Plantar fasciitis is a condition characterised by damage and inflammation to the plantar fascia (i.e. the connective tissue on the sole of the foot forming the inner arch. This usually occurs at the
attachment of the plantar fascia to the heel bone. Plantar fasciitis is the most common cause of heel pain seen in clinical practice. During walking or running, tension is placed through the plantar
fascia. When this tension is excessive (often due to poor foot biomechanics such as flat feet or if it is too repetitive or forceful, damage to the plantar fascia can occur. Plantar fasciitis is a
condition where there is damage to the plantar fascia with subsequent inflammation and degeneration. This may occur traumatically due to a high force going through the plantar fascia beyond what it
can withstand or, more commonly, due to gradual wear and tear associated with overuse. Occasionally, a heel spur may develop in association with plantar fasciitis.
The cause of plantar fasciitis is poorly understood and is thought to likely have several contributing factors. The plantar fascia is a thick fibrous band of connective tissue that originates from
the medial tubercle and anterior aspect of the heel bone. From there, the fascia extends along the sole of the foot before inserting at the base of the toes, and supports the arch of the foot.
Originally, plantar fasciitis was believed to be an inflammatory condition of the plantar fascia. However, within the last decade, studies have observed microscopic anatomical changes indicating that
plantar fasciitis is actually due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process. Due to this shift in thought about the underlying mechanisms in
plantar fasciitis, many in the academic community have stated the condition should be renamed plantar fasciosis. The structural breakdown of the plantar fascia is believed to be the result of
repetitive microtrauma (small tears). Microscopic examination of the plantar fascia often shows myxomatous degeneration, connective tissue calcium deposits, and disorganized collagen fibers.
Disruptions in the plantar fasciaâs normal mechanical movement during standing and walking (known as the Windlass mechanism) are thought to contribute to the development of plantar fasciitis by
placing excess strain on the calcaneal tuberosity.
The typical presentation is sharp pain localized at the anterior aspect of the calcaneus. Plantar fasciitis has a partial association with a heel spur (exostosis); however, many asymptomatic
individuals have bony heel spurs, whereas many patients with plantar fasciitis do not have a spur.
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 people who have plantar fasciitis recover with conservative treatments in just a few months. Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve) may ease the pain
and inflammation associated with plantar fasciitis. Stretching and strengthening exercises or use of specialized devices may provide symptom relief. These include physical therapy. A physical
therapist can instruct you in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist may also
teach you to apply athletic taping to support the bottom of your foot. Night splints. Your physical therapist or doctor may recommend wearing a splint that stretches your calf and the arch of your
foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and facilitates stretching. Orthotics. Your doctor may prescribe off-the-shelf heel cups,
cushions or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.
Most patients have good results from surgery. However, because surgery can result in chronic pain and dissatisfaction, it is recommended only after all nonsurgical measures have been exhausted. The
most common complications of release surgery include incomplete relief of pain and nerve damage.
Being overweight can place excess pressure and strain on your feet, particularly on your heels. Losing weight, and maintaining a healthy weight by combining regular exercise with a healthy, balanced
diet, can be beneficial for your feet. Wearing appropriate footwear is also important. Ideally, you should wear shoes with a low to moderate heel that supports and cushions your arches and heels.
Avoid wearing shoes with no heels.