Plantar fasciitis is the most common cause of heel pain. It can be caused by inadequate or inappropriate footwear, weight gain, or a particular exercise or activity. It is common for plantar
fasciitis symptoms to affect only one foot at a time. Treatment focuses on reducing pain and inflammation. Chronic (long-term) plantar fasciitis can lead to a build-up of bone (a "spur") at the point
where the plantar fascia connects to the heel bone. For this reason plantar fasciitis is sometimes referred to as "heel spur syndrome".
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.
Plantar fasciitis and heel spur pain usually begins in the bottom of the heel, and frequently radiates into the arch. At times, however, the pain may be felt only in the arch. The pain is most
intense when first standing, after any period of rest. Most people with this problem experience their greatest pain in the morning, with the first few steps after sleeping. After several minutes of
walking, the pain usually becomes less intense and may disappear completely, only to return later with prolonged walking or standing. If a nerve is irritated due to the swollen plantar fascia, this
pain may radiate into the ankle. In the early stages of Plantar Fasciitis and Heel Spurs, the pain will usually subside quickly with getting off of the foot and resting. As the disease progresses, it
may take longer periods of time for the pain to subside.
Your doctor will perform a physical exam to check for tenderness in your foot and the exact location of the pain to make sure that itâs not caused by a different foot problem. The doctor may ask
you to flex your foot while he or she pushes on the plantar fascia to see if the pain gets worse as you flex and better as you point your toe. Mild redness or swelling will also be noted. Your doctor
will evaluate the strength of your muscles and the health of your nerves by checking your reflexes, your muscle tone, your sense of touch and sight, your coordination, and your balance. X-rays or a
magnetic resonance imaging (MRI) scan may be ordered to check that nothing else is causing your heel pain, such as a bone fracture.
Non Surgical Treatment
Your doctor will determine what treatment is best for your condition. The most common treatments for plantar fasciitis include icing the affected area, inserting custom-made orthotics into your
shoes, massaging the plantar fascia, nonsteroidal anti-inflammatory drugs (NSAIDs), steroid injections, strengthening the foot, wearing a night splint, wearing shoes with arch support, physical
therapy, stretching the calf muscles, shockwave therapy or radiotherapy. To keep the plantar fascia lengthened as you sleep, your doctor may ask you to wear night splints. In the morning, taking your
first steps is less painful because the plantar fascia remains stretched throughout the night. Avoiding activities such as walking or running helps the healing process. Losing weight, if it is a
factor in the condition, may help to reduce the stress placed on the plantar fascia.
The majority of patients, about 90%, will respond to appropriate non-operative treatment measures over a period of 3-6 months. Surgery is a treatment option for patients with persistent symptoms, but
is NOT recommended unless a patient has failed a minimum of 6-9 months of appropriate non-operative treatment. There are a number of reasons why surgery is not immediately entertained including.
Non-operative treatment when performed appropriately has a high rate of success. Recovery from any foot surgery often takes longer than patients expect. Complications following this type of surgery
can and DO occur! The surgery often does not fully address the underlying reason why the condition occurred therefore the surgery may not be completely effective. Prior to surgical intervention, it
is important that the treating physician ensure that the correct diagnosis has been made. This seems self-evident, but there are other potential causes of heel pain. Surgical intervention may include
extracorporeal shock wave therapy or endoscopic or open partial plantar fasciectomy.
Stretching your plantar fasciitis is something you can do at home to relieve pain and speed healing. Ice massage performed three to four times per day in 15 to 20 minute intervals is also something
you can do to reduce inflammation and pain. Placing arch supports in your shoes absorbs shock and takes pressure off the plantar fascia.