Plantar Fasciitis is an inflammation caused by excessive stretching of the plantar fascia. The plantar fascia is a broad band of fibrous tissue which runs along the bottom surface of the foot,
attaching at the bottom of the heel bone and extending to the forefoot. When the plantar fascia is excessively stretched, this can cause plantar fasciitis, which can also lead to heel pain, arch
pain, and heel spurs.
The cause of plantar fasciitis is often unclear and may be multifactorial. Because of the high incidence in runners, it is best postulated to be caused by repetitive microtrauma. Possible risk
factors include obesity, occupations requiring prolonged standing and weight-bearing, and heel spurs. Other risk factors may be broadly classified as either extrinsic (training errors and equipment)
or intrinsic (functional, structural, or degenerative). Training errors are among the major causes of plantar fasciitis. Athletes usually have a history of an increase in distance, intensity, or
duration of activity. The addition of speed workouts, plyometrics, and hill workouts are particularly high-risk behaviors for the development of plantar fasciitis. Running indoors on poorly cushioned
surfaces is also a risk factor. Appropriate equipment is important. Athletes and others who spend prolonged time on their feet should wear an appropriate shoe type for their foot type and activity.
Athletic shoes rapidly lose cushioning properties. Athletes who use shoe-sole repair materials are especially at risk if they do not change shoes often. Athletes who train in lightweight and
minimally cushioned shoes (instead of heavier training flats) are also at higher risk of developing plantar fasciitis.
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.
After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs. A high arch, an area of maximum tenderness on the bottom of your
foot, just in front of your heel bone. Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down. Limited "up" motion
of your ankle. Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in
ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not
routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.
Non Surgical Treatment
Many types of treatment have been used to combat plantar fasciitis, including injections, anti-inflammatory medications, orthotics, taping, manipulation, night splinting, and instrument-assisted
soft-tissue manipulation (IASTM). IASTM begins with heat, followed by stretching. Stretching may be enhanced by applying ice to the plantar fascia. These stretches should be performed several times
per day, with the calf in the stretched position. IASTM uses stainless-steel instruments to effectively access small areas of the foot. IASTM is believed to cause a secondary trauma to injured soft
tissues as part of the healing process. Therapeutic modalities such as low-level laser, ultrasound, and electrical muscular stimulation may be effective in the reduction of pain and inflammation. Low
Dye strapping or taping of the foot is an essential part of successful treatment of plantar fasciitis. Extracorporeal shock-wave therapy (ESWT) was introduced with great promise at one time. Recent
studies have reported less favorable results. Some report no effect. Previous local steroid injection may actually have a negative effect on results from ESWT.
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.