The Plantar Fascia is a broad, thick band of tissue that runs from under the heel to the front of the foot. Through overuse the fascia can become inflamed and painful at its attachment to the heel
bone or calcaneus. The condition is traditionally thought to be inflammation, however this is now believed to be incorrect due to the absence of inflammatory cells within the fascia. The cause of
pain is thought to be degeneration of the collagen fibres close to the attachment to the heel bone.
The most frequent cause is an abnormal motion of the foot called excessive pronation. Normally, while walking or during long distance running, your foot will strike the ground on the heel, then roll
forward toward your toes and inward to the arch. Your arch should only dip slightly during this motion. If it lowers too much, you have what is known as excessive pronation. For more details on
pronation, please see the section on biomechanics and gait. Clinically not only those with low arches, but those with high arches can sometimes have plantar fasciitis. The mechanical structure of
your feet and the manner in which the different segments of your feet are linked together and joined with your legs has a major impact on their function and on the development of mechanically caused
problems. Merely having "flat feet" won't take the spring out of your step, but having badly functioning feet with poor bone alignment will adversely affect the muscles, ligaments, and tendons and
can create a variety of aches and pains. Excess pronation can cause the arch of your foot to stretch excessively with each step. It can also cause too much motion in segments of the foot that should
be stable as you are walking or running. This "hypermobility" may cause other bones to shift and cause other mechanically induced problems.
You'll typically first notice early plantar fasciitis pain under your heel or in your foot arch in the morning or after resting. Your heel pain will be worse with the first steps and improves with
activity as it warms up. As plantar fasciitis deteriorates, the pain will be present more often. You can determine what stage your are in using the following guidelines. No Heel Pain, Normal! Heel
pain after exercise. Heel pain before and after exercise. Heel pain before, during and after exercise. Heel pain all the time. Including at rest! This symptom progression is consistent with the four
stages of a typical overuse injury. Ultimately, further trauma and delayed healing will result in the formation of calcium (bone) within the plantar fascia. When this occurs adjacent to the heel bone
it is known as heel spurs, which have a longer rehabilitation period.
Your doctor will check your feet and watch you stand and walk. He or she will also ask questions about your past health, including what illnesses or injuries you have had. Your symptoms, such as
where the pain is and what time of day your foot hurts most. How active you are and what types of physical activity you do. Your doctor may take an X-ray of your foot if he or she suspects a problem
with the bones of your foot, such as a stress fracture.
Non Surgical Treatment
Many types of treatment have been used to combat plantar fasciitis, including injections, anti-inflammatory medications, orthotics, taping, manipulation, night splinting, and instrument-assisted
soft-tissue manipulation (IASTM). IASTM begins with heat, followed by stretching. Stretching may be enhanced by applying ice to the plantar fascia. These stretches should be performed several times
per day, with the calf in the stretched position. IASTM uses stainless-steel instruments to effectively access small areas of the foot. IASTM is believed to cause a secondary trauma to injured soft
tissues as part of the healing process. Therapeutic modalities such as low-level laser, ultrasound, and electrical muscular stimulation may be effective in the reduction of pain and inflammation. Low
Dye strapping or taping of the foot is an essential part of successful treatment of plantar fasciitis. Extracorporeal shock-wave therapy (ESWT) was introduced with great promise at one time. Recent
studies have reported less favorable results. Some report no effect. Previous local steroid injection may actually have a negative effect on results from ESWT.
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue
to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you. No matter what
kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive
shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.