Plantar fasciitis is the most common cause of pain on the bottom of the heel. Approximately 2 million patients are treated for this condition every year. Plantar fasciitis occurs when the strong band
of tissue that supports the arch of your foot becomes irritated and inflamed. The plantar fascia is a long, thin ligament that lies directly beneath the skin on the bottom of your foot. It connects
the heel to the front of your foot, and supports the arch of your foot.
There are a number of plantar fasciitis causes. The plantar fascia ligament is like a rubber band and loosens and contracts with movement. It also absorbs significant weight and pressure. Because of
this function, plantar fasciitis can easily occur from a number of reasons. Among the most common is an overload of physical activity or exercise. Athletes are particularly prone to plantar fasciitis
and commonly suffer from it. Excessive running, jumping, or other activities can easily place repetitive or excessive stress on the tissue and lead to tears and inflammation, resulting in moderate to
severe pain. Athletes who change or increase the difficulty of their exercise routines are also prone to overdoing it and causing damage. Another common cause of plantar fasciitis is arthritis.
Certain types of arthritis can cause inflammation to develop in tendons, resulting in plantar fasciitis. This cause is particularly common among elderly patients. Diabetes is also a factor that can
contribute to further heel pain and damage, particularly among the elderly. Among the most popular factors that contribute to plantar fasciitis is wearing incorrect shoes. In many cases, shoes either
do not fit properly, or provide inadequate support or cushioning. While walking or exercising in improper shoes, weight distribution becomes impaired, and significantly stress can be added to the
plantar fascia ligament.
Plantar fasciitis is characterized by the following signs and symptoms. Acute plantar fasciitis, pain is usually worse in the morning but may improve when activity continues; if the plantar fasciitis
is severe, activity will exacerbate the pain, pain will worsen during the day and may radiate to calf or forefoot, pain may be described anywhere from "minor pulling" sensation, to "burning", or to
"knife-like", the plantar fascia may be taut or thickened, passive stretching of the plantar fascia or the patient standing on their toes may exacerbate symptoms, acute tenderness deep in the
heel-pad along the insertion of the plantar aponeurosis at the medial calcaneal tuberosity and along the length of the plantar fascia, may have localized swelling. Chronic plantar fasciitis, plantar
fasciitis is classified as "chronic" if it has not resolved after six months, pain occurs more distally along the aponeurosis and spreads into the Achilles tendon.
Plantar fasciosis is confirmed if firm thumb pressure applied to the calcaneus when the foot is dorsiflexed elicits pain. Fascial pain along the plantar medial border of the fascia may also be
present. If findings are equivocal, demonstration of a heel spur on x-ray may support the diagnosis; however, absence does not rule out the diagnosis, and visible spurs are not generally the cause of
symptoms. Also, infrequently, calcaneal spurs appear ill defined on x-ray, exhibiting fluffy new bone formation, suggesting spondyloarthropathy (eg, ankylosing spondylitis, reactive arthritis. If an
acute fascial tear is suspected, MRI is done.
Non Surgical Treatment
If you walk or run a lot, cut back a little. You probably won't need to stop walking or running altogether. If you have either flatfeet or a high arch, ask your doctor about using inserts for your
shoes called orthotics. Orthotics are arch supports. You will need to be fitted for them. If you are overweight, losing weight can help lessen your heel pain. If your job involves standing on a hard
floor or standing in one spot for long periods, place some type of padding on the floor where you stand.
The most dramatic therapy, used only in cases where pain is very severe, is surgery. The plantar fascia can be partially detached from the heel bone, but the arch of the foot is weakened and full
function may be lost. Another surgery involves lengthening the calf muscle, a process called gastrocnemius recession. If you ignore the condition, you can develop chronic heel pain. This can change
the way you walk and cause injury to your legs, knees, hips and back. Steroid injections and some other treatments can weaken the plantar fascia ligament and cause potential rupture of the ligament.
Surgery carries the risks of bleeding, infection, and reactions to anesthesia. Plantar fascia detachment can also cause changes in your foot and nerve damage. Gastrocnemius resection can also cause
Calf stretch. Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your
hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch.
Plantar fascia stretch. This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you
in a controlled fashion. If it is difficult to reach your foot, wrap a towel around your big toe to help pull your toes toward you. Place your other hand along the plantar fascia. The fascia should
feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or