The plantar fascia is a thickened fibrous aponeurosis that originates from the medial tubercle of the calcaneus, runs forward to insert into the deep, short transverse ligaments of the metatarsal
heads, dividing into 5 digital bands at the metatarsophalangeal joints and continuing forward to form the fibrous flexor sheathes on the plantar aspect of the toes. Small plantar nerves are invested
in and around the plantar fascia, acting to register and mediate pain.
It usually starts following an increase in activity levels. Increase in weight. Standing for long periods. Poor footwear. Tight muscle groups. Abnormal pressure on the plantar Fascia can be caused by
any of the above. The plantar fascia becomes inflamed and tiny rips can occur where it attaches into the inside of the heel bone. The area becomes inflamed and swollen, and it is the increase in
fluid to the area that accumulates when weight is taken off the area that then causes the pain on standing.
When a patient has plantar fasciitis, the connective tissue that forms the arch of the foot becomes inflamed (tendonitis) and degenerative (tendinosis)--these abnormalities cause plantar fasciitis
and can make normal activities quite painful. Symptoms of plantar fasciitis are typically worsened early in the morning after sleep. At that time, the arch tissue is tight and simple movements
stretch the contracted tissue. As you begin to loosen the foot, the pain usually subsides, but often returns with prolonged standing or walking.
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
The following recommendations are appropriate. Wear shoes with adequate arch support and cushioned heels; discard old running shoes and wear new ones; rotate work shoes daily. Avoid long periods of
standing. Lose weight. Stretch the plantar fascia and warm up the lower extremity before participating in exercise. For increased flexibility, stretch the plantar fascia and the calf after exercise.
Do not exercise on hard surfaces. Avoid walking barefooted on hard surfaces. Avoid high-impact sports that require a great deal of jumping (eg, aerobics and volleyball). Apply ice for 20 minutes
after repetitive impact-loading activities and at the end of the day. Limit repetitive impact-loading activities such as running to every other day, and consider rest or cross-training for nonrunning
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.
Stretching your plantar fasciitis is something you can do at home to relieve pain and speed healing. Ice massage performed three to four times per day in 15 to 20 minute intervals is also something
you can do to reduce inflammation and pain. Placing arch supports in your shoes absorbs shock and takes pressure off the plantar fascia.