The deep plantar fascia (plantar aponeurosis) is a thick, pearly-white tissue with longitudinal fibers intimately attached to the skin. Plantar fasciitis, characterized by pain in the plantar region
of the foot that is worse when initiating walking, is one of the most common causes of foot and heel pain in adults. A large number of additional disorders can cause foot and heel pain. These include
Achilles tendinopathy, Haglundâs syndrome, Stress fractures due to osteoporosis.
You are more likely to develop plantar fasciitis if you are Active, sports that place excessive stress on the heel bone and attached tissue, especially if you have tight calf muscles or a stiff ankle
from a previous ankle sprain, which limits ankle movement eg. Running, ballet dancing and aerobics. Overweight. Carrying around extra weight increases the strain and stress on your plantar fascia.
Pregnant. The weight gain and swelling associated with pregnancy can cause ligaments to become more relaxed, which can lead to mechanical problems and inflammation. On your feet. Having a job that
requires a lot of walking or standing on hard surfaces ie factory workers, teachers and waitresses. Flat Feet or High Foot Arches. Changes in the arch of your foot changes the shock absorption
ability and can stretch and strain the plantar fascia, which then has to absorb the additional force. Middle-Aged or Older. With ageing the arch of your foot may begin to sag - putting extra stress
on the plantar fascia. Wearing shoes with poor support. Weak Foot Arch Muscles. Muscle fatigue allows your plantar fascia to overstress and cause injury. Arthritis. Some types of arthritis can cause
inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis. Diabetes. Although doctors don't know why, plantar fasciitis occurs more often in people with
Symptoms of the plantar fasciitis include a gradual onset of pain under the heel which may radiate into the foot. Tenderness is usually felt under and on the inside of the heel which is initially
worse first in the morning but eases as the foot warms up only to return later in the day or after exercise. Stretching the plantar fascia may be painful.
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
More than 90% of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods. Rest. Decreasing or even stopping the activities that make the pain worse is the
first step in reducing the pain. You may need to stop athletic activities where your feet pound on hard surfaces (for example, running or step aerobics). Ice. Rolling your foot over a cold water
bottle or ice for 20 minutes is effective. This can be done 3 to 4 times a day. Nonsteroidal anti-inflammatory medication. Drugs such as ibuprofen or naproxen reduce pain and inflammation. Using the
medication for more than 1 month should be reviewed with your primary care doctor. Exercise. Plantar fasciitis is aggravated by tight muscles in your feet and calves. Stretching your calves and
plantar fascia is the most effective way to relieve the pain that comes with this condition. Cortisone injections. Cortisone, a type of steroid, is a powerful anti-inflammatory medication. It can be
injected into the plantar fascia to reduce inflammation and pain. Your doctor may limit your injections. Multiple steroid injections can cause the plantar fascia to rupture (tear), which can lead to
a flat foot and chronic pain. Soft heel pads can provide extra support. Supportive shoes and orthotics. Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you
step and your heel strikes the ground, a significant amount of tension is placed on the fascia, which causes microtrauma (tiny tears in the tissue). A cushioned shoe or insert reduces this tension
and the microtrauma that occurs with every step. Soft silicone heel pads are inexpensive and work by elevating and cushioning your heel. Pre-made or custom orthotics (shoe inserts) are also helpful.
Night splints. Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you
sleep. Although it can be difficult to sleep with, a night splint is very effective and does not have to be used once the pain is gone. Physical therapy. Your doctor may suggest that you work with a
physical therapist on an exercise program that focuses on stretching your calf muscles and plantar fascia. In addition to exercises like the ones mentioned above, a physical therapy program may
involve specialized ice treatments, massage, and medication to decrease inflammation around the plantar fascia. Extracorporeal shockwave therapy (ESWT). During this procedure, high-energy shockwave
impulses stimulate the healing process in damaged plantar fascia tissue. ESWT has not shown consistent results and, therefore, is not commonly performed. ESWT is noninvasive-it does not require a
surgical incision. Because of the minimal risk involved, ESWT is sometimes tried before surgery is considered.
The most common surgical procedure for plantar fasciitis is plantar fascia release. It involves surgical removal of a part from the plantar fascia ligament which will relieve the inflammation and
reduce the tension. Plantar fascia release is either an open surgery or endoscopic surgery (insertion of special surgical instruments through small incisions). While both methods are performed under
local anesthesia the open procedure may take more time to recover. Other surgical procedures can be used as well but they are rarely an option. Complications of plantar fasciitis surgery are rare but
they are not impossible. All types of plantar fasciitis surgery pose a risk of infection, nerve damage, and anesthesia related complications including systemic toxicity, and persistence or worsening
of heel pain.