The plantar fascia is a thick band of connective tissue that runs along the underneath of the foot from the heel bone to the toes. At the heel it can also have fascial connections to the achilles
tendon. Its job is to maintain the arch of the foot, it acts as a bowstring pulled between the heel and the toes. "Itis" as a suffix indicates inflammation, but with the plantar fascia there is still
some controversy over what exactly happens to the tissue when it becomes painful.
The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more
prone to developing plantar fasciitis. Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly
evident when oneâs job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.
Heel pain is the most common symptom associated with plantar fasciosis. Your heel pain may be worse in the morning or after you have been sitting or standing for long periods. Pain is most common
under your heel bone, but you also may experience pain in your foot arch or on the outside aspect of your foot. Other common signs and symptoms of plantar fasciosis include mild swelling and redness
in your affected area, tenderness on the bottom of your heel, impaired ability to ambulate.
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
Cortisone is a powerful anti-inflammatory and when injected directly into the heel it will work almost immediately. Bear in mind however, that the treatment does not address the root cause of the
inflammation, and needs to be repeated every few months. Also note, these injections are quite painful, and most doctors today will consider other, less invasive treatment options first. ESWT (Extra
Corporeal Shockwave Treatment). A specialist targets therapeutic shockwaves to the affected heel area. This will stimulate a healing response in the affected tissue and ligaments, resulting in
reduced inflammation and pain. This treatment and may take from 3 to 4 months to be fully effective. Extracorpreal Shock Wave Therapy is the latest technology to treat chronic plantar fasciitis. It
is a non-invasive treatment and highly recommended for people who have tried other treatment like cortisone-injections, accupuncture etc with little or no success. Electroacupuncture and standard
acupuncture are used in the treatment of plantar fasciitis and other foot problems such as neuromas and nerve impingement, numbness in the toes etc. In some cases there is nerve entrapment within the
foot combined with referred pain from other areas of the body. Some research suggests that acunpuncture can be effective in the treatment of heel pain. A trigger point is an irritable knot in the
muscle tissue. When pressed trigger points are very tender and can cause pain in that specific spot or elsewhere in the body (referred pain). The response to pushing into the knot is a muscle twitch.
The foot contains 126 muscles, tendons and ligaments, so there are plenty of 'hiding places' for trigger points. Trigger points in the calf muscles often refer pain directly to the bottom of the
foot. Trigger point therapy of the lower leg and foot can therefore be successful in the treatment of plantar fasciitis.
Surgery is not a common treatment for this condition. Approximately 5% of people with plantar fasciitis require surgery if non-surgical methods do not help to relieve pain within a year. The surgical
procedure involves making an incision in the plantar fascia in order to decrease the tension of the ligament. Potential risks of this surgical procedure include irritation of the nerves around the
heel, continued plantar fasciitis, heel or foot pain, infection, flattening of the arch, problems relating to the anesthetic.
Do not walk barefoot on hard ground, particularly while on holiday. Many cases of heel pain occur when a person protects their feet for 50 weeks of the year and then suddenly walks barefoot while on
holiday. Their feet are not accustomed to the extra pressure, which causes heel pain. If you do a physical activity, such as running or another form of exercise that places additional strain on your
feet, you should replace your sports shoes regularly. Most experts recommend that sports shoes should be replaced after you have done about 500 miles in them.