Plantar fasciitis is one of the most common causes of heel pain. It involves pain and inflammation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot and connects your heel bone to your toes. Plantar fasciitis commonly causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position. Plantar fasciitis is particularly common in runners. In addition, people who are overweight and those who wear shoes with inadequate support are at risk of plantar fasciitis.
It usually starts following an increase in activity levels. Increase in weight. Standing for long periods. Poor footwear. Tight muscle groups. Abnormal pressure on the plantar Fascia can be caused by any of the above. The plantar fascia becomes inflamed and tiny rips can occur where it attaches into the inside of the heel bone. The area becomes inflamed and swollen, and it is the increase in fluid to the area that accumulates when weight is taken off the area that then causes the pain on standing.
Plantar fasciosis is characterized by pain at the bottom of the heel with weight bearing, particularly when first arising in the morning; pain usually abates within 5 to 10 min, only to return later in the day. It is often worse when pushing off of the heel (the propulsive phase of gait) and after periods of rest. Acute, severe heel pain, especially with mild local puffiness, may indicate an acute fascial tear. Some patients describe burning or sticking pain along the plantar medial border of the foot when walking.
A health care professional will ask you whether you have the classic symptoms of first-step pain and about your activities, including whether you recently have intensified your training or changed your exercise pattern. Your doctor often can diagnose plantar fasciitis based on your history and symptoms, together with a physical examination. If the diagnosis is in doubt, your doctor may order a foot X-ray, bone scan or nerve conduction studies to rule out another condition, such as a stress fracture or nerve problem.
Non Surgical Treatment
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home. Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery. Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia. Ice. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel,do not apply ice directly to the skin. Limit activities. Cut down on extended physical activities to give your heel a rest. Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia. Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation. If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these treatment approaches. Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia. Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis. Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain. Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal. Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients. Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
Most practitioners agree that treatment for plantar fasciitis is a slow process. Most cases resolve within a year. If these more conservative measures don’t provide relief after this time, your doctor may suggest other treatment. In such cases, or if your heel pain is truly debilitating and interfering with normal activity, your doctor may discuss surgical options with you. The most common surgery for plantar fasciitis is called a plantar fascia release and involves releasing a portion of the plantar fascia from the heel bone. A plantar fascia release can be performed through a regular incision or as endoscopic surgery, where a tiny incision allows a miniature scope to be inserted and surgery to be performed. About one in 20 patients with plantar fasciitis will need surgery. As with any surgery, there is still some chance that you will continue to have pain afterwards.
In one exercise, you lean forward against a wall with one knee straight and heel on the ground. Your other knee is bent. Your heel cord and foot arch stretch as you lean. Hold for 10 seconds, relax and straighten up. Repeat 20 times for each sore heel. It is important to keep the knee fully extended on the side being stretched. In another exercise, you lean forward onto a countertop, spreading your feet apart with one foot in front of the other. Flex your knees and squat down, keeping your heels on the ground as long as possible. Your heel cords and foot arches will stretch as the heels come up in the stretch. Hold for 10 seconds, relax and straighten up. Repeat 20 times. About 90 percent of people with plantar fasciitis improve significantly after two months of initial treatment. You may be advised to use shoes with shock-absorbing soles or fitted with an off-the-shelf shoe insert device like a rubber heel pad. Your foot may be taped into a specific position. If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medication. If you still have symptoms, you may need to wear a walking cast for two to three weeks or a positional splint when you sleep. In a few cases, surgery is needed for chronically contracted tissue.