Plantar Fasciitis is a painful foot condition that affects the Plantar Fascia tendon that runs along the bottom of the foot (as seen in the picture). This tendon runs along the arches of the foot.
Sometimes this tendon can become sore from normal use or strenuous activity, but this is not to be confused with the pain associated with Plantar Fasciitis. Small tears in the plantar fascia tendon
can cause foot discomfort and pain, if left untreated, can become unbearable (seen in picture below). These tears are made worse by over-use, strenuous activity, weight gain, improper foot wear and a
variety of other factors. Although there is no one absolute cause for the condition, it remains clear that this condition, while painful, can be corrected with products such as footwear, night
splints, insoles and a variety of other plantar fasaciitis products.
Plantar fasciitis tends to strike those who overtrain, neglect to stretch their calf muscles, or overdo hill work and speedwork. Plantar fasciitis can also be caused by biomechanical flaws, including
flat, high-arched feet and a tight Achilles tendon; excessive pronation; sudden increases in training mileage; beginning speedwork; wearing worn running shoes; running on hard surfaces, like asphalt
or concrete; or wearing high heels all day before switching into flat running shoes.
The most common symptom is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn. The pain is often worse in the morning when
you take your first steps, after standing or sitting for awhile, when climbing stairs, after intense activity. The pain may develop slowly over time, or come on suddenly after intense activity.
Plantar fasciitis is usually diagnosed by a health care provider after consideration of a personâs presenting history, risk factors, and clinical examination. Tenderness to palpation along the
inner aspect of the heel bone on the sole of the foot may be elicited during the physical examination. The foot may have limited dorsiflexion due to tightness of the calf muscles or the Achilles
tendon. Dorsiflexion of the foot may elicit the pain due to stretching of the plantar fascia with this motion. Diagnostic imaging studies are not usually needed to diagnose plantar fasciitis.
However, in certain cases a physician may decide imaging studies (such as X-rays, diagnostic ultrasound or MRI) are warranted to rule out other serious causes of foot pain. Bilateral heel pain or
heel pain in the context of a systemic illness may indicate a need for a more in-depth diagnostic investigation. Lateral view x-rays of the ankle are the recommended first-line imaging modality to
assess for other causes of heel pain such as stress fractures or bone spur development. Plantar fascia aponeurosis thickening at the heel greater than 5 millimeters as demonstrated by ultrasound is
consistent with a diagnosis of plantar fasciitis. An incidental finding associated with this condition is a heel spur, a small bony calcification on the calcaneus (heel bone), which can be found in
up to 50% of those with plantar fasciitis. In such cases, it is the underlying plantar fasciitis that produces the heel pain, and not the spur itself. The condition is responsible for the creation of
the spur though the clinical significance of heel spurs in plantar fasciitis remains unclear.
Non Surgical Treatment
More than 90% of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods. Rest. Decreasing or even stopping the activities that make the pain worse is the
first step in reducing the pain. You may need to stop athletic activities where your feet pound on hard surfaces (for example, running or step aerobics). Ice. Rolling your foot over a cold water
bottle or ice for 20 minutes is effective. This can be done 3 to 4 times a day. Nonsteroidal anti-inflammatory medication. Drugs such as ibuprofen or naproxen reduce pain and inflammation. Using the
medication for more than 1 month should be reviewed with your primary care doctor. Exercise. Plantar fasciitis is aggravated by tight muscles in your feet and calves. Stretching your calves and
plantar fascia is the most effective way to relieve the pain that comes with this condition. Cortisone injections. Cortisone, a type of steroid, is a powerful anti-inflammatory medication. It can be
injected into the plantar fascia to reduce inflammation and pain. Your doctor may limit your injections. Multiple steroid injections can cause the plantar fascia to rupture (tear), which can lead to
a flat foot and chronic pain. Soft heel pads can provide extra support. Supportive shoes and orthotics. Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you
step and your heel strikes the ground, a significant amount of tension is placed on the fascia, which causes microtrauma (tiny tears in the tissue). A cushioned shoe or insert reduces this tension
and the microtrauma that occurs with every step. Soft silicone heel pads are inexpensive and work by elevating and cushioning your heel. Pre-made or custom orthotics (shoe inserts) are also helpful.
Night splints. Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you
sleep. Although it can be difficult to sleep with, a night splint is very effective and does not have to be used once the pain is gone. Physical therapy. Your doctor may suggest that you work with a
physical therapist on an exercise program that focuses on stretching your calf muscles and plantar fascia. In addition to exercises like the ones mentioned above, a physical therapy program may
involve specialized ice treatments, massage, and medication to decrease inflammation around the plantar fascia. Extracorporeal shockwave therapy (ESWT). During this procedure, high-energy shockwave
impulses stimulate the healing process in damaged plantar fascia tissue. ESWT has not shown consistent results and, therefore, is not commonly performed. ESWT is noninvasive-it does not require a
surgical incision. Because of the minimal risk involved, ESWT is sometimes tried before surgery is considered.
Surgery for plantar fasciitis can be very successful in the right patients. While there are potential complications, about 70-80% of patients will find relief after plantar fascia release surgery.
This may not be perfect, but if plantar fasciitis has been slowing you down for a year or more, it may well be worth these potential risks of surgery. New surgical techniques allow surgery to release
the plantar fascia to be performed through small incisions using a tiny camera to locate and cut the plantar fascia. This procedure is called an endoscopic plantar fascia release. Some surgeons are
concerned that the endoscopic plantar fascia release procedure increases the risk of damage to the small nerves of the foot. While there is no definitive answer that this endoscopic plantar fascia
release is better or worse than a traditional plantar fascia release, most surgeons still prefer the traditional approach.
Exercises designed to stretch both your calf muscles and your plantar fascia (the band of tissue that runs under the sole of your foot) should help relieve pain and improve flexibility in the
affected foot. A number of stretching exercises are described below. It's usually recommended that you do the exercises on both legs, even if only one of your heels is affected by pain. This will
improve your balance and stability, and help relieve heel pain. Towel stretches. Keep a long towel beside your bed. Before you get out of bed in the morning, loop the towel around your foot and use
it to pull your toes towards your body, while keeping your knee straight. Repeat three times on each foot. Wall stretches. Place both hands on a wall at shoulder height, with one of your feet in
front of the other. The front foot should be about 30cm (12 inches) away from the wall. With your front knee bent and your back leg straight, lean towards the wall until you feel a tightening in the
calf muscles of your back leg. Then relax. Repeat this exercise 10 times before switching legs and repeating the cycle. You should practise wall stretches twice a day. Stair stretches. Stand on a
step of your stairs facing upstairs, using your banister for support. Your feet should be slightly apart, with your heels hanging off the back of the step. Lower your heels until you feel a
tightening in your calves. Hold this position for about 40 seconds, before raising your heels back to the starting position. Repeat this procedure six times, at least twice a day. Chair stretches.
Sit on a chair, with your knees bent at right angles. Turn your feet sideways so your heels are touching and your toes are pointing in opposite directions. Lift the toes of the affected foot upwards,
while keeping the heel firmly on the floor. You should feel your calf muscles and Achilles tendon (the band of tissue that connects your heel bone to your calf muscle) tighten. Hold this position for
several seconds and then relax. Repeat this procedure 10 times, five to six times a day. Dynamic stretches. While seated, roll the arch of your foot (the curved bottom part of the foot between your
toes and heel) over a round object, such as a rolling pin, tennis ball or drinks can. Some people find that using a chilled can from their fridge has the added benefit of helping to relieve pain.
Move your foot and ankle in all directions over the object for several minutes. Repeat the exercise twice a day.