Do you have sharp, stabbing, and/or aching pain on the bottom of your heel or arch?
Is the pain more severe when you first get up in the morning or when you first start walking after rest? If this describes your pain then you probably suffer from a condition known as PLANTAR
FASCIITIS. It sounds complicated, but plantar fasciitis is actually one of the most common foot problems. In the past plantar fasciitis has been called by other names, such as heel spur syndrome,
bone spurs or a stone bruise on the heel. The plantar fascia is a long thick ligament that runs along the arch of your foot from your heel bone (the calcaneus) to the ball of the foot. The job of the
plantar fascia is to help support your arch. When the fascia becomes inflamed and painful we call this PLANTAR FASCIITIS. The pain from plantar fasciitis most commonly occurs near the attachment of
the fascia to the calcaneus (heel bone), which is why most people who suffer from plantar fasciitis have pain on the bottom or inside of the heel. However, the pain can be anywhere along the fascia
from the heel to the ball of the foot.
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.
The major complaint of those with plantar fasciitis is pain and stiffness in the bottom of the heel. This develops gradually over time. It usually affects just one foot, but can affect both feet.
Some people describe the pain as dull, while others experience a sharp pain, and some feel a burning or ache on the bottom of the foot extending outward from the heel. The pain is usually worse in
the morning when you take your first steps out of bed, or if youâve been sitting or lying down for a while. Climbing stairs can be very difficult due to the heel stiffness. After prolonged
activity, the pain can flare-up due to increased inflammation. Pain is not usually felt during the activity, but rather just after stopping.
During the physical exam, your doctor checks for points of tenderness in your foot. The location of your pain can help determine its cause. Usually no tests are necessary. The diagnosis is made based
on the history and physical examination. Occasionally your doctor may suggest an X-ray or magnetic resonance imaging (MRI) to make sure your pain isn't being caused by another problem, such as a
stress fracture or a pinched nerve. Sometimes an X-ray shows a spur of bone projecting forward from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed
surgically. But many people who have bone spurs on their heels have no heel pain.
Non Surgical Treatment
Sometimes physical therapy modalities are helpful. The most frequently used modalities include ultrasound (high frequency sound vibrations that create a deep heat and reduce inflammation) and
galvanic electrical stimulation ( a carefully applied intermittent muscular stimulation to the heel and calf that helps reduce pain and relax muscle spasm, which is a contributing factor to the
pain). This treatment has been found most effective when given twice a week. Repeated taping and padding is sometimes used. The felt pads that will be strapped to your feet will compress after a few
days and must be reapplied. While wearing them they should be kept dry, but may be removed the night before your next appointment. Resistant cases of heel pain caused by plantar fasciitis, heel spurs
or cases of stress fracture of the calcaneus often need to be placed in a removable below knee cast boot. It is important to be aware of how your foot feels over this time period. If your foot is
still uncomfortable without the strapping, but was more comfortable while wearing it, that is an indication that the treatment should help. Remember, what took many months or years to develop can not
be eliminated in just a few days.
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.