Plantar fasciitis refers to an inflammation of the plantar fascia, a thick, fibrous band running along the sole of the foot. Such inflammation results from direct injury to the plantar fascia,
usually, repeated trauma to the tissue where the fascia attaches to the calcaneus or heel bone. The plantar fascia is critical in maintaining the footâs complex arch system, also playing a role in
balance and fine control of certain phases of the athleteâs gait. Injury to the plantar fascia is particularly painful and disabling for runners and can often prove stubbornly resistant to
treatment. Rehabilitation is frequently a lengthy and frustrating process. For these reasons, care should be taken where possible to avoid such injury by means of preventative exercises and
sensitivity to early warning signs.
The plantar fascia can also become aggravated by repetitive activity. If you increase the number of times the heel hits the ground, that can cause plantar fasciitis, a number of people develop
problems when their feet are unaccustomed to hard tile or wood floors. Other risk factors for plantar fasciitis include obesity, an extra high or low foot arch, and activities like running.
The pain is more intense with your first steps out of bed in the morning or after sitting for a while. The reason for this is that during rest our muscles and ligaments tend to shorten and tighten
up. The tightening of the plantar fascia means more traction on the ligament making the tissue even more sensitive. With sudden weight-bearing the tissue is being traumatised, resulting in a stabbing
pain. After walking around for a while the ligament warms up, becomes a little bit more flexible and adapts itself, making the pain go way entirely or becoming more of a dull ache. However, after
walking a long distance or standing for hours the pain will come back again. To prevent the sudden sharp pain in the morning or after sitting, it is important to give the feet a little warm-up first
with some simple exercises. Also, any barefoot walking should be avoided, especially first thing in the morning, as this will damage to the plantar fascia tissue. Aparty from pain in the heel or
symptoms may include a mild swelling under the heel. In addition, heel pain is often associated with tightness in the calf muscles. Tight calf muscles are a major contributing factor to Plantar
The health care provider will perform a physical exam. This may show tenderness on the bottom of your foot, flat feet or high arches, mild foot swelling or redness, stiffness or tightness of the arch
in the bottom of your foot. X-rays may be taken to rule out other problems.
Non Surgical Treatment
A change to properly fitting, appropriate shoes may be useful in some patients. Some individuals wear shoes that are too small, which can exacerbate many types of foot pain. Patients often find that
wearing shoes with thicker, well-cushioned midsoles, usually made of a material like high-density ethylene vinyl acetate (such as is found in many running shoes), decreases the pain associated with
long periods of walking or standing. Studies have shown that with age, running shoes lose a significant portion of their shock absorption. Thus, simply getting a new pair of shoes may be helpful in
decreasing pain. For individuals with flat feet, motion control shoes or shoes with better longitudinal arch support may decrease the pain associated with long periods of walking or standing. Motion
control shoes usually have the following characteristics: a straight last, board or combination lasted construction, an external heel counter, a wider flare and extra medial support. A change in
shoes was cited by 14 percent of patients with plantar fasciitis as the treatment that worked best for them.
If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles
and joints, a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting
their career. Plantar release surgery. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the
tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as, open surgery, where the section of the plantar fascia is
released by making a cut into your heel, endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the
plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open
surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to
choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with
all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the
advantages and disadvantages of both techniques with your surgical team. Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve
making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your
heel. It is claimed that EST works in two ways. It is thought to, have a "numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process.
However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE
states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective
than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).