Plantar fasciitis is a common foot disorder that affects more than two million people every year, especially runners. It is inflammation of the plantar fascia, a thick band of tissue on the bottom of
the foot. The most common area of pain is directly on the bottom of the heel, although some people may only have pain in the arch of the foot. Diagnosis of plantar fasciitis is typically done through
a physical examination, which includes listening to the patient history, palpation of the heel and possibly x-rays.
Excessive stretching of the plantar fascia can result in microtrauma of this structure either along its course or where it inserts onto the medial calcaneal tuberosity. This microtrauma, if
repetitive, can result in chronic degeneration of the plantar fascia fibers. The loading of the degenerative and healing tissue at the plantar fascia may cause significant plantar pain, particularly
with the first few steps after sleep or other periods of inactivity. The term fasciitis may, in fact, be something of a misnomer, because the disease is actually a degenerative process that occurs
with or without inflammatory changes, which may include fibroblastic proliferation. This has been proven from biopsies of fascia from people undergoing surgery for plantar fascia release.
The most common symptoms of plantar fasciitis include pain on the bottom of the foot near the heel, pain with the first few steps after getting out of bed in the morning, or after a long period of
rest, such as after a long car ride. The pain subsides after a few minutes of walking. Greater pain after (not during) exercise or activity.
A health care professional will ask you whether you have the classic symptoms of first-step pain and about your activities, including whether you recently have intensified your training or changed
your exercise pattern. Your doctor often can diagnose plantar fasciitis based on your history and symptoms, together with a physical examination. If the diagnosis is in doubt, your doctor may order a
foot X-ray, bone scan or nerve conduction studies to rule out another condition, such as a stress fracture or nerve problem.
Non Surgical Treatment
The initial treatment of plantar fasciitis focuses on reducing pain and inflammation. Resting the affected foot is the most important aspect of this treatment. Other initial treatment may include,
aplying ice to the sole of the foot, Anti-inflammatory medications. Gentle stretching of the plantar fascia and Achilles tendon. Physiotherapy. Taping the foot and ankle to provide adequate support
and alignment, Wearing supportive footwear with shock-absorbing soles or inserts. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Brufen) and diclofenac (Voltaren) are often used to
treat plantar fasciitis. It is unclear whether NSAIDs assist in the healing process but they are useful for controlling pain during treatment. If the condition does not respond to initial treatment,
a corticosteroid therapy may be recommended. This involves the injection of corticosteroid medication such as hydrocortisone (Solu-Cortef) directly into the affected area in order to treat the
inflammation and thus relieve the pain. Night splints to prevent the plantar fascia tightening during sleep may also be recommended at this stage.
When more conservative methods have failed to reduce plantar fasciitis pain, your doctor may suggest extracorporeal shock wave therapy, which is used to treat chronic plantar fasciitis.
Extracorporeal shock wave therapy uses sound waves to stimulate healing, but may cause bruises, numbness, tingling, swelling, and pain. When all else fails, surgery may be recommended to detach the
plantar fascia from the heel bone. Few people need surgery to treat the condition.