Plantar fasciitis is a painful inflammation of the plantar fascia, a fibrous band of tissue on the bottom of the foot that helps to support the arch. Plantar fasciitis occurs when this band of tissue
is overloaded or overstretched. This causes small tears in the fibers of the fascia, especially where the fascia meets the heel bone. Plantar fasciitis is common in obese people and in pregnant
women, perhaps because their extra body weight overloads the delicate plantar fascia. It is also more common in people with diabetes, although the exact reason for this is unknown. Plantar fasciitis
also can be triggered by physical activities that overstretch the fascia, including sports (volleyball, running, tennis), other exercises (step aerobics, stair climbing) or household exertion
(pushing furniture or a large appliance). In athletes, plantar fasciitis may follow intense training, especially in runners who push themselves too quickly to run longer distances. Worn or poorly
constructed shoes can contribute to the problem if they do not provide enough arch support, heel cushion or sole flexibility.
Far and away the most common cause of plantar fasciitis in an athlete is faulty biomechanics of the foot or leg. Faulty biomechanics causes the foot to sustain increased or prolonged stresses over
and above those of routine ground contacts. Throughout the phase of ground contact, the foot assumes several mechanical positions to dissipate shock while at the same time placing the foot in the
best position to deliver ground forces. With heel landing the foot is supinated (ankle rolled out). At mid-stance the foot is pronated (ankle rolled in). The foot is supinated again with toe-off. The
supination of the foot at heel strike and toe-off makes the foot a rigid lever. At heel strike the shock of ground contact is transferred to the powerful quads. During toe-off forward motion is
created by contraction of the gastroc complex plantar flexing the rigid lever of the foot pushing the body forward.
The main symptom of plantar fasciitis is heel pain when you walk. You may also feel pain when you stand and possibly even when you are resting. This pain typically occurs first thing in the morning
after you get out of bed, when your foot is placed flat on the floor. The pain occurs because you are stretching the plantar fascia. The pain usually lessens with more walking, but you may have it
again after periods of rest. You may feel no pain when you are sleeping because the position of your feet during rest allows the fascia to shorten and relax.
Physical examination is the best way to determine if you have plantar fasciitis. Your doctor examines the affected area to determine if plantar fasciitis is the cause of your pain. The doctor may
also examine you while you are sitting, standing, and walking. It is important to discuss your daily routine with your doctor. An occupation in which you stand for long periods of time may cause
plantar fasciitis. An X-ray may reveal a heel spur. The actual heel spur is not painful. The presence of a heel spur suggests that the plantar fascia has been pulled and stretched excessively for a
long period of time, sometimes months or years. If you have plantar fasciitis, you may or may not have a heel spur. Even if your plantar fasciitis becomes less bothersome, the heel spur will
Non Surgical Treatment
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home. Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with
recovery. Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia. Ice. Putting an ice pack on your heel for 20 minutes several times a day helps
reduce inflammation. Place a thin towel between the ice and your heel,do not apply ice directly to the skin. Limit activities. Cut down on extended physical activities to give your heel a rest. Shoe
modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia. Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs),
such as ibuprofen, may be recommended to reduce pain and inflammation. If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these treatment
approaches. Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia. Orthotic devices. Custom orthotic devices
that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis. Injection therapy. In some cases, corticosteroid injections are used to help reduce the
inflammation and relieve pain. Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal. Night splint. Wearing a night
splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients. Physical therapy. Exercises and other
physical therapy measures may be used to help provide relief.
Plantar fasciotomy is often considered after conservative treatment has failed to resolve the issue after six months and is viewed as a last resort. Minimally invasive and endoscopic approaches to
plantar fasciotomy exist but require a specialist who is familiar with certain equipment. Heel spur removal during plantar fasciotomy has not been found to improve the surgical outcome. Plantar heel
pain may occur for multiple reasons and release of the lateral plantar nerve branch may be performed alongside the plantar fasciotomy in select cases. Possible complications of plantar fasciotomy
include nerve injury, instability of the medial longitudinal arch of the foot, fracture of the calcaneus, prolonged recovery time, infection, rupture of the plantar fascia, and failure to improve the
pain. Coblation (TOPAZ) surgery has recently been proposed as alternative surgical approaches for the treatment of recalcitrant plantar fasciitis.