The plantar fascia is a tough and flexible band of tissue that runs under the sole of the foot. It connects the heel bone with the bones of the foot, and acts as a kind of shock absorber to the foot.
Sudden damage, or damage that occurs over many months or years, can cause tiny tears (microtears) to develop inside the tissue of the plantar fascia. This can cause the plantar fascia to thicken,
resulting in heel pain. The surrounding tissue and the heel bone can also sometimes become inflamed.
Plantar fasciitis can be confused with a condition called tarsal tunnel syndrome. In tarsal tunnel syndrome, an important nerve in the foot, the tibial nerve, is trapped and pinched as it passes
through the tarsal tunnel, a condition analogous to carpal tunnel syndrome in the wrist. This may cause symptoms similar to the pain of a plantar fasciitis. There are also other less common problems
such as nerve entrapments, stress fractures, and fat pad necrosis, all of which can cause foot pain. Finally, several rheumatologic conditions can cause heel pain. These syndromes such as Reiter's
syndrome and ankylosing spondylitis can cause heel pain similar to plantar fasciitis. If your symptoms are not typical for plantar fasciitis, or if your symptoms do not resolve with treatment, your
doctor will consider these possible diagnoses.
A very common complaint of plantar fasciitis is pain in the bottom of the heel. Plantar fasciitis is usually worse in the morning and may improve throughout the day. By the end of the day the pain
may be replaced by a dull aching that improves with rest. Most people suffering from plantar fasciitis also complain of increased heel pain after walking for a long period of time.
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
Your health care provider will often recommend these steps first Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation. Heel and foot stretching exercises. Night
splints to wear while sleeping to stretch the foot. Resting as much as possible for at least a week. Wearing shoes with good support and cushions. Other steps to relieve pain include aply ice to the
painful area. Do this at least twice a day for 10 - 15 minutes, more often in the first couple of days. Try wearing a heel cup, felt pads in the heel area, or shoe inserts. Use night splints to
stretch the injured fascia and allow it to heal. If these treatments do not work, your health care provider may recommend waring a boot cast, which looks like a ski boot, for 3 - 6 weeks. It can be
removed for bathing. Custom-made shoe inserts (orthotics). Steroid shots or injections into the heel. Smetimes, foot surgery is needed.
The most common surgical procedure for plantar fasciitis is plantar fascia release. It involves surgical removal of a part from the plantar fascia ligament which will relieve the inflammation and
reduce the tension. Plantar fascia release is either an open surgery or endoscopic surgery (insertion of special surgical instruments through small incisions). While both methods are performed under
local anesthesia the open procedure may take more time to recover. Other surgical procedures can be used as well but they are rarely an option. Complications of plantar fasciitis surgery are rare but
they are not impossible. All types of plantar fasciitis surgery pose a risk of infection, nerve damage, and anesthesia related complications including systemic toxicity, and persistence or worsening
of heel pain.