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Treat plantar fasciitis in 3 steps with injections, medication, and lifestyle adjustments

Treat plantar fasciitis in 3 steps with injections, medication, and lifestyle adjustments

Text◇He Jianxing and compiled by◇Liang Yingxiu

(Kuala Lumpur News) Although plantar fasciitis is not a fatal foot injury, it has caused many middle-aged men and women to suffer. Especially when they step on the ground when they get up in the morning, it is excruciatingly painful. In fact, the plantar fasciitis The treatment of inflammation is not complicated. The premise is that the diagnosis must be clear and other possible overlapping problems must be clarified. Only by prescribing the right medicine can the harm be minimized.

The back half of the foot is where the pain points of plantar fasciitis (plantar fasciitis) lie. Some patients also complain of pain reaching the center of the sole of their foot, but this is rare, and the reason may be related to the spread of pain. However, it is certain that as long as the pain point on the sole of the foot is pressed, the patient will definitely have a reaction, so it is not difficult to identify whether it is plantar fasciitis.

For orthopedic surgeons, most cases can be diagnosed only through consultation and palpation, but sometimes X-ray examination is used to find out whether there are underlying diseases. As for general clinics or government As long as the doctors at the clinic (klinik kesihatan) have enough experience, they can make a correct diagnosis in time through consultation and touching the pain points.

Orthopedic Consultant
Dr. Lin Xiaotian

Wear soft slippers to reduce stress

So what foot injuries overlap in the pain point area? Orthopedic consultant Dr Ling How Tieng pointed out that including bone fractures caused by osteoporosis, Achilles tendon inflammation, degenerative arthritis, gout or foot tumors, etc. However, due to plantar fasciitis, The symptoms are very obvious, including the location of the pain point (the back half of the sole of the foot), the very short duration of the pain (about a few seconds to minutes), and the pain as soon as it touches the ground after a period of rest, so it is not difficult to distinguish.

He said that conservative treatment for plantar fasciitis can be simply divided into three parts. First, if the patient really cannot bear the pain, non-steroidal anti-inflammatory analgesics (NSAIDs) can relieve the pain caused by inflammation. Severe pain, common drugs include ibuprofen, ketoprofen, naproxen and piroxicam, etc. However, you must follow the doctor’s instructions.

“The second part is the adjustment of daily routine, which can be divided into short-term and long-term. The so-called short-term is to avoid irritation of pain points as much as possible. Therefore, patients must look for suitable shoes, including slippers. It is recommended that the insoles must be softer, preferably It’s designed for the arch.”

“Take Malaysia as an example. Due to the hot weather all year round, many people do not have the habit of wearing shoes at home. However, patients with damaged plantar fascia must wear soft slippers at home to reduce pressure. Therefore, flip-flops or clogs, commonly known as Japanese slippers, are never suitable. The surfaces of these two shoes are flat and hard, which will cause greater irritation to patients with damaged fascia.”

Some plantar fasciitis is associated with tightness of the Achilles tendon.

A sudden increase in exercise volume in a short period of time

In recent years, you can find many insoles on the market specially designed for men and women with flat feet or high arched feet. These insoles designed by different manufacturers can alleviate the problem of plantar fasciitis to a certain extent, including supporting the arch and reducing pressure. Therefore, patients can choose suitable insoles according to their personal abilities and needs.

He pointed out that some rehabilitation training can also be included in the short-term part. There are four major factors in the formation of plantar fasciitis, namely flat feet, high arched feet, sudden weight gain in the short term, and sudden increase in exercise. In addition to these basic factors, In addition, whether the Achilles tendon is tight will also have an impact. Therefore, stretching training for the Achilles tendon can be performed as follows:

1/Find a suitable and stable object to hold on to, such as a sturdy table or chair;

2/Stand firmly with both feet and hold the table or chair with both hands during each training session;

3/Then stretch the foot with plantar fascia pain backwards and maintain the stretch for 5 to 10 seconds;

4/As for the other foot, support the body forward. At this time, you will feel that the stretched foot is being pulled;

5/Continue to maintain the posture.

