If your first step in the morning often feels like it involves a rusty nail being inserted into your heel, youâre not alone. Heel pain resulting from plantar fasciitis is the most prevalent
condition treated in podiatric clinics, and an additional 1 million Americans annually are seen by medical doctors for the condition, according to the Centers for Disease Control and Prevention. The
plantar fascia is the ligament that runs from the heel bone across the entire bottom of the foot and connects at the base of the toes. Ligaments connect bone to bone, and donât really constrict or
contract, but can become thickened because of inflammation. Inflammation of the plantar fascia can cause strain when you walk, specifically heel pain that is especially bad for the first few steps
after prolonged inactivity. It then typically loosens up once youâre up and about.
Repeated small injuries to the fascia (with or without inflammation) are thought to be the cause of plantar fasciitis. The injury is usually near to where the plantar fascia attaches to your heel
bone. You are more likely to injure your plantar fascia in certain situations. For example, if you are on your feet for a lot of the time, or if you do lots of walking, running, standing, etc, when
you are not used to it. (Plantar fasciitis may be confused with 'Policeman's heel', but they are different. Policeman's heel is plantar calcaneal bursitis - inflammation of the sack of fluid (bursa)
under the heel bone. This is not as common as plantar fasciitis.) Also, people with a sedentary lifestyle are more prone to plantar fasciitis. If you have recently started exercising on a different
surface, for example, running on the road instead of a track. If you have been wearing shoes with poor cushioning or poor arch support. If you are overweight this will put extra strain on your heel.
If there is overuse or sudden stretching of your sole. For example, athletes who increase running intensity or distance; poor technique starting 'off the blocks', etc. If you have a tight Achilles
tendon (the big tendon at the bottom of your calf muscles above your heel). This can affect your ability to flex your ankle and make you more likely to damage your plantar fascia. Often there is no
apparent cause for plantar fasciitis, particularly in older people. A common wrong belief is that the pain is due to a bony growth or 'spur' coming from the heel bone (calcaneum). Many people have a
bony spur of the heel bone but not everyone with this gets plantar fasciitis.
Symptoms of the plantar fasciitis include a gradual onset of pain under the heel which may radiate into the foot. Tenderness is usually felt under and on the inside of the heel which is initially
worse first in the morning but eases as the foot warms up only to return later in the day or after exercise. Stretching the plantar fascia may be painful.
Your doctor will check your feet and watch you stand and walk. He or she will also ask questions about your past health, including what illnesses or injuries you have had. Your symptoms, such as
where the pain is and what time of day your foot hurts most. How active you are and what types of physical activity you do. Your doctor may take an X-ray of your foot if he or she suspects a problem
with the bones of your foot, such as a stress fracture.
Non Surgical Treatment
A steroid (cortisone) injection is sometimes tried if your pain remains bad despite the above 'conservative' measures. It may relieve the pain in some people for several weeks but does not always
cure the problem. It is not always successful and may be sore to have done. Steroids work by reducing inflammation. Sometimes two or three injections are tried over a period of weeks if the first is
not successful. Steroid injections do carry some risks, including (rarely) tearing (rupture) of the plantar fascia. Extracorporeal shock-wave therapy. In extracorporeal shock-wave therapy, a machine
is used to deliver high-energy sound waves through your skin to the painful area on your foot. It is not known exactly how it works, but it is thought that it might stimulate healing of your plantar
fascia. One or more sessions of treatment may be needed. This procedure appears to be safe but it is uncertain how well it works. This is mostly because of a lack of large, well-designed clinical
trials. You should have a full discussion with your doctor about the potential benefits and risks. In studies, most people who have had extracorporeal shock-wave therapy have little in the way of
problems. However, possible problems that can occur include pain during treatment, skin reddening, and swelling of your foot or bruising. Another theoretical problem could include the condition
getting worse because of rupture of your plantar fascia or damage to the tissues in your foot. More research into extracorporeal shock-wave therapy for plantar fasciitis is needed. Other treatments.
Various studies and trials have been carried out looking at other possible treatments for plantar fasciitis. Such treatments include injection with botulinum toxin and treatment of the plantar fascia
with radiotherapy. These treatments may not be widely available. Some people benefit from wearing a special splint overnight to keep their Achilles tendon and plantar fascia slightly stretched. The
aim is to prevent the plantar fascia from tightening up overnight. In very difficult cases, sometimes a plaster cast or a removable walking brace is put on the lower leg. This provides rest,
protection, cushioning and slight stretching of the plantar fascia and Achilles tendon. However, the evidence for the use of splint treatment of plantar fasciitis is limited.
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.