WHEATON • ROCKVILLE • CHEVY CHASE • WASHINGTON, DC Foot Pain & Psoriatic Arthritis

Daniel El-Bogdadi, MD, FACR Arthritis and Rheumatism Associates, P.C.

Do you feel heel pain in the Plantar fasciitis ARTHRITIS morning or after a period of can be caused by inactivity? This might be an a number AND indication of plantar fasciitis that of factors, RHEUMATISM could be part of an underlying including aerobic ASSOCIATES, P.C. psoriatic arthritis condition. dance exercise, running, and Board Certified Rheumatologists Psoriatic arthritis is an inflammatory ballet. arthritis that typically causes pain, Herbert S.B. Baraf MD FACP MACR swelling and stiffness in the Robert L. Rosenberg peripheral joints or spine. However, MD FACR CCD if you have psoriatic arthritis, you Evan L. Siegel may notice that not only are the MD FACR joints and spine involved, but Emma DiIorio symptoms may also occur in the soft MD FACR tissue such as tendons or ligaments. David G. Borenstein MD MACP MACR This usually happens in a place Alan K. Matsumoto where tendons and ligaments attach There are several treatment options MD FACP FACR to bone, known as the enthesis. for plantar fasciitis: David P. Wolfe When this attachment gets inflamed MD FACR it is called enthesitis. • The first immediate intervention is Paul J. DeMarco MD FACP FACR to decrease or stop any Shari B. Diamond One of the more common areas to repetitive activities, such as MD FACP FACR get enthesitis is in the Achilles running or dancing, which may Ashley D. Beall tendon. Another common area for aggravate the condition. MD FACR inflammation is in thick band of (over) Angus B. Worthing MD FACR connective tissue that runs along the Guada Respicio bottom of the foot, known as the MD MS FACP FACR plantar fascia. When this gets Justin Peng inflamed, it is commonly referred to MD FACR as plantar fasciitis. Usually you will Rachel Kaiser MD MPH FACP FACR feel heel pain that is worse with the Nicole Saddic Thomas first steps in the morning or after a MD FACR period of inactivity, or worse at the Daniel El-Bogdadi end of the day. MD FACR CENTRAL CALL CENTER 301.942.7600 www.washingtonarthritis.com ARTHRITIS AND RHEUMATISM ASSOCIATES, P.C. Board Certified Rheumatologists

• Ice may also help; rolling your foot Despite these measures, your heel make sure medication is properly over a cold water bottle or ice pack pain may persist and more targeted delivered to the right location, for 20 minutes, 3 to 4 times a day, therapy may be needed. avoiding multiple steroid can ease pain and inflammation. injections, or to target appropriate Corticosteroids (cortisone) are surgical measures. • Non-steroidal anti-inflam- powerful anti-inflammatory matory drugs (NSAIDs), such medications that can be injected As a forerunner in the specialty of as ibuprofen or naproxen, can also directly into the plantar fascia and rheumatology, the physicians of help to reduce pain and swelling. can be very effective to locally Arthritis and Rheumatism reduce inflammation and pain. Associates, P.C. have been using • Regular stretching is often However, these should not be musculoskeletal ultrasound (MSK beneficial, but may be difficult to administered repeatedly, since US) since 2007 and are nationally do on your own; working with a repeated corticosteroid injections recognized as experts in this field. physical therapist may help you to may cause heel pad atrophy or properly stretch the plantar fascia. rupture of the plantar fascia tissue. ARA has incorporated the use of ultrasound as a diagnostic tool as • Orthotics (shoe inserts) may be If more conservative treatments fail, well as a procedural treatment helpful, especially if you have flat a fasciotomy or fasciectomy can be modality for aspirations and feet or a high arch. performed. This is a surgical injections. procedure where the fascia is cut to • Night splints may also be useful relieve tension or pressure. In some While the technology of and work to stretch the tendon by cases, ultrasound guidance may be ultrasound has been around for putting the foot in dorsiflexion used to perform a less invasive approximately 50 years, it has not (pulling the toes up). percutaneous (through the skin) been widely utilized by fasciotomy to treat plantar fascitis. rheumatologists until recently. • Medications or disease modifying With ultrasound our physicians agents (DMARDs) which treat Ultrasound guidance is often used can execute a procedure with psoriatic arthritis may help to treat for both corticosteroid injection more precision and more comfort inflammation of the plantar fascia. and percutaneous fasciotomy to to a patient. n

Precision Ultrasound Guided Injection for Plantar Fasciitis

CENTRAL CALL CENTER 301.942.7600 www.washingtonarthritis.com