The Plantar Fascia is a broad, thick band of tissue that runs from under the heel to the front of the foot. Through overuse the fascia can become inflamed and painful at its attachment to the heel bone or calcaneus. The condition is traditionally thought to be inflammation, however this is now believed to be incorrect due to the absence of inflammatory cells within the fascia. The cause of pain is thought to be degeneration of the collagen fibres close to the attachment to the heel bone.
Plantar fasciitis is the most common cause of heel pain, accounting for around four out of five cases. Plantar fasciitis is when the thick band of tissue that connects the heel bone with the rest of the foot (the plantar fascia) becomes damaged and thickened. Damage to the plantar fascia is thought to occur following sudden damage, for example, damaging your heel while jogging, running or dancing; this type of damage usually affects younger people who are physically active, gradual wear and tear of the tissues that make up the plantar fascia - this usually affects adults who are 40 years of age or over. You are at an increased risk of gradual wear and tear damaging your plantar fasciitis if you are overweight or obese, if you have a body mass index (BMI) of 30 or over, you are considered to be obese, have a job that involves spending long periods of time standing, wear flat-soled shoes, such as sandals or flip flops. Less common causes of heel pain are a stress fracture. A stress fracture can occur if your heel bone is damaged during an injury. Fat pad atrophy. Fat pad atrophy is where the layer of fat that lies under the heel bone, known as the fat pad, starts to waste away due to too much strain being placed on the pad. Women who wear high-heeled shoes for many years have an increased risk of developing fat pad atrophy. Bursitis. Bursitis is inflammation of one or more bursa (small fluid-filled sacs under the skin, usually found over the joints and between tendons and bones). It's possible to develop bursitis anywhere inside the body, not just in the foot. Tarsal tunnel syndrome. The nerves in the sole of your foot pass through a small tunnel on the inside of the ankle joint, known as the tarsal tunnel. If a cyst forms or the tunnel is damaged, the nerves can become compressed (squashed). This can cause pain anywhere along the nerve, including beneath your heel. Sever's disease. Sever's disease is a common cause of heel pain in children. It's caused by the muscles and tendons of the hamstrings and calves stretching and tightening in response to growth spurts. The stretching of the calf muscle pulls on the Achilles tendon. This pulls on the growing area of bone at the back of the heel (growth plate), causing pain in the heel. The pain is further aggravated by activities such as football and gymnastics. The pain often develops at the side of the heel, but can also be felt under the heel. Calf and hamstring stretches and, if necessary, heel pads are usually effective treatments for Sever's disease. Bone spurs. Bone spurs are an excess growth of bone that forms on a normal bone. Bone spurs can develop on the heel (a heel spur) and are more common in people with heel pain. However, they can also occur in people without heel pain. A heel spur does not cause heel pain.
The symptoms of plantar fasciitis include pain in the bottom of your foot, especially at the front or centre of the heel bone, pain that is worse when first rising in the morning (called "first-step pain"), when first standing up after any long period of sitting, or after increased levels of activity especially in non-supportive shoes. Seek medical advice about plantar fasciitis if you have heel pain or pain in the bottom of your foot, especially when you get up in the morning, that does not respond to treatment or if there is redness or bruising in the heel.
Most cases of plantar fasciitis are diagnosed by a health care provider who listens carefully to your description of symptoms. During an examination of your feet, your health care provider will have to press on the bottom of your feet, the area most likely to be painful in plantar fasciitis. Because the pain of plantar fasciitis has unique characteristics, pain upon rising, improvement after walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas, your health care provider will probably feel comfortable making the diagnosis based on your symptoms and a physical examination. Your health care provider may suggest that you have an X-ray of your foot to verify that there is no stress fracture causing your pain.
