Plantar fasciitis is a common foot disorder that affects more than two million people every year, especially runners. It is inflammation of the plantar fascia, a thick band of tissue on the bottom of the foot. The most common area of pain is directly on the bottom of the heel, although some people may only have pain in the arch of the foot. Diagnosis of plantar fasciitis is typically done through a physical examination, which includes listening to the patient history, palpation of the heel and possibly x-rays.
Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling. This is more likely to happen if your feet roll inward too much when you walk ( excessive pronation ). You have high arches or flat feet. You walk, stand, or run for long periods of time, especially on hard surfaces. You are overweight. You wear shoes that don’t fit well or are worn out. You have tight Achilles tendons or calf muscles.
A very common complaint of plantar fasciitis is pain in the bottom of the heel. Plantar fasciitis is usually worse in the morning and may improve throughout the day. By the end of the day the pain may be replaced by a dull aching that improves with rest. Most people suffering from plantar fasciitis also complain of increased heel pain after walking for a long period of time.
A physical exam performed in the office along with the diagnostic studies as an x-ray. An MRI may also be required to rule out a stress fracture, or a tear of the plantar fascia. These are conditions that do not normally respond to common plantar fasciitis treatment.
Non Surgical Treatment
Shoe therapy, finding and wearing shoes that allow your feet to be in their natural position, is the most important treatment for plantar fasciosis. Shoes that possess a flat heel, are wide in the toe box, lack toe spring, and have flexible soles are most appropriate for this foot problem. An increasing number of shoe companies are producing shoes with these design characteristics, but shoes that include all these features are still difficult to find. For some suggested footwear models, see our clinic’s shoe list. Most conventional footwear can be modified by stretching the shoe’s upper, stretching out the toe spring, removing the shoe’s liner, and cutting the shoe at certain key points to allow more room for your foot. Visit your podiatrist to help you with these shoe modifications. Correct Toes is another helpful conservative treatment method for plantar fasciosis. Correct Toes addresses the root cause of your plantar fasciosis by properly aligning your big toe and reducing the tension created by your abductor hallucis longus on the blood vessels that feed and “cleanse” the tissues of your plantar fascia. Your plantar fasciosis-related pain will diminish when the dead tissue is washed away. A rehabilitation program, which includes targeted stretches and other exercises, for your foot may be helpful too. Dietary changes and aerobic exercise are particularly important for overweight individuals who have plantar fasciosis. Water aerobics may be most appropriate for those individuals whose pain does not allow them to walk or cycle. Physical therapy may be another helpful treatment modality for this problem, and includes ultrasound, electrical stimulation, contrast baths, and range-of-motion exercises. Massage, acupuncture, reflexology, and magnet therapy are holistic approaches that may be helpful.
Surgery is rarely needed in the treatment of plantar fasciitis. The vast majority of patients diagnosed with plantar fasciitis will recover given ample time. With some basic treatment steps, well over 90% of patients will achieve full recovery from symptoms of plantar fasciitis within one year of the onset of treatment. Simple treatments include anti-inflammatory medication, shoe inserts, and stretching exercises. In patients where a good effort with these treatments fails to provide adequate relief, some more aggressive treatments may be attempted. These include cortisone injections or extracorporeal shock wave treatments.