Perform the same movements 5 to 10 times as a set. You can perform a set of training movements every morning and evening.

Stretching the Achilles tendon can help improve some plantar discomfort, and this set of stretching actions can be performed several times in the morning and evening.

In addition, patients with plantar fasciitis can also consult a physical therapist to customize a shoe cover according to their condition and their own conditions. The advantage of this type of shoe cover is that it can reduce the fascial pull caused by the patient’s natural foot drooping while sleeping. , but not every patient is suitable because it is another burden.

“As for the long-term adjustment of life routine, it focuses on the choice and intensity of exercise, and then controlling the patient’s weight within a reasonable range. Many times, patients have greatly improved by this stage of treatment, but weight loss does not happen overnight. can be achieved, which is why it is considered a long-term component.”

“The third part of the treatment is when there is still no improvement after anti-inflammatory and analgesic drugs and adjustments to daily routine. In order to relieve the patient’s pain caused by fascial inflammation, the doctor will inject steroids into the affected area as appropriate. However, it must be noted Yes, the purpose of injecting steroids is the same as taking anti-inflammatory and analgesic drugs, which is to temporarily relieve pain. In the final analysis, patients still have to adjust their daily routine, otherwise no amount of drugs will be able to improve the problem.”

The pain point of plantar fasciitis is on the back half of the sole of the foot (red circle).

Unable to get rid of pain and need surgery

If left untreated, is it possible that plantar fasciitis will go away on its own? He said that it is possible that, as mentioned before, plantar fasciitis occurs more from lifestyle, such as sudden weight gain or sudden increase in activity. If a person is unable to move due to plantar fasciitis , it is indeed possible to solve the problem by mistake, but if you can understand the root cause of the pain, you can achieve twice the result with half the effort during treatment.

“Plantar fasciitis is not a disease but caused by an incorrect lifestyle. It is very different from chronic diseases such as hypertension or diabetes. In addition to adjusting lifestyle, the latter two must also be controlled with medication. illness.”

If the three conservative treatments for plantar fasciitis have been used, but the patient still cannot get rid of the pain, the next step is surgical treatment. The specific method is that the patient first undergoes partial anesthesia, and then the inflamed foot is surgically removed. The plantar fascia can be removed and then sutured. However, it is worth noting that most patients with plantar fasciitis do not need surgery. Just adjusting their daily routine is enough to solve the problem. Therefore, how do doctors explain the condition to patients? It is also a key part of treatment.

Unrelated bone spurs and high uric acid index

Question 1: Does plantar fasciitis refer to bone spurs on the soles of the feet? Or does high uric acid index cause gout?

Answer 1: In fact, there has always been a misconception about plantar fasciitis, that is, it is thought to be caused by bone spurs (spurs) on the soles of the feet. However, this is not correct. The real scientific name of bone spurs is osteophytes. It refers to the ossified protrusions that form along the edge of the joint, but patients with plantar fasciitis do not necessarily have bone spurs, and even people who have bone spurs found on X-rays do not necessarily have plantar fasciitis. “With or without thorns” are two different things that have nothing to do with each other.

Gout due to high uric acid and plantar fasciitis are completely different issues. Gout can occur in bones, joints, ligaments, etc. of the hands and feet. It is different from plantar fasciitis in several ways. The first is that it can attack at any time, and the second is that the pain lasts for a long time.

The key is to adjust your daily routine

Question 2: When a person has plantar fasciitis, is the only treatment available is anti-inflammatory and painkillers?

Answer 2: Taking anti-inflammatory and analgesic drugs is only one of the treatment methods. In fact, the more important thing is to adjust your daily routine, such as wearing suitable shoes, controlling your weight and paying attention to the intensity of exercise.

