it it seems like it can Nag on like it's not necessarily like a quick fix kind of thing no it can can be something that could be chronic even even for you know a few years Years A lot of times it takes a few months to kind of settle in and then also to go away so the treatment can be sometimes lengthy I think the biggest thing is patience and persistence and perseverance with the patients to follow through with the treatment plan okay so patients have to have patience for this to go away so let's talk about treating it I mean yeah so a lot of times patients come and they say oh I got an x-ray and they feel like there's this bony spur on the bottom that like Doc take down the spur and I tell them unfortunately that's not going to treat their symptoms but I think the biggest thing is the diagnosis okay so the diagnosis how do you make that diagnosis yeah so again anytime we look at the fee we take both feet uh you know the the shoes and socks off have them stand look at their alignment sometimes different alignments whether people are flat foot or have what's called a canvas or a high arch foot can predispose patients to have you know pain in their fascia and then secondly would be the location of the pain and then the best probably the biggest clinical sign is when patients have actually pain right underneath the I guess the medial heel where the fascia attaches to the calcaneus or the heel bone okay any special tests or investigations that we do for this yeah I use my thumb and I press the Danny push test there you go uh that's not patented or copyrighted I guess should be okay so you do the push test you do that you do an x-ray and sometimes I would say the X-ray would be more to make sure there's nothing nothing weird going on you have to rule out some things and a lot of times family doctors have an ultrasound that come with it that says the fascia is either thickened partial tears inflamed and then they give me measurements but at the end of the day I think the clinical diagnosis is probably the key okay so there are some investigations that you may have had done for your plantar fasciitis but they're not necessary to make the diagnosis it's a clinical diagnosis yeah so again pushing right at the fascia and the patients scream they have pain and then they would say yes this is the pain I think that's the biggest question is this the pain that they're having whether it be you know coming out of the first steps out of bed or after a long sitting period essentially you want to reproduce the patient's symptoms all right so that's the diagnosis let's jump into treatment now operative non-operative yeah so I think the Mainstay treatment is non-operative you know my approach to plantar fasciitis is to tackle the plantar fascia the plantar fasciitis treatment with multiple things all at once I think that's probably the most effective multimodal approach there you go so starting one with proper Footwear you know nice comfortable shoes some people like to get Orthotics that can be sometimes helpful to offload the pain in the heel secondly we to get an anti-inflammatory cream that you can apply locally at that area to decrease the inflammation locally and to decrease some of the symptoms secondly sorry thirdly would be to do a lot of stretching okay you want to stretch the fascia so essentially what's happening is the fascia gets really really tight when you're sleeping no one sleeps with their feet up all right I think that's the biggest thing so their feet are down the fascia shrinks down and then when they get out of the bed or after a long sitting period that's where you stretch the fashion if it's inflamed that's where the symptoms come now you're doing exercise do you ever get do Active Release where someone else is like almost doing like a massage there there's a lot of different things out there I mean if you could go you want to see your physiotherapist you have a massage therapist a Cairo osteopath essentially you want to stretch the fascia if there's different ways of decreasing inflammation as well if they want to use adjunctive modalities and things like ultrasound therapy and all that stuff but essentially the goal is to decrease in inflammation where the the fascia attaches and also just stretch it another thing too what I like to recommend is cryo stretching it's a essentially a very easy you freeze a water bottle and you roll your foot or need your plantar fascia on a frozen water bottle so it's Icing at the same time as stretching it some people like to get like either baseball lacrosse while something small like really really hard on the on the bottom and they start stretching the final fascia okay what's really cool about this treatment is that you can do a lot of this on your own the thing about plantar fasciitis if you Google it the first two or three hits are going to be sponsored ads right and whenever you have a sponsored sort of AD or a sponsored hit on YouTube you have to watch out because there's science mixed in with marketing and the line gets blurred and you can't tell what science and what's marketing still go to those sites you can but just recognize that there's some science and some marketing and they're mixed in on like here where we're just giving you the facts so those are a lot of treatments that are easy to do not very expensive and do they work like well it's a success rate typically yeah so another thing for treatment just one last thing is night splinting okay so like I alluded to before everyone sleeps with their feet that are downwards so the nice blend premise is essentially to stretch your fascia while you're sleeping so essentially when you get up your foot's already stretched out right now there's a lot of different night splints out there there's some different socks and stuff like that there's some big kind of air cast type boots essentially you want to get one that's actually going to stretch your foot and not just pull your toes right right so it has to go all the way and correct when you're moving at the ankle we don't want to move it correct so there's different things out there obviously I want to make sure that either you get good guidance from your um your surgeon your foot specialist or your pedorthist and this works a lot of the time yeah so like I said I the multi-motor