Plantar fasciitis is a common, painful foot condition. Patients, and sometimes doctors often confuse the terms plantar fasciitis and heel spurs. Plantar fasciitis refers to the syndrome of inflammation of the band of tissue that runs from the heel along the arch of the foot; a heel spur is a hook of bone that can form on the heel bone (calcaneus). About 70% of patients with plantar fasciitis have been noted to have a heel spur that can be seen on x-ray. Plantar fasciitis is most often seen in middle-aged men and women, but can be found in all age groups. The condition is diagnosed with the classic symptoms of pain well focused deep in the heel area of the bottom of the foot. Often the pain from plantar fasciitis is most severe when you first stand on your feet in the morning. Pain often subsides quite quickly, but then returns after prolonged standing or walking. Plantar fasciitis is sometimes, but not always, associated with a rapid gain of weight. It is also sometimes seen in recreational athletes, especially runners. In these athletes, it is thought that the repetitive nature of the sports causes the damage to the fibrous tissue that forms the arch of the foot.
Plantar Fasciitis often leads to heel pain, heel spurs, and/or arch pain. The excessive stretching of the plantar fascia that leads to the inflammation and discomfort can be caused by the following: Over-pronation (flat feet) which results in the arch collapsing upon weight bearing A foot with an unusually high arch A sudden increase in physical activity Excessive weight on the foot, usually attributed to obesity or pregnancy Improperly fitting footwear Over-pronation (flat feet) is the leading cause of plantar fasciitis. Over-pronation occurs in the walking process, when a person's arch collapses upon weight bearing, causing the plantar fascia to be stretched away from the heel bone. With Plantar Fasciitis, the bottom of your foot usually hurts near the inside of the foot where the heel and arch meet. The pain is often acute either first thing in the morning or after a long rest, because while resting the plantar fascia contracts back to its original shape. As the day progresses and the plantar fascia continues to be stretched, the pain often subsides.
Plantar fasciitis is the inflammation of the plantar fascia - a band of tough fibrous tissue running along the sole of the foot. It occurs when small tears develop in the plantar fascia, leading to inflammation and heel pain. The plantar fascia tissue branches out from the heel like a fan, connecting the heel bone to the base of the toes. When the foot moves, the plantar fascia stretches and contracts. The plantar fascia helps to maintain the arch of the foot in much the same way that the string of a bow maintains the bow's arch. The most notable symptom of plantar fasciitis is heel pain. This is typically most severe in the middle of the heel though it may radiate along the sole of the foot. The pain is most often felt when walking first thing in the morning or after a period of rest. As walking continues the pain may decrease; however some degree of pain remains present on movement. The pain may disappear when resting, as the plantar fascia is relaxed. Redness, swelling and warmth over the affected area may also be noticed. The onset of plantar fasciitis is gradual and only mild pain may be experienced initially. However, as the condition progresses the pain experienced tends to become more severe. Chronic plantar fasciitis may cause a person to change their walking or running action, leading to symptoms of discomfort in the knee, hip and back.
During the physical exam, your doctor checks for points of tenderness in your foot. The location of your pain can help determine its cause. Usually no tests are necessary. The diagnosis is made based on the history and physical examination. Occasionally your doctor may suggest an X-ray or magnetic resonance imaging (MRI) to make sure your pain isn't being caused by another problem, such as a stress fracture or a pinched nerve. Sometimes an X-ray shows a spur of bone projecting forward from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain.
Non Surgical Treatment
Treatment for plantar fasciitis should begin with rest, icing, and over the counter medications. As mentioned above, an orthotic is a device that can be slipped into any pair of shoes and can often relieve pain and help to reverse the damage and occurrence of plantar fasciitis. They do this by adding support to the heel and helping to distribute weight during movement. In addition to orthotics, many people consider night splints for treating this condition. These devices are worn during the night while you sleep, helping to keep the plantar fascia stretched to promote healing. Physical therapy has also become a common option. With this conservative treatment alternative, a physical therapist designs a set of exercises that are intended to address your specific needs in order to promote healing.
Surgery for plantar fasciitis can be very successful in the right patients. While there are potential complications, about 70-80% of patients will find relief after plantar fascia release surgery. This may not be perfect, but if plantar fasciitis has been slowing you down for a year or more, it may well be worth these potential risks of surgery. New surgical techniques allow surgery to release the plantar fascia to be performed through small incisions using a tiny camera to locate and cut the plantar fascia. This procedure is called an endoscopic plantar fascia release. Some surgeons are concerned that the endoscopic plantar fascia release procedure increases the risk of damage to the small nerves of the foot. While there is no definitive answer that this endoscopic plantar fascia release is better or worse than a traditional plantar fascia release, most surgeons still prefer the traditional approach.
Factors that help prevent plantar fasciitis and reduce the risk of recurrence include. Exercises to strengthen the muscles of the lower leg and ankle. Warming up before commencing physical activity. Maintaining a healthy body weight. Avoiding high heeled footwear. Using orthotic devices such as arch supports and heel raises in footwear, particularly for people with very high arches or flat feet. Daily stretches of plantar fascia and Achilles tendon.