The plantar fascia is a thick, ligamentous connective tissue that runs from the heel bone to the ball of the foot. This strong and tight tissue helps maintain the arch of the foot. It is also one of
the major transmitters of weight across the foot as you walk or run. Thus, tremendous stress is placed on the plantar fascia, often leading to plantar fasciitis- a stabbing or burning pain in the
heel or arch of the foot. Plantar fasciitis is particularly common in runners. People who are overweight, women who are pregnant and those who wear shoes with inadequate support are also at a higher
risk. Prolonged plantar fasciitis frequently leads to heel spurs, a hook of bone that can form on the heel bone. The heel spur itself is not thought to be the primary cause of pain, rather
inflammation and irritation of the plantar fascia is the primary problem.
Plantar fasciitis is common in sports which involve running, dancing or jumping. Runners who overpronate where their feet roll in or flatten too much are particularly at risk the plantar fascia is
over stretched as the foot flattens. A common factor is tight calf muscles which lead to a prolonged or high velocity pronation or rolling in of the foot. This in turn produces repetitive
over-stretching of the plantar fascia leading to possible inflammation and thickening of the tendon. As the fascia thickens it looses flexibility and strength. Other causes include either a low arch
called pes planus or a very high arched foot known as pes cavus. Assessing the foot for plantar fasciitisExcessive walking in footwear which does not provide adequate arch support has been
attributed. Footwear for plantar fasciitis should be flat, lace-up and with good arch support and cushioning. Overweight individuals are more at risk of developing plantar fasciitis due to the excess
weight impacting on the foot.
Plantar fasciosis is characterized by pain at the bottom of the heel with weight bearing, particularly when first arising in the morning; pain usually abates within 5 to 10 min, only to return later
in the day. It is often worse when pushing off of the heel (the propulsive phase of gait) and after periods of rest. Acute, severe heel pain, especially with mild local puffiness, may indicate an
acute fascial tear. Some patients describe burning or sticking pain along the plantar medial border of the foot when walking.
Diagnosis of plantar fasciitis is based on a medical history, the nature of symptoms, and the presence of localised tenderness in the heel. X-rays may be recommended to rule out other causes for the
symptoms, such as bone fracture and to check for evidence of heel spurs. Blood tests may also be recommended.
Non Surgical Treatment
The good news is that plantar fasciitis is reversible and very successfully treated. About 90 percent of people with plantar fasciitis improve significantly within two months of initial treatment. If
your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medications (corticosteroid). Cortisone injections
have been shown to have short-term benefits but they actually retard your progress in the medium to long-term, which usually means that you will suffer recurrent bouts for longer. Due to poor foot
biomechanics being the primary cause of your plantar fasciitis it is vital to thoroughly assess and correct your foot and leg biomechanics to prevent future plantar fasciitis episodes or the
development of a heel spur. Your physiotherapist is an expert in foot assessment and its dynamic biomechanical correction. They may recommend that you seek the advice of a podiatrist, who is an
expert in the prescription on passive foot devices such as orthotics.
In unusual cases, surgical intervention is necessary for relief of pain. These should only be employed after non-surgical efforts have been used without relief. Generally, such surgical procedures
may be completed on an outpatient basis in less than one hour, using local anesthesia or minimal sedation administrated by a trained anesthesiologist. In such cases, the surgeon may remove or release
the injured and inflamed fascia, after a small incision is made in the heel. A surgical procedure may also be undertaken to remove bone spurs, sometimes as part of the same surgery addressing the
damaged tissue. A cast may be used to immobilize the foot following surgery and crutches provided in order to allow greater mobility while keeping weight off the recovering foot during healing. After
removal of the cast, several weeks of physical therapy can be used to speed recovery, reduce swelling and restore flexibility.