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.
Plantar fasciitis occurs because of irritation to the thick ligamentous connective tissue that runs from the heel bone to the ball of the foot. This strong and tight tissue contributes to maintaining
the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. Therefore, the stress placed on the this tissue is tremendous.
Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But
your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time. If you have foot pain at night, you may have a different problem, such as
arthritis, or a nerve problem such as tarsal tunnel syndrome.
To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain
other than plantar fasciitis. In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are
found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.
Non Surgical Treatment
Most health care providers agree that initial treatment for plantar fasciitis should be quite conservative. You'll probably be advised to avoid any exercise that is making your pain worse. Your
doctor may also advise one or more of these treatment options. A heel pad. In plantar fasciitis, a heel pad is sometimes used to cushion the painful heel if you spend a great deal of time on your
feet on hard surfaces. Also, over-the-counter or custom-made orthotics, which fit inside your shoes, may be constructed to address specific imbalances you may have with foot placement or gait.
Stretching: Stretching exercises performed three to five times a day can help elongate the heel cord. Ice: You may be advised to apply ice packs to your heel or to use an ice block to massage the
plantar fascia before going to bed each night. Pain relievers: Simple over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in decreasing inflammation
and pain. If you have stomach trouble from such drugs, your health care provider may prescribe an alternative. A night splint: A night splint is sometimes used to hold your foot at a specific angle,
which prevents the plantar fascia from shortening during sleep. Ultrasound: Ultrasound therapy can be performed to decrease inflammation and aid healing. Steroid injections: Anti-inflammatory steroid
injections directly into the tissue around your heel may be temporarily helpful. However, if these injections are used too many times, you may suffer other complications, such as shrinking of the fat
pad of your heel, which you need for insulation. Loss of the fat pad could actually increase your pain, or could even rupture the plantar fascia in rare cases. Walking cast: In cases of long-term
plantar fasciitis unresponsive to usual treatments, your doctor may recommend that you wear a short walking cast for about three weeks. This ensures that your foot is held in a position that allows
the plantar fascia to heal in a stretched, rather than shortened, position. Shock wave therapy, Extracorporeal shock wave therapy which may be prescribed prior to considering surgery if your symptoms
have persisted for more than six months. This treatment does not involve any actual incisions being made rather it uses a high intensity shock wave to stimulate healing of the plantar fascia.
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue
to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you. No matter what
kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive
shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.
You can help to prevent plantar fasciitis by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch and cushion the heel. In people who
are prone to episodes of plantar fasciitis, exercises that stretch the heel cord (known as the Achilles tendon) and the plantar fascia may help to prevent plantar fasciitis from returning. Ice
massage also can be used on the bottom of the foot after stressful athletic activities. It is possible that strict control of blood sugar will prevent plantar fasciitis in people with diabetes,
although this has not been proven.