Plantar fasciitis: Inflammation of the plantar fascia, the bowstring-like tissue that stretches from the heel bone to the base of the toes. Plantar fasciitis can be due to calcaneal spurs, which
typically cause localized tenderness and pain that is made worse by stepping down on the heel. Plantar fasciitis may be related to physical activity overload, abnormal foot mechanics, or may be due
to underlying diseases that cause arthritis, such as Reiter disease, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis. Treatment is designed to decrease inflammation and avoid
reinjury. Icing reduces pain and inflammation. Anti-inflammatory agents, such as ibuprofen and injections of cortisone, can help. Infrequently, surgery is done on chronically inflamed spurs. A
donut-shaped shoe insert can take pressure off a calcaneal spur and lessen plantar fasciitis.
Currently no single factor has been reliably identified as contributing to the development of plantar fasciitis. The two risk factors with the most support from current research. Decreased ankle
dorsiflexion. Increased Body Mass Index (BMI) in non-athletic populations. These factors are related in that both lead to increased strain on the arch, both lead to increased compression on the heel.
When dorsiflexion range of motion (ankle flexibility) is lacking, the body compensates by increasing movement of the arch. In this way, decreased ankle dorsiflexion influences pronation and places
strain on the underside of the foot. Similarly, having a high BMI causes strain because it places a load on the foot that may be in excess of what the foot can support. As mentioned earlier,
overpronation is thought to be a contributing factor, but studies on this have so far produced mixed results. The second way these factors relate to each other is in the way people stand. A lack of
ankle flexibility and a high BMI can both cause increased pressure on the heel in standing. Keeping weight on the heels causes compression under the heel. But it also means the muscles and ligaments
in the arch are not being used to balance your body weight. Lack of use, I suspect, is a greater danger than overuse. Looking beyond these potential contributors to heel pain though, there is one
major factor that overshadows them all-the way footwear alters the normal function of the foot.
The symptoms of plantar fasciitis include pain in the bottom of your foot, especially at the front or centre of the heel bone, pain that is worse when first rising in the morning (called "first-step
pain"), when first standing up after any long period of sitting, or after increased levels of activity especially in non-supportive shoes. Seek medical advice about plantar fasciitis if you have heel
pain or pain in the bottom of your foot, especially when you get up in the morning, that does not respond to treatment or if there is redness or bruising in the heel.
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
Treatment for plantar fasciitis includes medication, physical therapy, shock wave therapy, or surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are used to treat
the inflammation and pain of plantar fasciitis, but they wonât cure the condition. Corticosteroids can also be used to ease pain and reduce inflammation. Corticosteroids are applied either as a
topical solution in conjunction with a non-painful electric current or through injections to the affected area.
When more-conservative measures aren't working, your doctor might recommend steroid shots. Injecting a type of steroid medication into the tender area can provide temporary pain relief. Multiple
injections aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone. Extracorporeal shock wave therapy.
In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It's usually used for chronic plantar fasciitis that hasn't responded to more-conservative treatments. This
procedure may cause bruises, swelling, pain, numbness or tingling and has not been shown to be consistently effective. Surgery. Few people need surgery to detach the plantar fascia from the heel
bone. It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.