Plantar fasciitis is one of the most common conditions causing heel pain. The condition involves inflammation of the plantar fascia -- a tough, fibrous band of tissue that runs along the sole of the
foot with attachments to the heel bone (calcaneus) proximally and to the base of the toes distally. The plantar fascia provides support to the arch of the foot and has an important role in normal
foot mechanics during walking. Tension or stress in the plantar fascia increases when one places weight on the foot (such as with standing) and as one pushes off on the ball of the foot and toes --
motions which occur during normal walking or running. Inflammation and pain start in the fascia either as a result of an increase in activity level (as in initiating a walking or running program), or
in association with the normal aging process. With aging, the fascia loses some of its normal elasticity or resilience and can become irritated with routine daily activities. Less commonly, plantar
fasciitis can develop in association with general medical conditions such as lupus or rheumatoid arthritis.
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, 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.
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.
Most cases of plantar fasciitis are diagnosed by a health care provider who listens carefully to your description of symptoms. During an examination of your feet, your health care provider will have
to press on the bottom of your feet, the area most likely to be painful in plantar fasciitis. Because the pain of plantar fasciitis has unique characteristics, pain upon rising, improvement after
walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas, your health care provider will probably feel comfortable
making the diagnosis based on your symptoms and a physical examination. Your health care provider may suggest that you have an X-ray of your foot to verify that there is no stress fracture causing
Non Surgical Treatment
Talk to your doctor about the best treatment plan for you. Options include. Apply ice or a cold pack to the heel and arch for 15 to 20 minutes several times a day. Wrap the ice or cold pack in a
towel. Do not apply the ice directly to your skin. A special splint that will hold your foot in a neutral position while sleeping. Special shoe inserts that support the mid-arch region of your foot.
Inserts that are not customized may work just as well as those that are customized. Activity. Avoid running and other activities that may worsen pain. Begin stretching exercises to lengthen the
Achilles tendon and plantar fascia as recommended by your doctor. This is usually done when pain has lessened or improved. To help manage pain, your doctor may recommend over-the-counter nonsteroidal
anti-inflammatory medication (NSAIDs), such as ibuprofen or naproxen. Prescription pain relievers may also be required. Steroid injections may be used in some cases or if other treatment is not
working. A special type of sound wave called extracorporeal shock wave may also be considered in certain cases. This treatment happens under the care of your doctor. At this time, this is generally a
treatment for long-term cases that do not respond to other treatments. Massage therapy or accupuncture may also be effective for long-term cases. In a few cases, basic treatments don't help. Surgery
may be performed to cut the tight, swollen fascia.
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.