Plantar fasciitis is the most common cause of heel pain. The plantar fascia is the flat band of tissue (ligament) that connects your heel bone to your toes. It supports the arch of your foot. If you
strain your plantar fascia, it gets weak, swollen, and irritated (inflamed). Then your heel or the bottom of your foot hurts when you stand or walk. Plantar fasciitis is common in middle-aged people.
It also occurs in younger people who are on their feet a lot, like athletes or soldiers. It can happen in one foot or both feet.
You're more likely to develop the condition if you're female, overweight or have a job that requires a lot of walking or standing on hard surfaces. You're also at risk if you walk or run for
exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches also are more prone to plantar fasciitis.
Plantar fasciitis sufferers feel a sharp stab or deep ache in the middle of the heel or along the arch. Another sign is the morning hobble from the foot trying to heal itself in a contracted position
overnight. Taking that first step causes sudden strain on the bottom of the foot. The pain can recur after long spells of sitting, but it tends to fade during a run, once the area is warmed up.
X-rays are a commonly used diagnostic imaging technique to rule out the possibility of a bone spur as a cause of your heel pain. A bone spur, if it is present in this location, is probably not the
cause of your pain, but it is evidence that your plantar fascia has been exerting excessive force on your heel bone. X-ray images can also help determine if you have arthritis or whether other, more
rare problems, stress fractures, bone tumors-are contributing to your heel pain.
Non Surgical Treatment
If conservative treatments fail, and the symptoms of plantar fasciitis have not been relieved, the doctor may recommend one of the following treatments. Cortisone, or corticosteroids, is medications
that reduce inflammation. Cortisone is usually mixed with local anesthetics and injected into the plantar fascia where it attaches to the heel bone. In many cases this reduces the inflammation
present and allows the plantar fascia to begin healing. Local injections of corticosteroids may provide temporary or permanent relief. Recurrence of symptoms may be lessened by combining steroid
injections with other forms of treatment such as orthotics, changes in shoe gear, weight loss, stretching exercises, and rest. Repeated cortisone injections may result in rupture of the plantar
fascia, thinning of the heel's fat pad, and other tissue changes. Extracorporeal Shock Wave Therapy (ESWT) devices generate pulses of high-pressure sound that travel through the skin. For reasons
that are not fully understood, soft tissue and bone that are subjected to these pulses of high-pressure energy heal back stronger. There is both a high-energy and low-energy form of ESWT; and both
forms of shock wave therapy can be used in the treatment of plantar fasciitis. Research studies indicate ESWT is a safe and effective treatment option for plantar fasciitis. The recovery period is
shorter than traditional invasive surgery and the procedure eliminates many of the risks associated with traditional surgery.
Surgery is considered only after 12 months of aggressive nonsurgical treatment. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles
place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches. In gastrocnemius recession, one of
the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope,
an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage.
Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is
partially cut to relieve tension in the tissue. If you have a large bone spur, it will be removed, as well. Although the surgery can be performed endoscopically, it is more difficult than with an
open incision. In addition, endoscopy has a higher risk of nerve damage.
You can help to prevent plantar fasciitis by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch and cushion the heel. In people who
are prone to episodes of plantar fasciitis, exercises that stretch the heel cord (known as the Achilles tendon) and the plantar fascia may help to prevent plantar fasciitis from returning. Ice
massage also can be used on the bottom of the foot after stressful athletic activities. It is possible that strict control of blood sugar will prevent plantar fasciitis in people with diabetes,
although this has not been proven.