Plantar fasciitis is a dull to severe pain in your heel caused by a strain and inflammation of your plantar fascia. The plantar fascia is a scientific name for “foot tissue”. This particular tissue is a ligament attached at one side to the heel bone. At the other side, the tissue fans out to attach at the base of each of your five toes. Plantar fasciitis is the name for the condition that develops when that tissue becomes inflamed. When the plantar fascia is excessively stretched, micro-tears can occur, causing this swelling and subsequent pain.
Your plantar fascia (fay-sha) supports the arch of your foot as you run or walk. It is a thick, inelastic, fibrous band that starts in your heel, runs along the bottom of your foot, and spreads out to your toes. Plantar fasciitis is an inflammation of this fibrous band. If you are female or have a job that requires a lot of walking or standing on hard surfaces you are more at risk for plantar fasciitis. Additional causes include Being overweight, Having flat feet or high arches, Wearing shoes with poor support, Walking or running for exercise, Tight calf muscles that limit how far you can flex your ankles, Running on soft terrain, Increase in activity level, Genetic predisposition.
Patients experience intense sharp pain with the first few steps in the morning or following long periods of having no weight on the foot. The pain can also be aggravated by prolonged standing or sitting. The pain is usually experienced on the plantar surface of the foot at the anterior aspect of the heel where the plantar fascia ligament inserts into the calcaneus. It may radiate proximally in severe cases. Some patients may limp or prefer to walk on their toes. Alternative causes of heel pain include fat pad atrophy, plantar warts and foreign body.
Your doctor will perform a physical exam to check for tenderness in your foot and the exact location of the pain to make sure that it’s not caused by a different foot problem. The doctor may ask you to flex your foot while he or she pushes on the plantar fascia to see if the pain gets worse as you flex and better as you point your toe. Mild redness or swelling will also be noted. Your doctor will evaluate the strength of your muscles and the health of your nerves by checking your reflexes, your muscle tone, your sense of touch and sight, your coordination, and your balance. X-rays or a magnetic resonance imaging (MRI) scan may be ordered to check that nothing else is causing your heel pain, such as a bone fracture.
Non Surgical Treatment
No single treatment works best for everyone with plantar fasciitis. But there are many things you can try to help your foot get better. Give your feet a rest. Cut back on activities that make your foot hurt. Try not to walk or run on hard surfaces. To reduce pain and swelling, try putting ice on your heel. Or take an over-the-counter pain reliever like ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve). Do toe stretches , calf stretches and towel stretches several times a day, especially when you first get up in the morning. (For towel stretches, you pull on both ends of a rolled towel that you place under the ball of your foot.) Get a new pair of shoes. Pick shoes with good arch support and a cushioned sole. Or try heel cups or shoe inserts ( orthotics ). Use them in both shoes, even if only one foot hurts. If these treatments do not help, your doctor may recommend splints that you wear at night, shots of medicine (such as a steroid ) in your heel, or other treatments. You probably will not need surgery. Doctors only suggest it for people who still have pain after trying other treatments for 6 to 12 months.
Most studies indicate that 95% of those afflicted with plantar fasciitis are able to relieve their heel pain with nonsurgical treatments. If you are one of the few people whose symptoms don’t improve with other treatments, your doctor may recommend plantar fascia release surgery. Plantar fascia release involves cutting part of the plantar fascia ligament in order to release the tension and relieve the inflammation of the ligament. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. While the success rate is very high following surgery, one should be aware that there is often a prolonged postoperative period of discomfort similar to the discomfort experienced prior to surgery. This pain usually will abate within 2-3 months. One should always be sure to understand all the risks associated with any surgery they are considering.
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.