Plantar Fasciitis Vs. Diabetic Neuropathy

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Plantar Fasciitis Vs. Diabetic Neuropathy

Have you ever said, “My feet are hurting me so bad”? Now, this normal response could come from a variety of disorders or conditions from standing on your feet all day for family events to a more obvious reason like falling from a ladder and landing directly on heels (if that happens, seek immediate medical attention as you could have a significant injury like a heel or calcaneal fracture).

Two common complaints of foot pain are plantar fasciitis and diabetic neuropathy which have different causes and treatments.

PLANTAR FASCIITIS

Plantar fasciitis is one of the most common cause of orthopedic foot discomfort which stem from an injury to the plantar fasica (aka plantar aponeurosis), a deep fibrous tissue attached to the bottom of the heel and extending to the forefoot (balls of your feet). This tissue supports the arch of the foot while allowing for shock absorption during weight-bearing activities.

The damage or tearing of this strong piece of tissue can be caused by a variety of factors which place too much biomechanical stress on the plantar fascia. One of the most important factors in causing this condition would be decreased ankle mobility due primarily stiffness and inflexibility in the calf. Other factors could be increased weight-bearing (standing, walking, repetitive running), obesity, poor gait patterns, high or low arches, and improper footwear.

Usually, a person with plantar fasciitis will complain of significant discomfort upon the first step in the morning with extreme stiffness, tenderness at the bottom of the foot (especially the heel) and pain after resting once beginning another activity (after sitting for a movie or dinner).

Conservative treatment for plantar fasciitis usually consists of reducing stress on the plantar fascia which involves:

  1. Resting from aggravating activities like running or standing for long periods of time.
  2. Physical therapy (stretching of the calf complex, improving the ankle joint mobility, massage or soft tissue mobilization for the plantar fascia, modalities such as ultrasound as well as ice or heat).
  3. Over-the-counter or custom-made orthotics
  4. Night splint (devices to place a long duration but low stretch for the calf).

Home Exercises for Plantar Fasciitis (attach photos:

  1. Gastrocemis Stretch

  2. Soleus Stretch
  3. Plantar fascia stretch

  4. Self-massage with ball.

Finally, some individuals seek further medical intervention such as cortisone injections or PRP (plasma enriched protein) injections by the appropriate health care professional.

DIABETIC NEUROPATHY

On the other hand, diabetic neuropathy results from a sequelae of factors related to diabetes mellitus (DM), a chronic metabolic condition related to a lack of the effectiveness or production of the hormone insulin and elevated levels of sugar in the blood and urine.

Approximately 90-95% of all cases of DM are identified as Type II DM (lack of insulin effectiveness) which occur typically in the adult population but has been occurring more in children due to obesity. DM can have a host of risk factors which include: obesity, lack of physical activity, family history, race, age, predisposition to elevated levels of blood sugar.

This condition effects numerous body systems and will need a multi-factorial approach for management. Individuals with Type II DM will require consultation with the proper health care professionals to manage the disease process.

This condition causes damage and dysfunction affecting nerve fibers, first starting from the small nerve fibers (pain and heat nerve fibers) to the larger nerve fibers (balance, muscle and reflexes).  In relation to the feet, studies show that 1/5 to a 1/3 of these DM patients experience slowly progressive and unrelenting pain which can be described as burning, shooting, electrical, tingling, or numbness in the feet.

Despite the metabolic cause and no known cure at this time, individuals with Type II DM can benefit from reducing the severity of the foot symptoms with:

  1. Orthotics will reduce stress and strain on foot tissues and chance of injury or ulcer (wound).
  2. Foot Care: Due to foot numbness, individuals will need to check the soles of their feet daily to make sure a small object like a pebble does not cause a wound, leading to infections.
  3. Proper healthy diet
  4. Physical activity and exercise
  5. Glucose control in working with your physician.
  6. Reduce the associated cardiac complications.

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References

  1. Abbot CA et al. Prevalence and characteristics of painful diabetic neuropathy in a large community based diabetic population in UK. Diabetes Care. 2011 Oct; 34(10): 2220-2224.
  2. Atkins et al. A systematic review of treatments for the painful heel. Rheumatology. (Oxford) 1999. Oct; 38 (10): 968-973.
  3. Breiner A et al. Does the prevailing hypothesis that small fiber dysfunction procedes large-fiber dysfunction apply to Type I Diabetic patient. Diabetes Care. 2014 May;37 (5): 1418-1424.
  4. Beeson P. Plantar fasciopathy: revisiting the risk factors. Foot Ankle Surg. 2014 Sept; 20 (3): 160 – 165.
  5. Chen, Chien-Min et al. Comparative efficacy of corticosteroid injection and non-invasive treatments for plantar fasciitis: a systematic review and meta-analysis. Sci Rep. 2018; 8: 4033.
  6. Draghi F et al. Imaging of plantar fascia disorders: findings in plain radiography, US and MRI. Insights Imaging 2017 Feb; 8 (1): 69 – 78.
  7. Javed S et al. Clinical and diagnostic features of small fiber damage in diabetic polyneuropathy. Handb Clin Neurol. 2014; 126 (): 275 – 290.
  8. Knowler WC et al. Reduction in incidence of Type II diabetes with lifestyle intervention or metaformin. N Engl J Med. 2002 Feb 7; 346(6): 393 – 403.
  9. Kogle G et al. Biomechanics of longitudinal arch support mechanisms in foot orthoses and their affect on plantar aponeurosis strain. Clin Biomech 1996 Jul; 11(5): 243-252.
  10. Landfort KB and Menz HB. Plantar heel pain and fasciitis. BMJ Clinc Evid 2008 Feb 5; 2008. Pii: 1111.
  11. Lott DJ et al. Effect of footwear and orthotic devices on stress reduction – soft tissue strain of the Neuropathic Foot. Clin Biomech (Bristol, Avon) 2007 March; 22(3): 352 – 359.
  12. McNally EG and Shetty S Semin Musculoskelet Radiol. 2010 Sept; 14(3): 334 – 343.
  13. Riddle DL, Schapp SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004 May; 25(5): 303 – 10.
  14. Rosenbaum AJ et al.  Plantar heel pain. Med Clinic North Am 2014 Mar; 98(2): 339-352.
  15. Russel JW and Zillian LA. Diabetic Neuropathy. Continuum (Minneap Minn). 2014 Oct; 2015 Peripheral Nervous System Disorders); 1226-40.
  16. Smith et al. Lifestyle intervention for pre-diabetic neuropathy. Diabetes Care. 2006 Jun; 29(6): 1294-9.
  17. Theodorou D et al MR Imaging of abnormalities of the plantar fascia. Semin Musculoskelet. Radiol. 2002 June; 6(2): 105 – 118.
  18. Young C. In the clinic Plantar fasciitis. Ann Int Med 2012 Jun; 3 156.
  1. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-diabetes-and-risk-of-peripheral-neuropathy/
  1. https://www.medbridgeeducation.com/patient-education-library/condition/88-Plantar-Fasciitis
  1. HEP2Go.com (exercises)

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