Plantar fasciitis refers to an inflammation of the plantar fascia, a thick, fibrous band running along the sole of the foot. Such inflammation results from direct injury to the plantar fascia,
usually, repeated trauma to the tissue where the fascia attaches to the calcaneus or heel bone. The plantar fascia is critical in maintaining the footâs complex arch system, also playing a role in
balance and fine control of certain phases of the athleteâs gait. Injury to the plantar fascia is particularly painful and disabling for runners and can often prove stubbornly resistant to
treatment. Rehabilitation is frequently a lengthy and frustrating process. For these reasons, care should be taken where possible to avoid such injury by means of preventative exercises and
sensitivity to early warning signs.
Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling. This is more likely to happen
if your feet roll inward too much when you walk ( excessive pronation ). You have high arches or flat feet. You walk, stand, or run for long periods of time, especially on hard surfaces. You are
overweight. You wear shoes that don't fit well or are worn out. You have tight Achilles tendons or calf muscles.
Plantar fasciosis is characterized by pain at the bottom of the heel with weight bearing, particularly when first arising in the morning; pain usually abates within 5 to 10 min, only to return later
in the day. It is often worse when pushing off of the heel (the propulsive phase of gait) and after periods of rest. Acute, severe heel pain, especially with mild local puffiness, may indicate an
acute fascial tear. Some patients describe burning or sticking pain along the plantar medial border of the foot when walking.
Plantar fasciosis is confirmed if firm thumb pressure applied to the calcaneus when the foot is dorsiflexed elicits pain. Fascial pain along the plantar medial border of the fascia may also be
present. If findings are equivocal, demonstration of a heel spur on x-ray may support the diagnosis; however, absence does not rule out the diagnosis, and visible spurs are not generally the cause of
symptoms. Also, infrequently, calcaneal spurs appear ill defined on x-ray, exhibiting fluffy new bone formation, suggesting spondyloarthropathy (eg, ankylosing spondylitis, reactive arthritis. If an
acute fascial tear is suspected, MRI is done.
Non Surgical Treatment
The following recommendations are appropriate. Wear shoes with adequate arch support and cushioned heels; discard old running shoes and wear new ones; rotate work shoes daily. Avoid long periods of
standing. Lose weight. Stretch the plantar fascia and warm up the lower extremity before participating in exercise. For increased flexibility, stretch the plantar fascia and the calf after exercise.
Do not exercise on hard surfaces. Avoid walking barefooted on hard surfaces. Avoid high-impact sports that require a great deal of jumping (eg, aerobics and volleyball). Apply ice for 20 minutes
after repetitive impact-loading activities and at the end of the day. Limit repetitive impact-loading activities such as running to every other day, and consider rest or cross-training for nonrunning
When more-conservative measures aren't working, your doctor might recommend steroid shots. Injecting a type of steroid medication into the tender area can provide temporary pain relief. Multiple
injections aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone. Extracorporeal shock wave therapy.
In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It's usually used for chronic plantar fasciitis that hasn't responded to more-conservative treatments. This
procedure may cause bruises, swelling, pain, numbness or tingling and has not been shown to be consistently effective. Surgery. Few people need surgery to detach the plantar fascia from the heel
bone. It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.
In one exercise, you lean forward against a wall with one knee straight and heel on the ground. Your other knee is bent. Your heel cord and foot arch stretch as you lean. Hold for 10 seconds, relax
and straighten up. Repeat 20 times for each sore heel. It is important to keep the knee fully extended on the side being stretched. In another exercise, you lean forward onto a countertop, spreading
your feet apart with one foot in front of the other. Flex your knees and squat down, keeping your heels on the ground as long as possible. Your heel cords and foot arches will stretch as the heels
come up in the stretch. Hold for 10 seconds, relax and straighten up. Repeat 20 times. About 90 percent of people with plantar fasciitis improve significantly after two months of initial treatment.
You may be advised to use shoes with shock-absorbing soles or fitted with an off-the-shelf shoe insert device like a rubber heel pad. Your foot may be taped into a specific position. If your plantar
fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medication. If you still have symptoms, you may need to wear a
walking cast for two to three weeks or a positional splint when you sleep. In a few cases, surgery is needed for chronically contracted tissue.