The plantar fascia is a ligament that connects the heel to the toes on the bottom of the foot. It lies just below the skin layers as it passes over the arch of the foot. A common ailment called
plantar fasciitis is the result of this ligament becomes inflamed. This can Foot anatomyhappen from injury, physical stress, or sometimes for no obvious reason. The most common point for this
inflammation is where this ligament joints the heel bone. Typical symptoms are the pain on the bottom of the foot near the heel usually most intense in the mornings when arising or after a long
period with little movement. The pain typically diminishes with movement. Many suffering from plantar fasciitis have heel spurs. Even though they are in the same area they are unrelated and the heel
spurs do not cause the plantar fasciitis. Most times heel spurs will not cause pain and in many go undetected unless they have an x-ray for some other reason.
There are a number of plantar fasciitis causes. The plantar fascia ligament is like a rubber band and loosens and contracts with movement. It also absorbs significant weight and pressure. Because of
this function, plantar fasciitis can easily occur from a number of reasons. Among the most common is an overload of physical activity or exercise. Athletes are particularly prone to plantar fasciitis
and commonly suffer from it. Excessive running, jumping, or other activities can easily place repetitive or excessive stress on the tissue and lead to tears and inflammation, resulting in moderate to
severe pain. Athletes who change or increase the difficulty of their exercise routines are also prone to overdoing it and causing damage. Another common cause of plantar fasciitis is arthritis.
Certain types of arthritis can cause inflammation to develop in tendons, resulting in plantar fasciitis. This cause is particularly common among elderly patients. Diabetes is also a factor that can
contribute to further heel pain and damage, particularly among the elderly. Among the most popular factors that contribute to plantar fasciitis is wearing incorrect shoes. In many cases, shoes either
do not fit properly, or provide inadequate support or cushioning. While walking or exercising in improper shoes, weight distribution becomes impaired, and significantly stress can be added to the
plantar fascia ligament.
The typical presentation is sharp pain localized at the anterior aspect of the calcaneus. Plantar fasciitis has a partial association with a heel spur (exostosis); however, many asymptomatic
individuals have bony heel spurs, whereas many patients with plantar fasciitis do not have a spur.
Plantar fasciitis is usually diagnosed by a health care provider after consideration of a personâs presenting history, risk factors, and clinical examination. Tenderness to palpation along the
inner aspect of the heel bone on the sole of the foot may be elicited during the physical examination. The foot may have limited dorsiflexion due to tightness of the calf muscles or the Achilles
tendon. Dorsiflexion of the foot may elicit the pain due to stretching of the plantar fascia with this motion. Diagnostic imaging studies are not usually needed to diagnose plantar fasciitis.
However, in certain cases a physician may decide imaging studies (such as X-rays, diagnostic ultrasound or MRI) are warranted to rule out other serious causes of foot pain. Bilateral heel pain or
heel pain in the context of a systemic illness may indicate a need for a more in-depth diagnostic investigation. Lateral view x-rays of the ankle are the recommended first-line imaging modality to
assess for other causes of heel pain such as stress fractures or bone spur development. Plantar fascia aponeurosis thickening at the heel greater than 5 millimeters as demonstrated by ultrasound is
consistent with a diagnosis of plantar fasciitis. An incidental finding associated with this condition is a heel spur, a small bony calcification on the calcaneus (heel bone), which can be found in
up to 50% of those with plantar fasciitis. In such cases, it is the underlying plantar fasciitis that produces the heel pain, and not the spur itself. The condition is responsible for the creation of
the spur though the clinical significance of heel spurs in plantar fasciitis remains unclear.
Non Surgical Treatment
Most health care providers agree that initial treatment for plantar fasciitis should be quite conservative. You'll probably be advised to avoid any exercise that is making your pain worse. Your
doctor may also advise one or more of these treatment options. A heel pad. In plantar fasciitis, a heel pad is sometimes used to cushion the painful heel if you spend a great deal of time on your
feet on hard surfaces. Also, over-the-counter or custom-made orthotics, which fit inside your shoes, may be constructed to address specific imbalances you may have with foot placement or gait.
Stretching: Stretching exercises performed three to five times a day can help elongate the heel cord. Ice: You may be advised to apply ice packs to your heel or to use an ice block to massage the
plantar fascia before going to bed each night. Pain relievers: Simple over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often helpful in decreasing inflammation
and pain. If you have stomach trouble from such drugs, your health care provider may prescribe an alternative. A night splint: A night splint is sometimes used to hold your foot at a specific angle,
which prevents the plantar fascia from shortening during sleep. Ultrasound: Ultrasound therapy can be performed to decrease inflammation and aid healing. Steroid injections: Anti-inflammatory steroid
injections directly into the tissue around your heel may be temporarily helpful. However, if these injections are used too many times, you may suffer other complications, such as shrinking of the fat
pad of your heel, which you need for insulation. Loss of the fat pad could actually increase your pain, or could even rupture the plantar fascia in rare cases. Walking cast: In cases of long-term
plantar fasciitis unresponsive to usual treatments, your doctor may recommend that you wear a short walking cast for about three weeks. This ensures that your foot is held in a position that allows
the plantar fascia to heal in a stretched, rather than shortened, position. Shock wave therapy, Extracorporeal shock wave therapy which may be prescribed prior to considering surgery if your symptoms
have persisted for more than six months. This treatment does not involve any actual incisions being made rather it uses a high intensity shock wave to stimulate healing of the plantar fascia.
If you consider surgery, your original diagnosis should be confirmed by the surgeon first. In addition, supporting diagnostic evidence (such as nerve-conduction studies) should be gathered to rule
out nerve entrapment, particularly of the first branch of the lateral plantar nerve and the medial plantar nerve. Blood tests should consist of an erythrocyte sedimentation rate (ESR), rheumatoid
factor, human leukocyte antigen B27 (HLA-B27), and uric acid. Itâs important to understand that surgical treatment of bone spurs rarely improves plantar fasciitis pain. And surgery for plantar
fasciitis can cause secondary complications-a troubling condition known as lateral column syndrome.
Stretching exercises for the Achilles tendon and plantar fascia are recommend to relieve pain and aid in the healing process. Sometimes application of athletic tape is recommended. In moderate or
severe cases of plantar fasciitis, your doctor may recommend you wearing a night splint, which will stretch the arch of your foot and calf while you sleep. This helps to lengthen the Achilles tendon
and plantar fascia for symptom relief. Depending on the severity of your plantar fasciitis, your physician may prescribe a store-bought orthotic (arch support) or custom-fitted orthotic to help
distribute your foot pressure more evenly.