Plantar fasciitis is characterized by stiffness and inflammation of the main fascia (fibrous connective [ligament-like] tissue) on the bottom of the foot. It is occasionally associated with a bone
spur on the heel. Occasionally there may be a partial or complete tear of the fascia of the bottom of the foot. Bone spurs themselves usually do not cause symptoms.
Plantar fasciitis symptoms are usually exacerbated via "traction" (or stretching) forces on the plantar fascia. In simple terms, you plantar fascia is repeatedly overstretched. The most common reason
for the overstretching are an elongated arch due to either poor foot biomechanics (eg overpronation) or weakness of your foot arch muscles. Compression type plantar fascia injuries have a traumatic
history. Landing on a sharp object that bruises your plantar fascia is your most likely truma. The location of plantar fasciitis pain will be further under your arch than under your heel, which is
more likely to be a fat pad contusion if a single trauma caused your pain. The compression type plantar fasciitis can confused with a fat pad contusion that is often described as a "stone
The classic sign of plantar fasciitis is that the worst pain occurs with the first few steps in the morning, but not every patient will have this symptom. Patients often notice pain at the beginning
of activity that lessens or resolves as they warm up. The pain may also occur with prolonged standing and is sometimes accompanied by stiffness. In more severe cases, the pain will also worsen toward
the end of the day.
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose plantar fasciitis. Occasionally, further investigations such as an X-ray, ultrasound or MRI
may be required to assist with diagnosis and assess the severity of the condition.
Non Surgical Treatment
A steroid (cortisone) injection is sometimes tried if your pain remains bad despite the above 'conservative' measures. It may relieve the pain in some people for several weeks but does not always
cure the problem. It is not always successful and may be sore to have done. Steroids work by reducing inflammation. Sometimes two or three injections are tried over a period of weeks if the first is
not successful. Steroid injections do carry some risks, including (rarely) tearing (rupture) of the plantar fascia. Extracorporeal shock-wave therapy. In extracorporeal shock-wave therapy, a machine
is used to deliver high-energy sound waves through your skin to the painful area on your foot. It is not known exactly how it works, but it is thought that it might stimulate healing of your plantar
fascia. One or more sessions of treatment may be needed. This procedure appears to be safe but it is uncertain how well it works. This is mostly because of a lack of large, well-designed clinical
trials. You should have a full discussion with your doctor about the potential benefits and risks. In studies, most people who have had extracorporeal shock-wave therapy have little in the way of
problems. However, possible problems that can occur include pain during treatment, skin reddening, and swelling of your foot or bruising. Another theoretical problem could include the condition
getting worse because of rupture of your plantar fascia or damage to the tissues in your foot. More research into extracorporeal shock-wave therapy for plantar fasciitis is needed. Other treatments.
Various studies and trials have been carried out looking at other possible treatments for plantar fasciitis. Such treatments include injection with botulinum toxin and treatment of the plantar fascia
with radiotherapy. These treatments may not be widely available. Some people benefit from wearing a special splint overnight to keep their Achilles tendon and plantar fascia slightly stretched. The
aim is to prevent the plantar fascia from tightening up overnight. In very difficult cases, sometimes a plaster cast or a removable walking brace is put on the lower leg. This provides rest,
protection, cushioning and slight stretching of the plantar fascia and Achilles tendon. However, the evidence for the use of splint treatment of plantar fasciitis is limited.
If you consider surgery, your original diagnosis should be confirmed by the surgeon first. In addition, supporting diagnostic evidence (such as nerve-conduction studies) should be gathered to rule
out nerve entrapment, particularly of the first branch of the lateral plantar nerve and the medial plantar nerve. Blood tests should consist of an erythrocyte sedimentation rate (ESR), rheumatoid
factor, human leukocyte antigen B27 (HLA-B27), and uric acid. Itâs important to understand that surgical treatment of bone spurs rarely improves plantar fasciitis pain. And surgery for plantar
fasciitis can cause secondary complications-a troubling condition known as lateral column syndrome.
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.