Non Surgical Treatment
The following self-help treatments have been found to be most effective. Rest your foot. Reduce the amount of weight-bearing activities you participate in. Get off of your feet and elevate them. This will allow healing to begin. Apply ice to your foot. Applications of ice packs that provide a comfortable cooling to the heel and arch (not a freezing cold) will help reduce pain, swelling, and inflammation. Apply the ice to the heel and arch (not the toes). Make sure it is comfortable, and leave on your foot for about 20 minutes, 3 times a day. If you have any medical problems such as diabetes, poor circulation, etc., discuss the use of ice with your doctor before applying the ice. ActiveWrap allows you to apply comfortable cold therapy to your foot without messy ice cubes. Use while on the "go." Do not walk with bare feet. Always protect your heels, arches, and plantar fascia with good supportive shoes. Orthaheel Orthotic Flip Flops For Men and Women are designed for walking comfort with built in orthotic footbeds that help reduce foot pain from plantar fasciitis. Use in the house or on the beach. Stretch the Plantar Fascia while sleeping. Plantar Fasciitis and Heel Spur pain is usually worse with the first steps in the morning. This is due to the Plantar Fascia tightening up, or contracting while we sleep. To prevent these pain producing contractures of the plantar fascia, the foot must be held in its normal or neutral position while we sleep. This optimal position of the foot is maintained with our comfortable and supportive Night Splint. When foot contractures are prevented during sleep, the "first step pains" Plantar Fasciitis and Heel Spurs will gradually subside. Stretch the Plantar Fascia during the day. Even though the Plantar Fascia is a thick tissue band with very little "give" to it, with the proper care (a Night Splint and the following exercises) it can be stretched a small amount. By stretching the Plantar Fascia even a bit, its abnormal pull on the heel is reduced. This will help to reduce pain and inflammation in the heel and arch. Two of the most effective exercises recommended are. Before stepping down, especially after sleeping or resting, stretch the arch of the foot by stretching your legs out in front of you (do not bend the knee). Place a towel around the ball of the foot. Slowly pull on the ends of the towel, pulling the toes and ball of the foot back as far as is comfortable. Hold the foot in this position for ten seconds. Repeat at least ten times. You should feel a pull on the bottom of the foot, especially in the arch. This stretches the plantar fascia, and reduces its pull on the heel. Stand about 2 to 3 feet from a wall. Lean forward with your hands against the wall. With the painful foot behind, place the other foot forward. Press against the wall, shifting weight over the front foot, while straightening the back leg. Keep the heel of the back foot on the floor and feel the stretch in the heel, Achilles tendon, and calf. Hold this position for ten seconds. Repeat at least ten times, and try to do this three times a day. When these things are achieved, the inflammation and pain of Plantar Fasciitis and Heel Spurs will gradually subside. If you are unsure of the nature of your foot problem, if your pain is intense and does not subside, if you are a diabetic or have other medical problems, if your pain is due to an injury, if an open sore is present, if a mass can be felt, or if you think that you may have an infection, we suggest that before beginning any of the above treatments you consult with your doctor.
If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles and joints, a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting their career. Plantar release surgery. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as, open surgery, where the section of the plantar fascia is released by making a cut into your heel, endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the advantages and disadvantages of both techniques with your surgical team. Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your heel. It is claimed that EST works in two ways. It is thought to, have a "numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process. However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).
The following steps will help prevent plantar fasciitis or help keep the condition from getting worse if you already have it. Take care of your feet. Wear shoes with good arch support and heel cushioning. If your work requires you to stand on hard surfaces, stand on a thick rubber mat to reduce stress on your feet. Do exercises to stretch the Achilles tendon at the back of the heel. This is especially important before sports, but it is helpful for non-athletes as well. Ask your doctor about recommendations for a stretching routine. Stay at a healthy weight for your height. Establish good exercise habits. Increase your exercise levels gradually, and wear supportive shoes. If you run, alternate running with other sports that will not cause heel pain. Put on supportive shoes as soon as you get out of bed. Going barefoot or wearing slippers puts stress on your feet. If you feel that work activities caused your heel pain, ask your human resources department for information about different ways of doing your job that will not make your heel pain worse. If you are involved in sports, you may want to consult a sports training specialist for training and conditioning programs to prevent plantar fasciitis from recurring.