Plantar fasciitis, also called âheel pain syndrome,â affects approximately 2 million people in the United States each year. Plantar fasciitis can come on gradually as the result of a degenerative
process or sudden foot trauma. It can appear in one heel or both. It is generally worse on taking the first few steps in the morning or after prolonged sitting or non-weight-bearing movement.
Symptoms can be aggravated by activity and prolonged weight bearing. Obesity, too, is hard on the feet-it can cause plantar pain or it can make that pain worse. The plantar fascia connects the
calcaneal tubercle to the forefoot with five slips directed to each toe respectively. Other conditions, such as calcaneal fat pad atrophy, calcaneal stress fracture, nerve entrapment, and rheumatoid
arthritis may also cause foot pain. These conditions may be found in combination with plantar fasciitis, or separate from it. A blood test can help pinpoint the cause(s).
Plantar Fasciitis is caused by abnormal pronation of the foot. Contributing factors are obesity, weight gain, jobs that require a lot of walking or standing on hard surfaces, badly worn shoes with
little support, and also inactivity. As a result of over-pronation, with every step the Plantar Fascia (band of tissue under the foot) is being stretched, resulting in inflammation, irritation and
pain at the attachment of the fascia into the heel bone. In some cases the pain is felt under the foot, in the arch. Continuous pulling of the fascia at the heel bone, eventually may lead to the
development of bony growth on the heel. This is called a heel spur. When youâre at rest, such as while sleeping, the Plantar Fascia tightens and shortens. When body weight is rapidly applied to the
foot, the Fascia must stretch and quickly lengthen, causing micro-tears in the Fascia. As a result, the foot pain is more severe with your first steps in the morning, or after sitting for a long
period. Plantar Fasciitis is more likely to happen if you suffer from over-pronation (flattening of the arch), you stand or walk on hard surfaces, for long periods, you are overweight or pregnant,
you have tight calf muscles.
Pain is the main symptom. This can be anywhere on the underside of your heel. However, commonly, one spot is found as the main source of pain. This is often about 4 cm forward from your heel, and may
be tender to touch. The pain is often worst when you take your first steps on getting up in the morning, or after long periods of rest where no weight is placed on your foot. Gentle exercise may ease
things a little as the day goes by, but a long walk or being on your feet for a long time often makes the pain worse. Resting your foot usually eases the pain. Sudden stretching of the sole of your
foot may make the pain worse, for example, walking up stairs or on tiptoes. You may limp because of pain. Some people have plantar fasciitis in both feet at the same time.
Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You
will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot, this could be
a sign of nerve damage in your feet and legs (peripheral neuropathy) your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone infection,
you have stiffness and swelling in your heel, this could be a sign of arthritis. Possible further tests may include blood tests, X-rays - where small doses of radiation are used to detect problems
with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.
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.
Surgery may be considered in very difficult cases. Surgery is usually only advised if your pain has not eased after 12 months despite other treatments. The operation involves separating your plantar
fascia from where it connects to the bone; this is called a plantar fascia release. It may also involve removal of a spur on the calcaneum if one is present. Surgery is not always successful. It can
cause complications in some people so it should be considered as a last resort. Complications may include infection, increased pain, injury to nearby nerves, or rupture of the plantar fascia.
The best way to prevent plantar fasciitis is to wear shoes that are well made and fit your feet. This is especially important when you exercise or walk a lot or stand for a long time on hard
surfaces. Get new athletic shoes before your old shoes stop supporting and cushioning your feet. You should also avoid repeated jarring to the heel. Keep a healthy weight. Do your leg and foot
stretching exercises regularly.