Plantar fasciitis is the most common cause of heel pain in runners, eventually affecting 10 percent of the running community. While running, the plantar fascia works with the Achilles tendon to store
and return energy. Because of its powerful attachment to the base of the toe, the plantar fascia stabilizes the inner forefoot as forces peak during pushoff. Unlike bone spurs and stress fractures of
the heel, plantar fasciitis tends to produce pain during the pushoff phase while running, not during initial contact. A simple way to tell if you have plantar fasciitis versus a heel spur/stress
fracture is to walk on your toes: heel spurs and heel stress fractures feel better while you walk on your toes, while plantar fasciitis typically produces more discomfort when you shift your weight
onto your toes.
Although plantar fasciitis may result from a variety of factors, such as repeat hill workouts and/or tight calves, many sports specialists claim the most common cause for plantar fasciitis is fallen
arches. The theory is that excessive lowering of the arch in flat-footed runners inÂcreases tension in the plantar fascia and overloadÂs the attachment of the plantar fascia on the heel bone (i.e.,
the calcaneus). Over time, the repeated pulling of the plantar fascia associated with excessive arch lowering is thought to lead to chronic pain and inflammation at the plantar fasciaâs attachment
to the heel. In fact, the increased tension on the heel was believed to be so great that it was thought to eventually result in the formation of a heel spur.
Plantar fascia usually causes pain and stiffness on the bottom of your heel although some people have heel spurs and suffer no symptoms at all. Occasionally, heel pain is also associated with other
medical disorders such as arthritis (inflammation of the joint), bursitis (inflammation of the tissues around the joint). Those who have symptoms may experience âFirst stepâ pain (stone bruise
sensation) after getting out of bed or sitting for a period of time. Pain after driving. Pain on the bottom of your heel. Deep aching pain. Pain can be worse when barefoot.
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
In general, plantar fasciitis is a self-limiting condition. Unfortunately, the time until resolution is often six to 18 months, which can lead to frustration for patients and physicians. Rest was
cited by 25 percent of patients with plantar fasciitis in one study as the treatment that worked best. Athletes, active adults and persons whose occupations require lots of walking may not be
compliant if instructed to stop all activity. Many sports medicine physicians have found that outlining a plan of ârelative restâ that substitutes alternative forms of activity for activities
that aggravate the symptoms will increase the chance of compliance with the treatment plan. It is equally important to correct the problems that place individuals at risk for plantar fasciitis, such
as increased amount of weight-bearing activity, increased intensity of activity, hard walking/running surfaces and worn shoes. Early recognition and treatment usually lead to a shorter course of
treatment as well as increased probability of success with conservative treatment measures.
Surgery for plantar fasciitis can be very successful in the right patients. While there are potential complications, about 70-80% of patients will find relief after plantar fascia release surgery.
This may not be perfect, but if plantar fasciitis has been slowing you down for a year or more, it may well be worth these potential risks of surgery. New surgical techniques allow surgery to release
the plantar fascia to be performed through small incisions using a tiny camera to locate and cut the plantar fascia. This procedure is called an endoscopic plantar fascia release. Some surgeons are
concerned that the endoscopic plantar fascia release procedure increases the risk of damage to the small nerves of the foot. While there is no definitive answer that this endoscopic plantar fascia
release is better or worse than a traditional plantar fascia release, most surgeons still prefer the traditional approach.
Do your best to maintain healthy weight. Plantar fasciitis is caused by wear and tear on your feet. Being overweight drastically increases the pounding your feet take every day. Even losing a few
pounds can help reduce heel pain. Avoid jobs that require walking or standing for long periods of time. Having your body weight on your feet all day puts a lot of pressure on your plantar fascia
tissue. Replace your shoes on a regular basis. Buy new shoes when the old ones are worn-out. Make sure your shoes will fit your foot size comfortably at the end of the day. Pay attention to the width
as well as the length. Use good supportive shoes that will help you with your original problem like arch support, motion control, stability, cushioning etc. Stretch regularly as part of your daily
routine. There are a few special stretching techniques for the prevention. Choose soft surfaces for your exercise routine to walk, jog or run on. Rest and elevate your feet every chance you have.
Strengthen your foot muscles as part of your exercise routine. Strong foot muscles provide a good support to the plantar fascia. Change your shoes during the work week. Don't wear the same pair of
shoes every day. Perform Warm up exercises such as a short period of walking, a light jog or other easy movement and then stretch before starting the main exercise. Try to avoid dramatic changes in
your exercise routine. Increase your exercise level gradually. Donât run long distance if you are used to walk. Make the change slowly and gradually. Pay attention to your foot pain, do not ignore
it. Visit your doctor if the pain continues. Avoid the activities that cause you pain. Use over-the-counter Orthotics or inserts that your doctor may prescribe. Off-the-shelf or custom-fitted arch
supports (orthotics) will help distribute pressure to your feet more evenly. Try to avoid barefoot walking, since it may add stress on the plantar fascia ligament.