Plantar fasciitis: Inflammation of the plantar fascia, the bowstring-like tissue that stretches from the heel bone to the base of the toes. Plantar fasciitis can be due to calcaneal spurs, which
typically cause localized tenderness and pain that is made worse by stepping down on the heel. Plantar fasciitis may be related to physical activity overload, abnormal foot mechanics, or may be due
to underlying diseases that cause arthritis, such as Reiter disease, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis. Treatment is designed to decrease inflammation and avoid
reinjury. Icing reduces pain and inflammation. Anti-inflammatory agents, such as ibuprofen and injections of cortisone, can help. Infrequently, surgery is done on chronically inflamed spurs. A
donut-shaped shoe insert can take pressure off a calcaneal spur and lessen plantar fasciitis.
The cause of plantar fasciitis is poorly understood and is thought to likely have several contributing factors. The plantar fascia is a thick fibrous band of connective tissue that originates from
the medial tubercle and anterior aspect of the heel bone. From there, the fascia extends along the sole of the foot before inserting at the base of the toes, and supports the arch of the foot.
Originally, plantar fasciitis was believed to be an inflammatory condition of the plantar fascia. However, within the last decade, studies have observed microscopic anatomical changes indicating that
plantar fasciitis is actually due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process. Due to this shift in thought about the underlying mechanisms in
plantar fasciitis, many in the academic community have stated the condition should be renamed plantar fasciosis. The structural breakdown of the plantar fascia is believed to be the result of
repetitive microtrauma (small tears). Microscopic examination of the plantar fascia often shows myxomatous degeneration, connective tissue calcium deposits, and disorganized collagen fibers.
Disruptions in the plantar fasciaâs normal mechanical movement during standing and walking (known as the Windlass mechanism) are thought to contribute to the development of plantar fasciitis by
placing excess strain on the calcaneal tuberosity.
The pain is more intense with your first steps out of bed in the morning or after sitting for a while. The reason for this is that during rest our muscles and ligaments tend to shorten and tighten
up. The tightening of the plantar fascia means more traction on the ligament making the tissue even more sensitive. With sudden weight-bearing the tissue is being traumatised, resulting in a stabbing
pain. After walking around for a while the ligament warms up, becomes a little bit more flexible and adapts itself, making the pain go way entirely or becoming more of a dull ache. However, after
walking a long distance or standing for hours the pain will come back again. To prevent the sudden sharp pain in the morning or after sitting, it is important to give the feet a little warm-up first
with some simple exercises. Also, any barefoot walking should be avoided, especially first thing in the morning, as this will damage to the plantar fascia tissue. Aparty from pain in the heel or
symptoms may include a mild swelling under the heel. In addition, heel pain is often associated with tightness in the calf muscles. Tight calf muscles are a major contributing factor to Plantar
Diagnosis of plantar fasciitis is based on a medical history, the nature of symptoms, and the presence of localised tenderness in the heel. X-rays may be recommended to rule out other causes for the
symptoms, such as bone fracture and to check for evidence of heel spurs. Blood tests may also be recommended.
Non Surgical Treatment
Anti-inflammatory medications can help decrease the inflammation in the arch and heel of your foot. These medications include Advil, Mtrin, Ibuprofen, and Aleve. Use the medication as directed on the
package. If you tolerate it well, take it daily for two weeks then discontinue for one week. If symptoms worsen or return, resume for two weeks, then stop. You should eat when taking these
medications, as they can be hard on your stomach. Ach Support. Over the counter inserts provide added arch support and soft cushion. Based on the individual needs of your foot, you may require custom
inserts. Achilles Tendon Stretch. Pace a shoe insert under your affected foot. Place your affected leg behind your unaffected leg with the toes of your back foot pointed towards the heel of your
other foot. Lean into the wall. Bend your front knee while keeping your back leg straight with your heel firmly on the ground. Hold the stretch for a count of 10. A set is 10 repetitions. Perform the
stretch at least three times a day.
If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles
and joints, a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting
their career. Plantar release surgery. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the
tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as, open surgery, where the section of the plantar fascia is
released by making a cut into your heel, endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the
plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open
surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to
choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with
all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the
advantages and disadvantages of both techniques with your surgical team. Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve
making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your
heel. It is claimed that EST works in two ways. It is thought to, have a "numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process.
However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE
states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective
than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).
Preventing plantar fasciitis is crucial. There are many choices to help prevent the occurrence of this condition, and keep it from returning. One of the most important is maintaining a healthy weight
in order to reduce tension on the plantar fascia. In addition, shoes are very important, and should fit well and provide ample cushioning and support throughout the heel, arch, and ball of the foot
so that weight is distributed evenly throughout the foot. Try to avoid walking barefoot on hard surfaces and replace old shoes before they wear out, especially shoes that you run or exercise in. When
exercising, start off slow and ease into new routines to prevent sudden or excessive stress on tissue. Lastly, keep your calf muscles and the tissue of your feet stretched. Greater flexibility in the
tissue makes them less susceptible to damage.