Running shoes designed to fit the patient

Question 3: Some people say that wearing slippers is more likely to cause plantar fasciitis. Is it okay to wear covered shoes?

Answer 3: Not necessarily. Everything still depends on whether the structure of the slippers or bags is suitable, including whether the insole is soft and has an arch design. Therefore, I would recommend wearing running shoes because its design has taken into account the user’s sprinting and stepping. It is particularly suitable for patients with plantar fasciitis.

Attacks are related to daily activities

Question 4: Is plantar fasciitis hereditary? Or does it have to do with taking the stairs or climbing all the time?

Answer 4: It is not hereditary. Its onset is related to personal life style. If a person regularly maintains moderate exercise, whether it is walking up and down stairs, walking or playing ball games, it will not cause damage to the fascia. It will only occur if a person has not exercised for a long time but rashly increases the amount of exercise beyond the body’s load, or if the weight increases suddenly. Something will happen.

It hurts my heart to step on the ground

Flat foot fascia is susceptible to damage

Have you ever tried to wake up in the morning and suddenly feel a sharp pain in the sole of your foot as soon as you step on the ground? It feels like being stabbed hard by a knife. At this time, almost all kinds of adjectives to describe the pain include heart-wrenching, heart-breaking, Neither excruciating pain nor unbearable pain can describe the feeling at this moment.

Orthopedic consultant Dr Ling How Tieng pointed out that some patients have complained that the pain sometimes makes them shed tears, but the pain comes and goes quickly, lasting only a few seconds to a few minutes, and then everything seems to be fine, but As long as I get up the next day, this torture happens again. Although it does not pose any threat to life, such recurring pain directly affects the quality of one’s life.

Considered a mid-life health hazard

“Actually, you feel severe pain when you step on the ground, but the pain goes away quickly. This is a common foot injury. Its scientific name is plantar fasciitis, and it is also one of the cases commonly encountered in orthopedic clinics. One, it’s also called jogger’s heel because the patient has to be able to walk.”

People who sit in wheelchairs for a long time or rarely walk will not experience plantar fasciitis. The reason why they feel severe pain is that the fascia is continuously stimulated and injured and becomes chronically inflamed. After the inflammation, pain occurs. This This is how plantar fasciitis develops.

He revealed that patients are both male and female, but the age group is concentrated between 35 and 65 years old. The chance of plantar fasciitis in teenagers younger than 35 years old or retired people or elders older than 65 years old is very low. The reason is that Although teenagers under 35 years old are active, their fascia has not yet degenerated. As for retired people over the age of 65, this is because their activity levels have been greatly reduced. Therefore, from another perspective, it is not an exaggeration to regard plantar fasciitis as a middle-aged health hazard.

“The human plantar fascia is a layer of connective tissue similar to a mesh. If you break open the skin on the sole of the foot, you can see that the fascia extends from the heel to the five toes in a fan-like form. Its function is similar to Ligaments, in addition to supporting the human body when standing, can also absorb the reaction force from the ground when people move, thereby achieving a shock-absorbing effect.”

The number of people with flat feet is increasing day by day

He said that everyone’s plantar fascia will suffer minor tears every day due to various activities such as walking, running, jumping, etc., but it can be repaired in time through the nutrients in the blood to ensure that the fascia is in good health. condition.

“However, for people with congenital flat feet or high arched feet, because the force application point and bearing range of their feet contacting the ground are different from normal people, the fascia that originally provides sufficient elasticity for the arch of the foot is easily damaged. Men and women with flat feet Generally speaking, the fascia is still in good condition from adolescence to young adulthood. Therefore, although flat feet have stretched the fascia to the limit, as long as it moves a little, the fascia can return to normal. At this time, the plantar fascia of men and women with flat feet It’s still fine, but it’s chronic inflammation for a long time.”

