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.
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.
Patients with plantar fasciitis typically experience pain underneath the heel and along the inner sole of the foot. In less severe cases, patients may only experience an ache or stiffness in the
plantar fascia or heel that increases with rest (typically at night or first thing in the morning) following activities which place stress on the plantar fascia. These activities typically include
standing, walking or running excessively (especially up hills, on uneven surfaces or in poor footwear such as thongs), jumping, hopping and general weight bearing activity. The pain associated with
this condition may also warm up with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting
performance. In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Patients with this condition may also experience swelling, tenderness on firmly touching
the plantar fascia (often on a specific spot on the inner aspect of the heel) and sometimes pain on performing a plantar fascia stretch.
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
Give your painful heel lots of rest. You may need to stay completely off your foot for several days when the pain is severe. Your healthcare provider may recommend or prescribe anti-inflammatory
medicines, such as aspirin or ibuprofen. These drugs decrease pain and inflammation. Adults aged 65 years and older should not take non-steroidal anti-inflammatory medicine for more than 7 days
without their healthcare providerâs approval. Resting your heel on an ice pack for a few minutes several times a day can also help. Try to cushion your foot. You can do this by wearing athletic
shoes, even at work, for awhile. Heel cushions can also be used. The cushions should be worn in both shoes. They are most helpful if you are overweight or an older adult. Your provider may recommend
special arch supports or inserts for your shoes called orthotics, either custom-made or off the shelf. These supports can be particularly helpful if you have flat feet or high arches. Your provider
may recommend an injection of a cortisone-like medicine. Lose weight if needed. A night splint may be recommended. This will keep the plantar fascia stretched while you are sleeping. Physical therapy
for additional treatments may be recommended. Surgery is rarely needed.
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.