Plantar fasciitis causes pain in the bottom of the heel. The plantar fascia is a thin ligament that connects your heel to the front of your foot. It supports the arch in your foot and is important in
helping you walk. Plantar fasciitis is one of the most common orthopedic complaints. Your plantar fascia ligaments experience a lot of wear and tear in your daily life. Normally, these ligaments act
as shock absorbers, supporting the arch of the foot. Too much pressure on your feet can damage or tear the ligaments. The plantar fascia becomes inflamed, and the inflammation causes heel pain and
It is common to see patients with Plantar Fasciitis who have been wearing shoes that are too soft and flexible. The lack of support can be stressful on the heel for those patients whoâs feet
arenât particularly stable. If these ill fitting shoes are worn for long enough, the stress will lead to Heel Pain as the inflammation of the fascia persists. Footwear assessment and advice will be
essential in order to get on top of the Plantar Fasciitis. It may surprise some people to learn that high heeled shoes are not the cause of Plantar Fasciitis, although they can cause tight calf
muscles. High arches can lead to Plantar Fasciitis. This is due to the lack of contact under the sole of the foot. Even sports shoes which appear to have good arch support inside are often too soft
and not high enough to make contact with the arch of the foot. Hence, the plantar fascia is unsupported. This can lead to Heel pain and Plantar Fasciitis. Flat feet can lead to Plantar Fasciitis.
Flat feet is caused by ligament laxity and leads to foot instability. Other structures such as muscles, tendons and fascia work harder to compensate for this instability. Heel pain or Plantar
Fasciitis arises when the instability is too great for these other structures to cope with. The strain on the fascia is too severe and the inflammation sets in. Over stretching can lead to Plantar
Fasciitis. Certain calf stretches put the foot into a position that creates a pulling sensation through the sole of the foot. This can cause Plantar Fasciitis which can cause pain in the arch of the
foot as well as Heel Pain.
Patients with plantar fasciitis typically experience pain underneath the heel and along the inner sole of the foot. In less severe cases, patients may only experience an ache or stiffness in the
plantar fascia or heel that increases with rest (typically at night or first thing in the morning) following activities which place stress on the plantar fascia. These activities typically include
standing, walking or running excessively (especially up hills, on uneven surfaces or in poor footwear such as thongs), jumping, hopping and general weight bearing activity. The pain associated with
this condition may also warm up with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting
performance. In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Patients with this condition may also experience swelling, tenderness on firmly touching
the plantar fascia (often on a specific spot on the inner aspect of the heel) and sometimes pain on performing a plantar fascia stretch.
Plantar fasciitis is usually diagnosed by a health care provider after consideration of a personâs 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
There are a number of treatments that can help relieve heel pain and speed up your recovery. These include resting your heel, try to avoid walking long distances and standing for long periods,
regular stretching, stretching your calf muscles and plantar fascia, pain relief, using an icepack on the affected heel and taking painkillers, such as non-steroidal anti-inflammatory drugs (NSAIDs)
wearing good-fitting shoes that support and cushion your foot, running shoes are particularly useful, using supportive devices such as orthoses (rigid supports that are put inside the shoe) or
strapping. Around four out of five cases of heel pain resolve within a year. However, having heel pain for this length of time can often be frustrating and painful. In around one in 20 cases, the
above treatments are not enough, and surgery may be recommended to release the plantar fascia.
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue
to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you. No matter what
kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive
shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.