“However, when they reach middle age, the flexibility of the fascia is much less than before and begins to degenerate. But at this time, they usually shoulder the greatest responsibilities, whether they are important people at work or the backbone of the family. etc., the amount of activity every day is much greater than when I was a teenager or retired.”

This is also when the fascia in its worst condition encounters a huge amount of activity, the chances of fascia damage, inflammation and pain will increase. It is worth noting that in recent years, outpatient clinics have found an increase in men and women with flat feet. This also explains why Why Plantar Fasciitis Is Increasingly Common.

As for the damage to the fascia of men and women with high cavus, it is completely different from that of flat feet. High cavus means that the force application point of the foot is concentrated on the heel. Long-term pressure causes fascia damage and inflammation, so it excludes other health problems. Men and women with congenital flat feet or high arched feet may be considered a high-risk group for plantar fasciitis due to factors such as high uric acid index, rheumatoid factor or degenerative arthritis.

Inflammation of fascia due to inability to bear load

“Most of the cases we come into contact with clinically are men and women who are suddenly overweight, or who have not exercised for a long time, and suddenly engage in strenuous exercise that exceeds their body’s capacity. These two situations suddenly increased after the Movement Control Order (MCO) was opened, and the reason is that patients During the epidemic, I gained weight, and after not exercising for a long time, I suddenly started intense exercise, which caused the fascia to be unable to bear the load, become damaged, inflamed, and cause pain.

He pointed out that although sudden weight gain is one of the culprits of plantar fasciitis, it does not mean that the body mass index (BMI) is excessive. For example, a man and woman weighing 100 kilograms will definitely have plantar fasciitis. There is a wonderful mechanism, that is, if his weight is maintained at the same level, the various tissues of the body will adapt.

Therefore, although this person may appear to be overweight to outsiders, as long as he does not gain weight in a short period of time, such as gaining 5 to 10 kilograms in just a few months, the chance of fascia damage will be reduced accordingly.

Among the cases that Lin Xiaotian came into contact with, some patients not only had congenital flat feet, but also gained weight in a short period of time, and suddenly increased the amount of exercise in pursuit of health, and as a result, something went wrong. Therefore, he would like to emphasize that the importance of exercise to health is unquestionable, but if you have not exercised for a long time, you must do a step-by-step and warm-up and stretch once you restart exercise, otherwise it will easily cause unnecessary injuries, including Plantar fasciitis.

“In addition to the pain at the moment when you get up in the morning and step on the ground, the pain of plantar fasciitis will also occur in the afternoon, that is, the patient has been sitting for a long time, and then the pain will be unbearable when he stands up. The principle is the same as that in the morning. The severe pain is the same because the patient has rested for a long time when he gets up in the morning, and the foot moves less during rest, so it hurts as soon as it touches the ground.”

The pain point is in the back half of the sole of the foot

Another obvious symptom of plantar fasciitis is that the pain points are concentrated in the back half of the sole of the foot. Although the fascia extends from the heel to the foot in a fan-like form, the pressure is also dispersed as it extends, so in the end 90% of the pain points remain. It is concentrated in the back half of the sole of the foot, and in very rare cases it is between the back half of the sole and the toes. If pain occurs even in the toes, then attention must be paid to other foot injuries.

How long will this pain last? Every clinical observation found that the pain in most patients lasts from a few seconds to a few minutes from the beginning to the end. It will be much better after taking a few steps. At first, the pain is so painful that tears are shed, but after taking a few steps, the pain subsides. You can become ‘accustomed’ or ‘numbed’, and it will seem fine if you continue walking, but the pain will reoccur after a period of rest. This is another special feature of plantar fasciitis, which is helpful for doctors to diagnose.

The symptoms of plantar fasciitis are obvious, and sometimes the condition can be diagnosed simply by asking, palpating and observing the patient’s condition. However, other possible latent diseases must be ruled out, including bone fractures and arthritis caused by osteoporosis. Inflammation of the Kiris tendon, degenerative arthritis, gout, and foot tumors.

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