approach I would say for me and my hands I've seen probably 75 to 80 percent of my patients tend to get some type of improvement and I think that's where I start with the majority of my patients what kind of time frame are we talking because some of these people have suffered for a long time and they're like listen I've been doing this for a month or six weeks it's still not working yet how long do you push through that before you maybe say I need to go to the next level so I think about two to three months depending on severity of treatment sorry the severity of the symptoms and again depending on what stage the patients come and see me that's where we might tweak the bit the uh treatment okay let's take it up a notch now these these sort of conservative measures that are fairly inexpensive I've worked in 75 80 I've even read 90 of the time if you're at one of the unfortunate 10 to 20 where this is not working what are some options available yeah so that that would be my non-invasive approach that we just talked about and then we get into maybe a little bit more invasive meaning uh injections okay so for me there's two injections that I'll use for this uh number one being corticosteroids or steroid injection where you inject right where the fascia attaches to the um to the Bone right into that space to decrease the inflammation locally so that would be one more inexpensive very calmly and most you know Obsession yeah it could be pretty successful and the newer thing that we're probably doing now is called PRP or platelet-rich plasma um more expensive but if you look at some of the studies there's been evidence to show that PRP has been more successful in terms of functional uh recovery decreased symptoms and there's some randomized controlled trials too okay so you start with a cortisone or a corticosteroid first if that doesn't work as an injection you consider PRP yeah and people will ask how many times can I have an injection how many times can I get a cortisone injection yeah so for me I just try to spread them out I don't like doing multiple injections probably four to six months you could probably do that every four to six is there any risk a lot of people are also going to ask this well I've had an injection I'm worried about like a rupture of some type of complication related to the cortisone this is something that's dangerous and could rupture that fashion yeah so in theory there is that always that downside of rupture however if you look at some of the treatments for plantar fasciitis it might work cutting or releasing it not that we're trying to achieve that yeah okay all right so you've got injections uh either cortisone try that first if that doesn't work you might have to dig into your pocketbook and get some PRP yeah and then what about shock wave therapy right about shock wave there so Shockwave I would say a lot of patients come to me and say hey I've tried it it kind of works does it work I would say the evidence is probably loose out there I don't necessarily recommend to doing it however if they want to try and do that or if they've already had some success then I would say you can try it now if you're one of the few people that still hasn't got relief from the conservative and the injections you mentioned surgical intervention yeah I would say that's very rare I can't say that I've done many surgeries for plantar fasciitis specifically some of the treatments would be either partial release or a full release of the plantar fascia again that could be done endoscopic meaning with a camera it could be done with a small incision and then there's some osteotamines where you're essentially just changing the alignment of the calcaneus which is a heel bone where the fascia attaches to try to decrease the tension so you have less of that pull okay so the operation is not to go in and knock off potentially a little bone spur that's there because a lot of people would ask you for that say somehow they got an x-ray and it shows this little thing and then everyone's like listen this is my problem I just need this to go away and it's going to be fine I don't I don't see that as being the main reason I know there's some people who do claim that you know removing that plant or spur will relieve all the the pain right I just don't see it yeah the deal with that bone spur is maybe years ago we used to think that was the cause and he just used to go in and take out that bone spur but what we've learned is a lot of people have plantar fasciitis without the bone spur and a lot of people have bone spurs on their heel and don't have plantar fasciitis so it's not related to your plantar fasciitis and the studies that we've looked at so get that out of your mind that I got a heel spur that's why I got plantar fasciitis and the other important message here is that surgery is very very very rarely required for plantar fascia is the vast majority of the time you can treat it with the non-operative less conservative or even injection that we've talked about so most of the time it's going to go away and get treated with the knot with the less invasive stuff occasionally you might need some injections and very very very rarely a surgery indicated in this correct am I lying or my telling the truth about it I'll say you're telling the truth all right Dr Aurora pretty much gets people walking on a cloud that's what his whole profession does gets people walking again and obviously we recognize it's going to be very debilitating if you start your day rolling out of bed with Agony in your feet that affects so many other aspects of your life so definitely talk to your local practitioner about options to deal with your plantar fasciitis yeah and if you're you know standing up walking for 23 hours of the day your feet are going to be sore so you're going to have to think of a way that you can modify your activities if you do have plantar fasciitis to give your body a chance to heal it so you feel better there you go awesome summary if you like this video please like it subscribe to our Channel and remember you are in charge of your own health thank you Dr Aurora thanks for having me

Channel: Talking With Docs

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Id: i4mEsV4rx68

Length: 12min 15sec (735 seconds)

Published: Wed Jun 28 2023