The plantar fascia is a thick fibrous band that runs the length of the sole of the foot. The plantar fascia helps maintain the complex arch system of the foot and plays a role in one's balance and
the various phases of gait. Injury to this tissue, called plantar fasciitis, is one of the most disabling running injuries and also one of the most difficult to resolve. Plantar fasciitis represents
the fourth most common injury to the lower limb and represents 8 -10% of all presenting injuries to sports clinics (Ambrosius 1992, Nike 1989). Rehabilitation can be a long and frustrating process.
The use of preventative exercises and early recognition of danger signals are critical in the avoidance of this injury.
The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more
prone to developing plantar fasciitis. Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly
evident when oneâs job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.
The classic sign of plantar fasciitis is that the worst pain occurs with the first few steps in the morning, but not every patient will have this symptom. Patients often notice pain at the beginning
of activity that lessens or resolves as they warm up. The pain may also occur with prolonged standing and is sometimes accompanied by stiffness. In more severe cases, the pain will also worsen toward
the end of the day.
Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your plantar fasciitis they will investigate
WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts. X-rays may show calcification within the plantar fascia or at its
insertion into the calcaneus, which is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests
(including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.
Non Surgical Treatment
There are a number of treatments that can help relieve heel pain and speed up your recovery. These include resting your heel, try to avoid walking long distances and standing for long periods,
regular stretching, stretching your calf muscles and plantar fascia, pain relief, using an icepack on the affected heel and taking painkillers, such as non-steroidal anti-inflammatory drugs (NSAIDs)
wearing good-fitting shoes that support and cushion your foot, running shoes are particularly useful, using supportive devices such as orthoses (rigid supports that are put inside the shoe) or
strapping. Around four out of five cases of heel pain resolve within a year. However, having heel pain for this length of time can often be frustrating and painful. In around one in 20 cases, the
above treatments are not enough, and surgery may be recommended to release the plantar fascia.
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.
Maintain a healthy weight. This minimizes the stress on your plantar fascia. Choose supportive shoes. Avoid high heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency.
Don't go barefoot, especially on hard surfaces. Don't wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet. If you're a runner, buy new
shoes after about 500 miles of use. Change your sport. Try a low-impact sport, such as swimming or bicycling, instead of walking or jogging. Apply ice. Hold a cloth-covered ice pack over the area of
pain for 15 to 20 minutes three or four times a day or after activity. Or try ice massage. Freeze a water-filled paper cup and roll it over the site of discomfort for about five to seven minutes.
Regular ice massage can help reduce pain and inflammation. Stretch your arches. Simple home exercises can stretch your plantar fascia, Achilles tendon and calf muscles.