The deep plantar fascia (plantar aponeurosis) is a thick, pearly-white tissue with longitudinal fibers intimately attached to the skin. Plantar fasciitis, characterized by pain in the plantar region
of the foot that is worse when initiating walking, is one of the most common causes of foot and heel pain in adults. A large number of additional disorders can cause foot and heel pain. These include
Achilles tendinopathy, Haglundâs syndrome, Stress fractures due to osteoporosis.
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.
Most patients with plantar fasciitis describe a sharp or stabbing pain on the bottom of the heel that is most severe when they first get up in the morning or after a period of resting. Some may feel
like the heel is bruised while others may describe tightness or even a pulling sensation on the heel or arch.
Your doctor may look at your feet and watch the way you stand, walk and exercise. He can also ask you questions about your health history, including illnesses and injuries that you had in your past.
The symptoms you have such as the pain location or when does your foot hurts most. Your activity routine such as your job, exercise habits and physical activities preformed. Your doctor may decide to
use an X-ray of your foot to detect bones problems. MRI or ultrasound can also be used as further investigation of the foot condition.
Non Surgical Treatment
No single treatment works best for everyone with plantar fasciitis. But there are many things you can try to help your foot get better. Give your feet a rest. Cut back on activities that make your
foot hurt. Try not to walk or run on hard surfaces. To reduce pain and swelling, try putting ice on your heel. Or take an over-the-counter pain reliever like ibuprofen (such as Advil or Motrin) or
naproxen (such as Aleve). Do toe stretches , calf stretches and towel stretches several times a day, especially when you first get up in the morning. (For towel stretches, you pull on both ends of a
rolled towel that you place under the ball of your foot.) Get a new pair of shoes. Pick shoes with good arch support and a cushioned sole. Or try heel cups or shoe inserts ( orthotics ). Use them in
both shoes, even if only one foot hurts. If these treatments do not help, your doctor may recommend splints that you wear at night, shots of medicine (such as a steroid ) in your heel, or other
treatments. You probably will not need surgery. Doctors only suggest it for people who still have pain after trying other treatments for 6 to 12 months.
Most practitioners agree that treatment for plantar fasciitis is a slow process. Most cases resolve within a year. If these more conservative measures don't provide relief after this time, your
doctor may suggest other treatment. In such cases, or if your heel pain is truly debilitating and interfering with normal activity, your doctor may discuss surgical options with you. The most common
surgery for plantar fasciitis is called a plantar fascia release and involves releasing a portion of the plantar fascia from the heel bone. A plantar fascia release can be performed through a regular
incision or as endoscopic surgery, where a tiny incision allows a miniature scope to be inserted and surgery to be performed. About one in 20 patients with plantar fasciitis will need surgery. As
with any surgery, there is still some chance that you will continue to have pain afterwards.
Stretching your plantar fasciitis is something you can do at home to relieve pain and speed healing. Ice massage performed three to four times per day in 15 to 20 minute intervals is also something
you can do to reduce inflammation and pain. Placing arch supports in your shoes absorbs shock and takes pressure off the plantar fascia.