A common condition that affects people of all ages. Symptoms include heel pain that is worse upon arising in the morning or standing after prolonged sitting. The pain is caused by inflammation of the plantar fascia, the ligament that connects the heel bone to the toes.
Because the plantar fascia supports your foot and gets used every time you take a step, it has to absorb a large amount of stress and weight. If too much pressure is put on the plantar fascia, the fibers can become damaged or start to tear. The body responds by causing inflammation in the affected area. This is what causes the pain and stiffness of plantar fasciitis. Things that can increase the risk of plantar fasciitis include tight calf muscles. Tight calves make it harder to flex your foot, and this puts more stress on the plantar fascia. Weight. Carrying a few extra pounds puts added pressure on your feet every time you take a step. Activities that put a lot of stress on the feet. This includes things like running, hiking, dancing, and aerobics. Bad shoes. Footwear that doesn’t give your foot the support it needs increases your risk of plantar fasciitis. You’ll want to ditch any shoes that have thin soles or inadequate arch support, or ones that don’t fit your feet properly. Routinely wearing high heels can also cause your Achilles tendon to contract over time, making it harder to flex your foot. Jobs that involve a lot of standing or walking on hard surfaces. Jobs that keep you on your feet all day, like waiting tables or working in a store, can cause damage to your plantar fascia. High arches, flat feet, or other foot problems. The shape of your foot can affect the way your weight is distributed on your feet when you stand. If weight distribution is a bit off, it can add to a person’s risk of plantar fasciitis. How someone walks can increase the stress on certain parts of the foot too.
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.
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
Check your shoes to make sure they offer sufficient support and motion control. They should bend only at the ball of the foot, where your toes attach to the foot. This is very important. Avoid any shoe that bends in the center of the arch or behind the ball of the foot. It offers insufficient support and will stress your plantar fascia. The human foot was not designed to bend here and neither should a shoe be designed to do this. You may also strengthen the muscles in your arch by performing toe curls or “doming”. Toe curls may be done by placing a towel on a kitchen floor and then curling your toes to pull the towel towards you. This exercise may also be done without the towel against the resistance of the floor. Plantar fasciitis is usually controlled with conservative treatment. Besides surgery and cortisone injections, physical therapy modalities such as electrical stimulation and ultrasound can be used. Often the foot will be taped to limit pronation. Following control of the pain and inflammation an orthotic (a custom made shoe insert) can be used to control over-pronation.
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.
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.