Plantar fasciitis is a painful inflammatory process of the plantar fascia, a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along
the sole of the foot towards the five toes. Pain in the arch or heel often indicates inflammation of the long band of tissue under the foot (the plantar fascia). It can cause sharp pain and
discomfort in either the mid arch region or at the inside heel, and less commonly the outside heel. It frequently causes pain upon rising from rest (especially first thing in the morning) and can
progress to agony by the end of the day. Although plantar fasciitis is the most common cause of this pain, it must be skilfully differentially diagnosed from other conditions via a thorough history
taking and physical examination.
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
Plantar fasciitis is characterized by the following signs and symptoms. Acute plantar fasciitis, pain is usually worse in the morning but may improve when activity continues; if the plantar fasciitis
is severe, activity will exacerbate the pain, pain will worsen during the day and may radiate to calf or forefoot, pain may be described anywhere from "minor pulling" sensation, to "burning", or to
"knife-like", the plantar fascia may be taut or thickened, passive stretching of the plantar fascia or the patient standing on their toes may exacerbate symptoms, acute tenderness deep in the
heel-pad along the insertion of the plantar aponeurosis at the medial calcaneal tuberosity and along the length of the plantar fascia, may have localized swelling. Chronic plantar fasciitis, plantar
fasciitis is classified as "chronic" if it has not resolved after six months, pain occurs more distally along the aponeurosis and spreads into the Achilles tendon.
Diagnosis of plantar fasciitis is based on a medical history, the nature of symptoms, and the presence of localised tenderness in the heel. X-rays may be recommended to rule out other causes for the
symptoms, such as bone fracture and to check for evidence of heel spurs. Blood tests may also be recommended.
Non Surgical Treatment
In general, plantar fasciitis is a self-limiting condition. Unfortunately, the time until resolution is often six to 18 months, which can lead to frustration for patients and physicians. Rest was
cited by 25 percent of patients with plantar fasciitis in one study as the treatment that worked best. Athletes, active adults and persons whose occupations require lots of walking may not be
compliant if instructed to stop all activity. Many sports medicine physicians have found that outlining a plan of ârelative restâ that substitutes alternative forms of activity for activities
that aggravate the symptoms will increase the chance of compliance with the treatment plan. It is equally important to correct the problems that place individuals at risk for plantar fasciitis, such
as increased amount of weight-bearing activity, increased intensity of activity, hard walking/running surfaces and worn shoes. Early recognition and treatment usually lead to a shorter course of
treatment as well as increased probability of success with conservative treatment measures.
Surgery is rarely used in the treatment of plantar fasciitis. However it may be recommended when conservative treatment has been tried for several months but does not bring adequate relief of
symptoms. Surgery usually involves the partial release of the plantar fascia from the heel bone. In approximately 75% of cases symptoms are fully resolved within six months. In a small percentage of
cases, symptoms may take up to 12 months to fully resolve.
There are certain things that you can do to try to prevent plantar fasciitis, especially if you have had it before. These include regularly changing training shoes used for running or walking.
Wearing shoes with good cushioning in the heels and good arch support. Losing weight if you are overweight. Regularly stretching the plantar fascia and Achilles tendon, especially before exercise.
Avoiding exercising on hard surfaces.