Plantar fasciitis is one of the most common causes of heel pain. It involves pain and inflammation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot and
connects your heel bone to your toes. Plantar fasciitis commonly causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar
fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position. Plantar fasciitis is particularly common in runners. In addition, people who
are overweight and those who wear shoes with inadequate support are at risk of plantar fasciitis.
Repeated small injuries to the fascia (with or without inflammation) are thought to be the cause of plantar fasciitis. The injury is usually near to where the plantar fascia attaches to your heel
bone. You are more likely to injure your plantar fascia in certain situations. For example, if you are on your feet for a lot of the time, or if you do lots of walking, running, standing, etc, when
you are not used to it. (Plantar fasciitis may be confused with 'Policeman's heel', but they are different. Policeman's heel is plantar calcaneal bursitis - inflammation of the sack of fluid (bursa)
under the heel bone. This is not as common as plantar fasciitis.) Also, people with a sedentary lifestyle are more prone to plantar fasciitis. If you have recently started exercising on a different
surface, for example, running on the road instead of a track. If you have been wearing shoes with poor cushioning or poor arch support. If you are overweight this will put extra strain on your heel.
If there is overuse or sudden stretching of your sole. For example, athletes who increase running intensity or distance; poor technique starting 'off the blocks', etc. If you have a tight Achilles
tendon (the big tendon at the bottom of your calf muscles above your heel). This can affect your ability to flex your ankle and make you more likely to damage your plantar fascia. Often there is no
apparent cause for plantar fasciitis, particularly in older people. A common wrong belief is that the pain is due to a bony growth or 'spur' coming from the heel bone (calcaneum). Many people have a
bony spur of the heel bone but not everyone with this gets plantar fasciitis.
The pain associated with plantar fasciitis is typically gradual in onset and is usually located over the inner or medial aspect of the heel. Occasionally, the pain will be sudden in onset, occurring
after missing a step or after jumping from a height. The pain is commonly most severe upon arising from bed in the morning, or after periods of inactivity during the day. Thus, it causes what is
known as "first-step pain." The degree of discomfort can sometimes lessen with activity during the course of the day or after "warming-up", but can become worse if prolonged or vigorous activity is
undertaken. The pain is also often noted to be more severe in bare feet or in shoes with minimal or no padding at the sole.
Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your plantar fasciitis they will investigate
WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts. X-rays may show calcification within the plantar fascia or at its
insertion into the calcaneus, which is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests
(including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.
Non Surgical Treatment
Rest until the pain resolves and you are feeling better. For most people with plantar fasciitis it is very difficult to rest as daily routine demands using their feet during the day for work or other
activities. By using the painful foot you keep on hurting the plantar fascia, harming the foot and increasing inflammation. Rest as much as you can, reduce unnecessary activities and additional
stress on the fascia. Cold therapy like applying ice to the bottom of your foot helps reduce pain and inflammation. Cold therapy can be used all the time until symptoms have resolved. Some patients
prefer to roll their foot over an iced cold drink can or bottle taken out of the freezer. Physical therapy Exercises are good plantar fasciitis treatment. Stretching and other physical therapy
measures may be used to provide relief. Stretching the plantar fascia is reported in scientific studies to be a very effective treatment technique. Gait analysis will determine if you overpronate or
oversupinate. An expert may perform a test of the way you stand and walk to see if you step in a way that puts more stress on the plantar fascia. You can try to change the way you walk and stand
according to the experts recommendation as part of your treatment. Exercise the foot muscles to make the muscles stronger. One good exercise is grabbing and lifting up a towel or marbles using your
toes. You can do the same exercise without a towel as though you are grasping something with the toes of each foot. Another good exercise is walking as tall as you can on your toes and on the balls
of your feet. Stretching the plantar fascia and the calf muscles several times a day is an important part of the treatment and prevention. There are many stretching exercises for the plantar fascia
and the calf muscles that you can find. Long term treatment should not focus in reduction of pain and inflammation alone. This is a passive short term relief treatment. Stretching exercises results
are longer and more flexible foot movement which can prevent another fascia injury. Plantar fasciitis taping technique can assist the foot getting rest and help it from getting injured again.
Athletic tape is applied in strips on the skin on the bottom of the foot supporting the plantar fascia. The tape restricts the movement of the foot so the fascia can not be injured again. Taping
supports the foot by putting the tired foot muscles and tendons in a physiologically more relaxed position. A night splint is worn during sleep. It holds the calf muscles and plantar fascia in a
stretched position. Night splint treatment lets the fascia heal in a stretched position so it will not get bruised again when waking up and stretching it again while walking. Orthotics or inserts
that your doctor may prescribe or custom made arch supports (orthotics) plantar fascia orthotic. help to distribute the pressure on your feet more evenly. Arch Support gives a little raise to the
arch assisting the plantar fascia. There are also over-the-counter inserts that are used for arch support and heel cushioning. Heel cups and cradles provide extra comfort and cushion the heel. They
reduce shock placed on the foot during everyday activities like Shock absorbers. Anti-inflammatory or Pain medication that a clinician may recommend can be a plantar fasciitis treatment.
Non-steroidal anti-inflammatory drugs such as ibuprofen can reduce swelling and relieve pain. However, these medications may have many side effects and it is important to consider the potential risks
and benefits. These medications may relieve the pain and inflammation but will not cure the fascia. Lose weight as much as you can. Extra weight puts more stress on your plantar fascia. Platelet Rich
Plasma or PRP therapy, is a procedure which involves an injection of special plasma, made out of the patients own blood, to the injured area. Platelets are special blood components that have a major
role in the body ability to heal itself. Blood is taken from the patient and separated into its components. The platelet rich part of the blood is than taken and injected into the injured area - in
our case to the bottom of the foot. The special plasma helps the foot recovery process. The procedure is actually maximizing the body's natural healing response of the treated area. Extracorporeal
shock wave therapy is a procedure which sound waves are targeted at the area of heel pain to encourage healing. It is mostly used for chronic plantar fasciitis which does not respond to conservative
treatments. This procedure has many possible side effects like bruising, swelling, pain or numbness and has not proved to be consistently effective. Corticosteroid injection (or cortisone shots) into
the painful area may provide relief in severe cases. This kind of medication is very efficient in inflammation reduction. Corticosteroid injections usually provide short-term relief from plantar
fasciitis pain. Symptom relief from the corticosteroid injection lasts for 3 to 6 weeks, but the effect often deteriorates and symptoms return. Botox Injections (botulinum toxin) are used to relieve
the pain of plantar fasciitis, assist foot function recovery and the ability to walk better. Although the use of Botox injections as heel pain treatment is relatively new, there are a number of
medical studies that show significant good results.
Surgery is rarely needed in the treatment of plantar fasciitis. The vast majority of patients diagnosed with plantar fasciitis will recover given ample time. With some basic treatment steps, well
over 90% of patients will achieve full recovery from symptoms of plantar fasciitis within one year of the onset of treatment. Simple treatments include anti-inflammatory medication, shoe inserts, and
stretching exercises. In patients where a good effort with these treatments fails to provide adequate relief, some more aggressive treatments may be attempted. These include cortisone injections or
extracorporeal shock wave treatments.