Overview
Plantar fasciitis causes pain under your heel. It usually goes in time. Treatment may speed up recovery. Treatment includes rest, good footwear, heel pads, painkillers, and exercises. A steroid injection or other treatments may be used in more severe cases. Plantar fasciitis means inflammation of your plantar fascia. Your plantar fascia is a strong band of tissue (like a ligament) that stretches from your heel to your middle foot bones. It supports the arch of your foot and also acts as a shock-absorber in your foot.
Causes
Plantar Fasciitis is simply caused by overstretching of the plantar fascia ligament under the foot. So why is the ligament being overstretched? There are different factors, over-use, too much sports, running, walking or standing for long periods (e.g. because of your job) weight gain, our feet are designed to carry a ‘normal’ weight. Any excess weight places great pressure on the bones, nerves, muscles and ligaments in the feet, which sooner or later will have consequences. Even pregnancy (in the last 10 weeks) can cause foot problems! age, as we get older ligaments become tighter & shorter and msucles become weaker; the ideal circumstances for foot problems, unsupportive footwear, ‘floppy’ shoes with no support as well as thongs affect our walking pattern, walking barefoot, especially on hard surfaces like concrete or tiles, low arch and flat feet or over-pronation. An important contributing factor to Plantar Fasciitis is ‘excess pronation’ (or over-pronation). This is a condition whereby the feet roll over, the arches collapse and the foot elongates. This unnatural elongation puts excess strain on the ligaments, muscles and nerves in the foot. When the foot is not properly aligned, the bones unlock and cause the foot to roll inward. With every step taken your foot pronates and elongates, stretching the plantar fascia and causing inflammation and pain at the attachment of the plantar fascia into the heel bone. Re-alignment of the foot should therefore an important part of the treament regime.
Symptoms
Plantar fasciitis sufferers feel a sharp stab or deep ache in the middle of the heel or along the arch. Another sign is the morning hobble from the foot trying to heal itself in a contracted position overnight. Taking that first step causes sudden strain on the bottom of the foot. The pain can recur after long spells of sitting, but it tends to fade during a run, once the area is warmed up.
Diagnosis
To diagnose plantar fasciitis, your doctor will physically examine your foot by testing your reflexes, balance, coordination, muscle strength, and muscle tone. Your doctor may also advise a magnetic resonance imaging (MRI) or X-ray to rule out other others sources of your pain, such as a pinched nerve, stress fracture, or bone spur.
Non Surgical Treatment
Heel cups are used to decrease the impact on the calcaneus and to theoretically decrease the tension on the plantar fascia by elevating the heel on a soft cushion. Although heel cups have been found to be useful by some physicians and patients, in our experience they are more useful in treating patients with fat pad syndrome and heel bruises than patients with plantar fasciitis. In a survey of 411 patients with plantar fasciitis, heel cups were ranked as the least effective of 11 different treatments.
Surgical Treatment
In very rare cases plantar fascia surgery is suggested, as a last resort. In this case the surgeon makes an incision into the ligament, partially cutting the plantar fascia to release it. If a heel spur is present, the surgeon will remove it. Plantar Fasciitis surgery should always be considered the last resort when all the conventional treatment methods have failed to succeed. Endoscopic plantar fasciotomy (EPF) is a form of surgery whereby two incisions are made around the heel and the ligament is being detached from the heel bone allowing the new ligament to develop in the same place. In some cases the surgeon may decide to remove the heel spur itself, if present. Just like any type of surgery, Plantar Fascia surgery comes with certain risks and side effects. For example, the arch of the foot may drop and become weak. Wearing an arch support after surgery is therefore recommended. Heel spur surgeries may also do some damage to veins and arteries of your foot that allow blood supply in the area. This will increase the time of recovery.
Stretching Exercises
Stretching exercises for the Achilles tendon and plantar fascia are recommend to relieve pain and aid in the healing process. Sometimes application of athletic tape is recommended. In moderate or severe cases of plantar fasciitis, your doctor may recommend you wearing a night splint, which will stretch the arch of your foot and calf while you sleep. This helps to lengthen the Achilles tendon and plantar fascia for symptom relief. Depending on the severity of your plantar fasciitis, your physician may prescribe a store-bought orthotic (arch support) or custom-fitted orthotic to help distribute your foot pressure more evenly.
Ramona Mckissick 