Plantar Fasciitis is the Latin term for "inflammation of the plantar fascia". The plantar fascia is a thick, fibrous ligament that runs under the foot from the heel bone to the toes. It forms the
arch of the foot and functions as our natural shock-absorbing mechanism. Unlike muscle tissue, the plantar fascia is not very elastic and therefore is very limited in its capacity to stretch or
elongate. Herein lies the problem, when too much traction is placed on the plantar fascia (for various reasons) micro-tearing will occur, resulting in irritation, inflammation and pain. Plantar
Fasciitis usually causes pain under the heel. However some people may experience pain under the arch of the foot. Both heel pain and arch discomfort are related to Plantar Fasciitis, with heel pain
being far more common than arch pain.
Repeated small injuries to the fascia (with or without inflammation) are thought to be the cause of plantar fasciitis. The injury is usually near to where the plantar fascia attaches to your heel
bone. You are more likely to injure your plantar fascia in certain situations. For example, if you are on your feet for a lot of the time, or if you do lots of walking, running, standing, etc, when
you are not used to it. (Plantar fasciitis may be confused with 'Policeman's heel', but they are different. Policeman's heel is plantar calcaneal bursitis - inflammation of the sack of fluid (bursa)
under the heel bone. This is not as common as plantar fasciitis.) Also, people with a sedentary lifestyle are more prone to plantar fasciitis. If you have recently started exercising on a different
surface, for example, running on the road instead of a track. If you have been wearing shoes with poor cushioning or poor arch support. If you are overweight this will put extra strain on your heel.
If there is overuse or sudden stretching of your sole. For example, athletes who increase running intensity or distance; poor technique starting 'off the blocks', etc. If you have a tight Achilles
tendon (the big tendon at the bottom of your calf muscles above your heel). This can affect your ability to flex your ankle and make you more likely to damage your plantar fascia. Often there is no
apparent cause for plantar fasciitis, particularly in older people. A common wrong belief is that the pain is due to a bony growth or 'spur' coming from the heel bone (calcaneum). Many people have a
bony spur of the heel bone but not everyone with this gets plantar fasciitis.
Heel pain is the most common symptom associated with plantar fasciosis. Your heel pain may be worse in the morning or after you have been sitting or standing for long periods. Pain is most common
under your heel bone, but you also may experience pain in your foot arch or on the outside aspect of your foot. Other common signs and symptoms of plantar fasciosis include mild swelling and redness
in your affected area, tenderness on the bottom of your heel, impaired ability to ambulate.
After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs. A high arch, an area of maximum tenderness on the bottom of your
foot, just in front of your heel bone. Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down. Limited "up" motion
of your ankle. Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in
ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not
routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.
Non Surgical Treatment
In general, we start by correcting training errors. This usually requires relative rest, the use of ice after activities, and an evaluation of the patient's shoes and activities. Next, we try
correction of biomechanical factors with a stretching and strengthening program. If the patient still has no improvement, we consider night splints and orthotics. Finally, all other treatment options
are considered. Non-steroidal anti-inflammatory medications are considered throughout the treatment course, although we explain to the patient that this medicine is being used primarily for pain
control and not to treat the underlying problem.
When more conservative methods have failed to reduce plantar fasciitis pain, your doctor may suggest extracorporeal shock wave therapy, which is used to treat chronic plantar fasciitis.
Extracorporeal shock wave therapy uses sound waves to stimulate healing, but may cause bruises, numbness, tingling, swelling, and pain. When all else fails, surgery may be recommended to detach the
plantar fascia from the heel bone. Few people need surgery to treat the condition.