Plantar fasciitis is a painful inflammation of the plantar fascia, a fibrous band of tissue on the bottom of the foot that helps to support the arch. Plantar fasciitis occurs when this band of tissue is overloaded or overstretched. This causes small tears in the fibers of the fascia, especially where the fascia meets the heel bone. Plantar fasciitis is common in obese people and in pregnant women, perhaps because their extra body weight overloads the delicate plantar fascia. It is also more common in people with diabetes, although the exact reason for this is unknown. Plantar fasciitis also can be triggered by physical activities that overstretch the fascia, including sports (volleyball, running, tennis), other exercises (step aerobics, stair climbing) or household exertion (pushing furniture or a large appliance). In athletes, plantar fasciitis may follow intense training, especially in runners who push themselves too quickly to run longer distances. Worn or poorly constructed shoes can contribute to the problem if they do not provide enough arch support, heel cushion or sole flexibility.
Factors which may contribute to plantar fasciitis and heel spurs include a sudden increase in daily activities, increase in weight (not usually a problem with runners), or a change of shoes. Dramatic increase in training intensity or duration may cause plantar fasciitis. Shoes that are too flexible in the middle of the arch or shoes that bend before the toe joints will cause an increase in tension in the plantar fascia. Even though you may have run in shoes that are flexible before, now that you have developed plantar fasciitis, make certain that your shoe is stable and does not bend in the midfoot. Check and be certain that your shoes are not excessively worn. Shoes that do not sufficiently control excessive pronation combined with an increase in training can lead to this condition. A change in running style or parameters, such as starting speed work, running on the ball of your foot or sudden increase in hill workouts may lead to problems. All changes should be gradual and not abrupt. Gait changes such as altering your foot strike, switching shoe style, running barefoot or in minimalist shoes should all be made gradually and not abruptly. The "terrible too's" of too much, too soon, too often with too little rest also applies to "too many changes with too little adaptation". Make your changes gradually and allow your muscles, bones, and other body structures to adapt to the alterations you may be attempting.
The major complaint of those with plantar fasciitis is pain and stiffness in the bottom of the heel. This develops gradually over time. It usually affects just one foot, but can affect both feet. Some people describe the pain as dull, while others experience a sharp pain, and some feel a burning or ache on the bottom of the foot extending outward from the heel. The pain is usually worse in the morning when you take your first steps out of bed, or if you’ve been sitting or lying down for a while. Climbing stairs can be very difficult due to the heel stiffness. After prolonged activity, the pain can flare-up due to increased inflammation. Pain is not usually felt during the activity, but rather just after stopping.
Plantar fasciitis is usually diagnosed by a health care provider after consideration of a person’s presenting history, risk factors, and clinical examination. Tenderness to palpation along the inner aspect of the heel bone on the sole of the foot may be elicited during the physical examination. The foot may have limited dorsiflexion due to tightness of the calf muscles or the Achilles tendon. Dorsiflexion of the foot may elicit the pain due to stretching of the plantar fascia with this motion. Diagnostic imaging studies are not usually needed to diagnose plantar fasciitis. However, in certain cases a physician may decide imaging studies (such as X-rays, diagnostic ultrasound or MRI) are warranted to rule out other serious causes of foot pain. Bilateral heel pain or heel pain in the context of a systemic illness may indicate a need for a more in-depth diagnostic investigation. Lateral view x-rays of the ankle are the recommended first-line imaging modality to assess for other causes of heel pain such as stress fractures or bone spur development. Plantar fascia aponeurosis thickening at the heel greater than 5 millimeters as demonstrated by ultrasound is consistent with a diagnosis of plantar fasciitis. An incidental finding associated with this condition is a heel spur, a small bony calcification on the calcaneus (heel bone), which can be found in up to 50% of those with plantar fasciitis. In such cases, it is the underlying plantar fasciitis that produces the heel pain, and not the spur itself. The condition is responsible for the creation of the spur though the clinical significance of heel spurs in plantar fasciitis remains unclear.
Non Surgical Treatment
Cortisone is a powerful anti-inflammatory and when injected directly into the heel it will work almost immediately. Bear in mind however, that the treatment does not address the root cause of the inflammation, and needs to be repeated every few months. Also note, these injections are quite painful, and most doctors today will consider other, less invasive treatment options first. ESWT (Extra Corporeal Shockwave Treatment). A specialist targets therapeutic shockwaves to the affected heel area. This will stimulate a healing response in the affected tissue and ligaments, resulting in reduced inflammation and pain. This treatment and may take from 3 to 4 months to be fully effective. Extracorpreal Shock Wave Therapy is the latest technology to treat chronic plantar fasciitis. It is a non-invasive treatment and highly recommended for people who have tried other treatment like cortisone-injections, accupuncture etc with little or no success. Electroacupuncture and standard acupuncture are used in the treatment of plantar fasciitis and other foot problems such as neuromas and nerve impingement, numbness in the toes etc. In some cases there is nerve entrapment within the foot combined with referred pain from other areas of the body. Some research suggests that acunpuncture can be effective in the treatment of heel pain. A trigger point is an irritable knot in the muscle tissue. When pressed trigger points are very tender and can cause pain in that specific spot or elsewhere in the body (referred pain). The response to pushing into the knot is a muscle twitch. The foot contains 126 muscles, tendons and ligaments, so there are plenty of 'hiding places' for trigger points. Trigger points in the calf muscles often refer pain directly to the bottom of the foot. Trigger point therapy of the lower leg and foot can therefore be successful in the treatment of plantar fasciitis.
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.