Plantar Fasciitis

Plantar fasciitis refers to pain on the undersurface of the heel. It is one of the most common conditions seen by a foot and ankle specialist.

The Plantar Fascia refers to a thick band of tissue that connects the heel to the front of the foot. For a number of reasons, the Plantar Fascia can become inflamed, leading to pain along the heel attachment.

lassic symptoms of plantar fasciitis include pain with the first few steps in the morning upon getting out of bed and increased pain after strenuous activity.

While the true cause of plantar fasciitis is usually known, there are several known risk factors for the development of this disease process. Repetitive high impact activity, such as with running and sports is one known risk factor. Others include excessively high arches (pes cavus deformity), tight calf muscles, obesity, and excessive weight bearing in non-supportive shoe wear can lead to the development of plantar fasciitis. Many believe that a “heel spur” causes plantar fasciitis. This is not necessarily the case as many have plantar fasciitis and have no evidence of a heel spur on x-rays. Others do have a spur that may aggravate this condition.

This condition is diagnosed by taking a patient’s history and from a physical examination of the affected foot/ankle. X-rays are usually ordered to look for other causes of heel pain.

Treatment is aimed at easing pain and inflammation. Initially activity modification and/or rest may be prescribed. Stretching exercises and the use of ice are also helpful to ease symptoms. The use of a night-time splint may be prescribed. The purpose of this is to provide a gentle stretch to the calf muscles to prevent it from tightening. Changes in shoe wear and orthotics may of benefit to some. Anti-inflammatory medications (NSAID) may also be prescribed to reduce pain and inflammation. Cortisone injections are used for this condition on a limited basis. There is the potential for rupture of the Plantar Fascia with too many injections. Fortunately, a large majority will improve with non-surgical care.

Surgery is limited to those who failed to improve with the aforementioned conservative treatments. A plantar fascia release involves cutting part of the plantar fascia to reduce tension on it. Additional procedures including removal of any bone spurs and a nerve release may also be necessary to increase the success rate of the procedure. Patients are immobilized in a boot or splint following this surgery to allow healing to take place.