Plantar Fasciitis

The plantar fascia is a long, thin ligament along the bottom of the foot that creates the arch of the foot. It extends from the heel bone, and then splits and fans out to attach itself to the toes.

Plantar fasciitis results when the plantar fascia becomes inflamed from overstretching or overuse, causing pain in the heel and bottom of the foot. It can occur in one or both feet due to excessive standing or increased activity, and is one of the most common orthopedic complaints.

Pain associated with plantar fasciitis is usually relieved effectively by employing non-surgical methods, which usually resolve symptoms within 2-12 months. For severe cases that are unresolved, through conservative treatment, surgery may be considered.

Causes

Plantar fasciitis occurs when you strain or irritate the plantar fascia ligament. Repeated strain can result in tiny tears in the ligament, leading to pain and swelling, which can make walking difficult.

Strains can occur due to:

Obesity or sudden weight gain
Tight Achilles tendon which connects the calf muscles to the heel
Starting a new activity or increasing the intensity of an activity
Wearing improper shoes with soles that are too soft, too rigid, do not fit well or offer poor support

Symptoms

The major complaint associated with plantar fasciitis is pain and stiffness in the heel and foot. The pain associated with this condition becomes more intense:

In the morning when arising from bed
When walking after sitting or standing for some time
When climbing stairs
After exercise

Diagnosis

Your provider diagnoses plantar fasciitis by reviewing the patient’s medical history and conducting a physical examination that checks for tenderness of the sole of the foot.

X-rays of the foot may be taken to evaluate the alignment of the foot, as well as evaluate for a fracture or bone spur if these are suspected.

Treatment

Plantar fasciitis is usually treated with conservative measures, which include:

Rest: Rest is the first step that is considered for reducing pain and preventing further damage to the fascia.
Ice: Rolling the foot over a frozen water bottle can be effective in reducing swelling, and is recommended for 20 minutes, 3-4 times a day.
Medications: NSAIDs (non-steroidal anti-inflammatory drugs) may be prescribed for relief of pain and inflammation.
Exercise: calf stretches and plantar fascia stretches are effective in relieving pain. Eccentric, calf descents are the primary focus of exercises.
Supportive shoes and orthotics may be recommended to reduce pain while walking or standing.
Night splints may be used to maintain the plantar fascia in a neutral position while sleeping, to decrease pain with first steps in the morning.
Physical therapy may be recommended for instruction on eccentric and stretching exercises, massage and ice treatments.
Shockwave therapy or PRP injections may be performed if the above modalities are not effective. Steroid injections of the plantar fascia are not recommended because they increase the risk of rupture.

Surgery

Surgical treatment is only considered when conservative treatment does not provide effective relief after 12 months. There are two surgeries your surgeon may perform, each depending on the patient’s particular situation.

Gastrocnemius recession: Tight calf or gastrocnemius muscles can strain the plantar fascia. To release this stress, your surgeon surgically lengthens the calf muscle, thereby increasing the motion of the ankle.

Plantar fascia release: If the patient’s ankle range of motion is normal, but heel pain persists, a partial release procedure is recommended. The surgical procedure involves partially cutting the plantar fascia ligament to relieve tension. While this surgery may be performed endoscopically, an open incision procedure is easier to perform and is associated with a lower risk of nerve damage.