Plantar fasciitis causes pain in the bottom of the heel. The plantar fascia is a thin ligament that connects your heel to the front of your foot. It supports the arch in your foot and is important in
helping you walk. Plantar fasciitis is one of the most common orthopedic complaints. Your plantar fascia ligaments experience a lot of wear and tear in your daily life. Normally, these ligaments act
as shock absorbers, supporting the arch of the foot. Too much pressure on your feet can damage or tear the ligaments. The plantar fascia becomes inflamed, and the inflammation causes heel pain and
The cause of plantar fasciitis is poorly understood and is thought to likely have several contributing factors. The plantar fascia is a thick fibrous band of connective tissue that originates from
the medial tubercle and anterior aspect of the heel bone. From there, the fascia extends along the sole of the foot before inserting at the base of the toes, and supports the arch of the foot.
Originally, plantar fasciitis was believed to be an inflammatory condition of the plantar fascia. However, within the last decade, studies have observed microscopic anatomical changes indicating that
plantar fasciitis is actually due to a non-inflammatory structural breakdown of the plantar fascia rather than an inflammatory process. Due to this shift in thought about the underlying mechanisms in
plantar fasciitis, many in the academic community have stated the condition should be renamed plantar fasciosis. The structural breakdown of the plantar fascia is believed to be the result of
repetitive microtrauma (small tears). Microscopic examination of the plantar fascia often shows myxomatous degeneration, connective tissue calcium deposits, and disorganized collagen fibers.
Disruptions in the plantar fasciaâs normal mechanical movement during standing and walking (known as the Windlass mechanism) are thought to contribute to the development of plantar fasciitis by
placing excess strain on the calcaneal tuberosity.
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.
The health care provider will perform a physical exam. This may show tenderness on the bottom of your foot, flat feet or high arches, mild foot swelling or redness, stiffness or tightness of the arch
in the bottom of your foot. X-rays may be taken to rule out other problems.
Non Surgical Treatment
Your GP or podiatrist may advise you to change your footwear. You should avoid wearing flat-soled shoes, because they will not provide your heel with support and could make your heel pain worse.
Ideally, you should wear shoes that cushion your heels and provide a good level of support to the arches of your feet. For women wearing high heels, and for men wearing heeled boots or brogues, can
provide short- to medium-term pain relief, as they help reduce pressure on the heels. However, these types of shoes may not be suitable in the long term, because they can lead to further episodes of
heel pain. Your GP or podiatrist can advise on footwear. Orthoses are insoles that fit inside your shoe to support your foot and help your heel recover. You can buy orthoses off-the-shelf from sports
shops and larger pharmacies. Alternatively, your podiatrist should be able to recommend a supplier. If your pain does not respond to treatment and keeps recurring, or if you have an abnormal foot
shape or structure, custom-made orthoses are available. These are specifically made to fit the shape of your feet. However, there is currently no evidence to suggest that custom-made orthoses are
more effective than those bought off-the-shelf. An alternative to using orthoses is to have your heel strapped with sports strapping (zinc oxide) tape, which helps relieve pressure on your heel. Your
GP or podiatrist can teach you how to apply the tape yourself. In some cases, night splints can also be useful. Most people sleep with their toes pointing down, which means tissue inside the heel is
squeezed together. Night splints, which look like boots, are designed to keep your toes and feet pointing up while you are asleep. This will stretch both your Achilles tendon and your plantar fascia,
which should help speed up your recovery time. Night splints are usually only available from specialist shops and online retailers. Again, your podiatrist should be able to recommend a supplier. If
treatment hasn't helped relieve your painful symptoms, your GP may recommend corticosteroid injections. Corticosteroids are a type of medication that have a powerful anti-inflammatory effect. They
have to be used sparingly because overuse can cause serious side effects, such as weight gain and high blood pressure (hypertension). As a result, it is usually recommended that no more than three
corticosteroid injections are given within a year in any part of the body. Before having a corticosteroid injection, a local anaesthetic may be used to numb your foot so you don't feel any
In very rare cases plantar fascia surgery is suggested, as a last resort. In this case the surgeon makes an incision into the ligament, partially cutting the plantar fascia to release it. If a heel
spur is present, the surgeon will remove it. Plantar Fasciitis surgery should always be considered the last resort when all the conventional treatment methods have failed to succeed. Endoscopic
plantar fasciotomy (EPF) is a form of surgery whereby two incisions are made around the heel and the ligament is being detached from the heel bone allowing the new ligament to develop in the same
place. In some cases the surgeon may decide to remove the heel spur itself, if present. Just like any type of surgery, Plantar Fascia surgery comes with certain risks and side effects. For example,
the arch of the foot may drop and become weak. Wearing an arch support after surgery is therefore recommended. Heel spur surgeries may also do some damage to veins and arteries of your foot that
allow blood supply in the area. This will increase the time of recovery.
You can help to prevent plantar fasciitis by maintaining a healthy weight, by warming up before participating in sports and by wearing shoes that support the arch and cushion the heel. In people who
are prone to episodes of plantar fasciitis, exercises that stretch the heel cord (known as the Achilles tendon) and the plantar fascia may help to prevent plantar fasciitis from returning. Ice
massage also can be used on the bottom of the foot after stressful athletic activities. It is possible that strict control of blood sugar will prevent plantar fasciitis in people with diabetes,
although this has not been proven.