Plantar fasciitis is a painful inflammatory process of the plantar fascia, a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along
the sole of the foot towards the five toes. Pain in the arch or heel often indicates inflammation of the long band of tissue under the foot (the plantar fascia). It can cause sharp pain and
discomfort in either the mid arch region or at the inside heel, and less commonly the outside heel. It frequently causes pain upon rising from rest (especially first thing in the morning) and can
progress to agony by the end of the day. Although plantar fasciitis is the most common cause of this pain, it must be skilfully differentially diagnosed from other conditions via a thorough history
taking and physical examination.
Plantar fasciitis is the most common injury of the plantar fascia and is the most common cause of heel pain. Approximately 10% of people have plantar fasciitis at some point during their lifetime. It
is commonly associated with long periods of standing and is much more prevalent in individuals with excessive inward rolling of the foot, which is seen with flat feet. Among non-athletic populations,
plantar fasciitis is associated with obesity and lack of physical exercise.
The symptoms of plantar fasciitis are pain on the bottom of the heel, pain in the arch of the foot, pain that is usually worse upon arising, pain that increases over a period of months. People with
plantar fasciitis often describe the pain as worse when they get up in the morning or after theyâve been sitting for long periods of time. After a few minutes of walking the pain decreases, because
walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.
X-rays are a commonly used diagnostic imaging technique to rule out the possibility of a bone spur as a cause of your heel pain. A bone spur, if it is present in this location, is probably not the
cause of your pain, but it is evidence that your plantar fascia has been exerting excessive force on your heel bone. X-ray images can also help determine if you have arthritis or whether other, more
rare problems, stress fractures, bone tumors-are contributing to your heel pain.
Non Surgical Treatment
Check your shoes to make sure they offer sufficient support and motion control. They should bend only at the ball of the foot, where your toes attach to the foot. This is very important. Avoid any
shoe that bends in the center of the arch or behind the ball of the foot. It offers insufficient support and will stress your plantar fascia. The human foot was not designed to bend here and neither
should a shoe be designed to do this. You may also strengthen the muscles in your arch by performing toe curls or "doming". Toe curls may be done by placing a towel on a kitchen floor and then
curling your toes to pull the towel towards you. This exercise may also be done without the towel against the resistance of the floor. Plantar fasciitis is usually controlled with conservative
treatment. Besides surgery and cortisone injections, physical therapy modalities such as electrical stimulation and ultrasound can be used. Often the foot will be taped to limit pronation. Following
control of the pain and inflammation an orthotic (a custom made shoe insert) can be used to control over-pronation.
Surgery is not a common treatment for this condition. Approximately 5% of people with plantar fasciitis require surgery if non-surgical methods do not help to relieve pain within a year. The surgical
procedure involves making an incision in the plantar fascia in order to decrease the tension of the ligament. Potential risks of this surgical procedure include irritation of the nerves around the
heel, continued plantar fasciitis, heel or foot pain, infection, flattening of the arch, problems relating to the anesthetic.