The deep plantar fascia (plantar aponeurosis) is a thick, pearly-white tissue with longitudinal fibers intimately attached to the skin. Plantar fasciitis, characterized by pain in the plantar region
of the foot that is worse when initiating walking, is one of the most common causes of foot and heel pain in adults. A large number of additional disorders can cause foot and heel pain. These include
Achilles tendinopathy, Haglundâs syndrome, Stress fractures due to osteoporosis.
Plantar fasciitis is caused by small, repetitive trauma to the plantar fascia. This trauma can be due to activity that puts extra stress on the foot. Plantar fasciitis is most common in people who
are 40-60 years old. Other risk factors that increase your chance of getting plantar fasciitis include physical exertion, especially in sports such as running, Volleyball, tennis, a sudden increase
in exercise intensity or duration, physical activity that stresses the plantar fascia. People who spend a lot of time standing, a sudden increase in activities that affect the feet, obesity or weight
gain, pre-existing foot problems, including an abnormally tight Achilles tendon, flat feet, or an ankle that rolls inward too much. Poor footwear. Heel spurs.
The heel pain characteristic of plantar fasciitis is usually felt on the bottom of the heel and is most intense with the first steps of the day. Individuals with plantar fasciitis often have
difficulty with dorsiflexion of the foot, an action in which the foot is brought toward the shin. This difficulty is usually due to tightness of the calf muscle or Achilles tendon, the latter of
which is connected to the back of the plantar fascia. Most cases of plantar fasciitis resolve on their own with time and respond well to conservative methods of treatment.
Your doctor will perform a physical exam to check for tenderness in your foot and the exact location of the pain to make sure that itâs not caused by a different foot problem. The doctor may ask
you to flex your foot while he or she pushes on the plantar fascia to see if the pain gets worse as you flex and better as you point your toe. Mild redness or swelling will also be noted. Your doctor
will evaluate the strength of your muscles and the health of your nerves by checking your reflexes, your muscle tone, your sense of touch and sight, your coordination, and your balance. X-rays or a
magnetic resonance imaging (MRI) scan may be ordered to check that nothing else is causing your heel pain, such as a bone fracture.
Non Surgical Treatment
Reducing inflammation in the plantar fascia ligament is an important part of treatment, though this does not address the underlying damage to the ligament. Initial home treatment includes staying off
your feet and applying ice for 15 to 20 minutes three or four times a day to reduce swelling. You can also try reducing or changing your exercise activities. Using arch supports in your shoes and
doing stretching exercises may also help to relieve pain. Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (i.e. Motrin or Advil) and naproxen (i.e. Aleve), are often used to reduce
inflammation in the ligament. If home treatments and over-the-counter anti-inflammatory drugs donât ease the pain, an injection of a corticosteroid directly into the damaged section of the ligament
can be given. Your doctor can do this in his or her office. Your doctor may use an ultrasound device to help determine the best place for the injection. Corticosteroids can also be administered on
the skin of your heel or the arch of your foot, and then a painless electrical current is applied to let the steroid pass through your skin and into the muscle. Physical therapy is an important part
of treatment for planter fasciitis. It can help stretch your plantar fascia and Achilles tendons. A physical therapist can also show you exercises to strengthen your lower leg muscles, helping to
stabilize your walk and lessen the workload on your plantar fascia. If pain continues and other methods arenât working, your doctor may recommend extracorporeal shock wave therapy. Sound waves are
bombarded against your heel to stimulate healing within the ligament. This treatment can result in bruises, swelling, pain, and numbness, and has not been proven to be consistently effective in
Most studies indicate that 95% of those afflicted with plantar fasciitis are able to relieve their heel pain with nonsurgical treatments. If you are one of the few people whose symptoms don't improve
with other treatments, your doctor may recommend plantar fascia release surgery. Plantar fascia release involves cutting part of the plantar fascia ligament in order to release the tension and
relieve the inflammation of the ligament. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. While the success rate is very high following surgery,
one should be aware that there is often a prolonged postoperative period of discomfort similar to the discomfort experienced prior to surgery. This pain usually will abate within 2-3 months. One
should always be sure to understand all the risks associated with any surgery they are considering.