The plantar fascia is a thickened fibrous aponeurosis that originates from the medial tubercle of the calcaneus and runs forward to form the longitudinal foot arch. The function of the plantar fascia
is to provide static support of the longitudinal arch and dynamic shock absorption. Individuals with pes planus (low arches or flat feet) or pes cavus (high arches) are at increased risk for
developing plantar fasciitis.
Plantar fasciitis occurs because of irritation to the thick ligamentous connective tissue that runs from the heel bone to the ball of the foot. This strong and tight tissue contributes to maintaining
the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. Therefore, the stress placed on the this tissue is tremendous.
Symptoms of plantar fasciitis include pain in the heel of the foot. Some people complain of a sharp stabbing pain especially with walking. Others describe the pain as a dull ache after prolonged
standing. The pain of plantar fasciitis is often worst in the morning or following activity.
Your doctor can usually diagnose plantar fasciitis just by talking to you and examining your feet. Rarely, tests are needed if the diagnosis is uncertain or to rule out other possible causes of heel
pain. These can include X-rays of the heel or an ultrasound scan of the fascia. An ultrasound scan usually shows thickening and swelling of the fascia in plantar fasciitis.
Non Surgical Treatment
To alleviate the stress and pain on the fascia, the person can take shorter steps and avoid walking barefoot. Activities that involve foot impact, such as jogging, should be avoided. The most
effective treatments include the use of in-shoe heel and arch cushioning with calf-stretching exercises and night splints that stretch the calf and plantar fascia while the patient sleeps.
Prefabricated or custom-made foot orthotics may also alleviate fascial tension and symptoms. Other treatments may include activity modifications, NSAIDs, weight loss in obese patients, cold and ice
massage therapy, and occasional corticosteroid injections. However, because corticosteroid injections can predispose to plantar fasciosis, many clinicians limit these injections. For recalcitrant
cases, physical therapy, oral corticosteroids, and cast immobilization should be used before surgical intervention is considered. A newer form of treatment for recalcitrant types of plantar fasciosis
is extracorporeal pulse activation therapy (EPAT), in which low-frequency pulse waves are delivered locally using a handheld applicator. The pulsed pressure wave is a safe, noninvasive technique that
stimulates metabolism and enhances blood circulation, which helps regenerate damaged tissue and accelerate healing. EPAT is being used at major medical centers.
In unusual cases, surgical intervention is necessary for relief of pain. These should only be employed after non-surgical efforts have been used without relief. Generally, such surgical procedures
may be completed on an outpatient basis in less than one hour, using local anesthesia or minimal sedation administrated by a trained anesthesiologist. In such cases, the surgeon may remove or release
the injured and inflamed fascia, after a small incision is made in the heel. A surgical procedure may also be undertaken to remove bone spurs, sometimes as part of the same surgery addressing the
damaged tissue. A cast may be used to immobilize the foot following surgery and crutches provided in order to allow greater mobility while keeping weight off the recovering foot during healing. After
removal of the cast, several weeks of physical therapy can be used to speed recovery, reduce swelling and restore flexibility.
Stretching exercises for the Achilles tendon and plantar fascia are recommend to relieve pain and aid in the healing process. Sometimes application of athletic tape is recommended. In moderate or
severe cases of plantar fasciitis, your doctor may recommend you wearing a night splint, which will stretch the arch of your foot and calf while you sleep. This helps to lengthen the Achilles tendon
and plantar fascia for symptom relief. Depending on the severity of your plantar fasciitis, your physician may prescribe a store-bought orthotic (arch support) or custom-fitted orthotic to help
distribute your foot pressure more evenly.