Overview
Plantar fasciitis was previously believed to be inflammation of the fascia near its insertion on the heel bone. The suffix (-itis) means inflammation. Studies, however, reveal that changes in the tissue associated with the injury are degenerative and not related to inflammation, at least not in the way most people typically think of inflammation. Sudden onset of heel pain may indeed be related to acute inflammation. For persistent heel pain the condition more closely resembles long-standing degeneration of the plantar fascia near its attachment than inflammation. This could explain why anti-inflammatory medications and injections have been unsuccessful at treating it. But there is more to heel pain than just the plantar fascia.
Causes
Factors which may contribute to plantar fasciitis and heel spurs include a sudden increase in daily activities, increase in weight, or a change of shoes or allowing your current shoes to wear excessively. Shoes that are too flexible in the middle of the arch or shoes that bend before the toe joints will cause an increase in tension in the plantar fascia. Make sure your shoes are not excessively worn and that they do not bend in the "middle of the arch".
Symptoms
Patients experience intense sharp pain with the first few steps in the morning or following long periods of having no weight on the foot. The pain can also be aggravated by prolonged standing or sitting. The pain is usually experienced on the plantar surface of the foot at the anterior aspect of the heel where the plantar fascia ligament inserts into the calcaneus. It may radiate proximally in severe cases. Some patients may limp or prefer to walk on their toes. Alternative causes of heel pain include fat pad atrophy, plantar warts and foreign body.
Diagnosis
X-rays are a commonly used diagnostic imaging technique to rule out the possibility of a bone spur as a cause of your heel pain. A bone spur, if it is present in this location, is probably not the cause of your pain, but it is evidence that your plantar fascia has been exerting excessive force on your heel bone. X-ray images can also help determine if you have arthritis or whether other, more rare problems, stress fractures, bone tumors-are contributing to your heel pain.
Non Surgical Treatment
The plantar fascia is a band of tissue, much like a tendon, that starts at your heel and goes along the bottom of your foot. It attaches to each one of the bones that form the ball of your foot. The plantar fascia works like a rubber band between the heel and the ball of your foot to form the arch of your foot. If the band is short, you'll have a high arch, and if it's long, you'll have a low arch, what some people call flatfeet. A pad of fat in your heel covers the plantar fascia to help absorb the shock of walking. Damage to the plantar fascia can be a cause of heel pain.
Surgical Treatment
Like every surgical procedure, plantar fasciitis surgery carries some risks. Because of these risks your doctor will probably advise you to continue with the conventional treatments at least 6 months before giving you approval for surgery. Some health experts recommend home treatment as long as 12 months. If you can’t work because of your heel pain, can’t perform your everyday activities or your athletic career is in danger, you may consider a plantar fasciitis surgery earlier. But keep in mind that there is no guarantee that the pain will go away completely after surgery. Surgery is effective in many cases, however, 20 to 25 percent of patients continue to experience heel pain after having a plantar fasciitis surgery.
Stretching Exercises
Exercises designed to stretch both your calf muscles and your plantar fascia (the band of tissue that runs under the sole of your foot) should help relieve pain and improve flexibility in the affected foot. A number of stretching exercises are described below. It's usually recommended that you do the exercises on both legs, even if only one of your heels is affected by pain. This will improve your balance and stability, and help relieve heel pain. Towel stretches. Keep a long towel beside your bed. Before you get out of bed in the morning, loop the towel around your foot and use it to pull your toes towards your body, while keeping your knee straight. Repeat three times on each foot. Wall stretches. Place both hands on a wall at shoulder height, with one of your feet in front of the other. The front foot should be about 30cm (12 inches) away from the wall. With your front knee bent and your back leg straight, lean towards the wall until you feel a tightening in the calf muscles of your back leg. Then relax. Repeat this exercise 10 times before switching legs and repeating the cycle. You should practise wall stretches twice a day. Stair stretches. Stand on a step of your stairs facing upstairs, using your banister for support. Your feet should be slightly apart, with your heels hanging off the back of the step. Lower your heels until you feel a tightening in your calves. Hold this position for about 40 seconds, before raising your heels back to the starting position. Repeat this procedure six times, at least twice a day. Chair stretches. Sit on a chair, with your knees bent at right angles. Turn your feet sideways so your heels are touching and your toes are pointing in opposite directions. Lift the toes of the affected foot upwards, while keeping the heel firmly on the floor. You should feel your calf muscles and Achilles tendon (the band of tissue that connects your heel bone to your calf muscle) tighten. Hold this position for several seconds and then relax. Repeat this procedure 10 times, five to six times a day. Dynamic stretches. While seated, roll the arch of your foot (the curved bottom part of the foot between your toes and heel) over a round object, such as a rolling pin, tennis ball or drinks can. Some people find that using a chilled can from their fridge has the added benefit of helping to relieve pain. Move your foot and ankle in all directions over the object for several minutes. Repeat the exercise twice a day.