Plantar fasciitis is a painful inflammatory process of the plantar fascia, a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along
the sole of the foot towards the five toes. Pain in the arch or heel often indicates inflammation of the long band of tissue under the foot (the plantar fascia). It can cause sharp pain and
discomfort in either the mid arch region or at the inside heel, and less commonly the outside heel. It frequently causes pain upon rising from rest (especially first thing in the morning) and can
progress to agony by the end of the day. Although plantar fasciitis is the most common cause of this pain, it must be skilfully differentially diagnosed from other conditions via a thorough history
taking and physical examination.
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 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.
The health care provider will perform a physical exam. This may show tenderness on the bottom of your foot, flat feet or high arches, mild foot swelling or redness, stiffness or tightness of the arch
in the bottom of your foot. X-rays may be taken to rule out other problems.
Non Surgical Treatment
In general, we start by correcting training errors. This usually requires relative rest, the use of ice after activities, and an evaluation of the patient's shoes and activities. Next, we try
correction of biomechanical factors with a stretching and strengthening program. If the patient still has no improvement, we consider night splints and orthotics. Finally, all other treatment options
are considered. Non-steroidal anti-inflammatory medications are considered throughout the treatment course, although we explain to the patient that this medicine is being used primarily for pain
control and not to treat the underlying problem.
Surgery is considered only after 12 months of aggressive nonsurgical treatment. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles
place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches. In gastrocnemius recession, one of
the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope,
an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage.
Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is
partially cut to relieve tension in the tissue. If you have a large bone spur, it will be removed, as well. Although the surgery can be performed endoscopically, it is more difficult than with an
open incision. In addition, endoscopy has a higher risk of nerve damage.
The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally,
they should be performed 2 - 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and
eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in
symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your
foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head until you feel a stretch in the back of your calf, Achilles tendon, plantar fascia or leg. Hold for 5
seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free. Resistance Band Calf Strengthening. Begin this exercise with a resistance band around your foot as
demonstrated and your foot and ankle held up towards your head. Slowly move your foot and ankle down against the resistance band as far as possible and comfortable without pain, tightening your calf
muscle. Very slowly return back to the starting position. Repeat 10 - 20 times provided the exercise is pain free.