Plantar fasciitis is an inflammation of the plantar fascia, which is a strong ligament that runs from the heel bone (calcaneus) to the long bones (metatarsals) in the front of your foot.
This ligament helps the bones of the foot absorb the shock that occurs when your foot contacts the ground as you first step down. It then holds the toes firmly on the ground as your body passes over your foot.
This inflammation occurs in both high arched feet and in flat feet. Typically, pain is noted first thing in the morning, or after sitting or standing in one place for a prolonged time. The pain is most often located where the ligament attaches to the heel bone, although some people also experience pain in the mid portion of the arch, or on the outside of the foot.
Interestingly, heel pain in the same location as the attachment of the plantar fascia can be caused by other conditions, ranging from some types of arthritis to certain venereal diseases. That’s why your health care provider will probably ask you certain screening questions and possibly may order diagnostic tests.
Many times, x-rays will help determine whether you have a bone spur on your heel bone (which is not thought to be the cause of the pain, but rather an indication that your plantar fascia ligament has been abnormally pulling on your heel bone.) An x-ray can also indicate whether arthritis is present in the heel bone or show rarer conditions such as bone tumors or stress fractures.
If your health care provider is certain that you are suffering from plantar fasciitis, you may be presented with one or more of the following treatment options:
Anti-inflammatory medicines (examples would be Motrin or Advil, brand names for ibuprofen) Cryotherapy (ice therapy) ice packs, ice baths, ice sprays Taping the bottom of your foot, to restrict certain foot movements thought to be the cause of the inflammation, such as overpronation (when your foot rolls to the inside too much or flattens out too much). Steroid injections e.g. cortisone or a local anesthetic such as lidocaine to decrease the inflammation and provide some pain relief. Footbeds, pads or orthotics. A variety of materials from felt to cork to stainless steel can be shaped to support the foot. These devices can be purchased as over-the-counter products (footbeds, pads) or they can be orthotics fabricated from an impression of the foot (this is typically done by the health care provider). Shoe therapy is particularly important for those whose plantar fasciitis has been brought about by participating in sports, especially running. Exercise program for the overweight individual (water aerobics for those whose pain doesn’t allow them to walk or cycle) coupled with dietary recommendations. Physical therapy which includes treatments like ultrasound, electrical stimulation, contrast bathing (putting the injured/painful part in cold water, then in hot, then back in cold water to stimulate circulation and healing), range-of-motion exercises, massage and many others. Holistic approaches include accupuncture, reflexology, magnet therapy and others.
Most people get better with these conservative treatments, although it may take many months to get completely better, and unfortunately sometimes it does come back at a later date. Your health care provider may recommend surgery if you are not better after about six months to a year. The surgery will likely include release of a portion of the ligament where it attaches to your heel bone and some surgeons also remove any bone spur that has formed. This surgery can be performed through a traditional open incision or through a specialized endoscopic (small incision with insertion of a camera which guides and magnifies the instruments doing the release of the ligament). There are studies currently underway to determine which method is better.