The plantar fascia is a thickened fibrous aponeurosis that originates from the medial tubercle of the calcaneus, runs forward to insert into the deep, short transverse ligaments of the metatarsal heads, dividing into 5 digital bands at the metatarsophalangeal joints and continuing forward to form the fibrous flexor sheathes on the plantar aspect of the toes. Small plantar nerves are invested in and around the plantar fascia, acting to register and mediate pain.
The plantar fascia can also become aggravated by repetitive activity. If you increase the number of times the heel hits the ground, that can cause plantar fasciitis, a number of people develop problems when their feet are unaccustomed to hard tile or wood floors. Other risk factors for plantar fasciitis include obesity, an extra high or low foot arch, and activities like running.
Plantar fascia usually causes pain and stiffness on the bottom of your heel although some people have heel spurs and suffer no symptoms at all. Occasionally, heel pain is also associated with other medical disorders such as arthritis (inflammation of the joint), bursitis (inflammation of the tissues around the joint). Those who have symptoms may experience ‘First step’ pain (stone bruise sensation) after getting out of bed or sitting for a period of time. Pain after driving. Pain on the bottom of your heel. Deep aching pain. Pain can be worse when barefoot.
Plantar fasciitis is one of many conditions causing “heel pain”. Some other possible causes include nerve compression either in the foot or in the back, stress fracture of the calcaneus, and loss of the fatty tissue pad under the heel. Plantar fasciitis can be distinguished from these and other conditions based on a history and examination done by a physician. It should be noted that heel spurs are often inappropriately thought to be the sole cause of heel pain. In fact, heel spurs are common and are nothing more than the bone’s response to traction or pulling-type forces from the plantar fascia and other muscles in the foot where they attach to the heel bone. They are commonly present in patients without pain, and frequently absent from those who have pain. It is the rare patient who has a truly enlarged and problematic spur requiring surgery.
Non Surgical Treatment
Treatment of plantar fasciitis is sometimes a drawn out and frustrating process. A program of rehabilitation should be undertaken with the help of someone qualified and knowledgeable about the affliction. Typically, plantar fasciitis will require at least six weeks and up to six months of conservative care to be fully remedied. Should such efforts not provide relief to the athlete, more aggressive measures including surgery may be considered. The initial goals of physical therapy should be to increase the passive flexion of the foot and improve flexibility in the foot and ankle, eventually leading to a full return to normal function. Prolonged inactivity in vigorous sports is often the price to be paid for thorough recovery. Half measures can lead to a chronic condition, in some cases severely limiting athletic ability. As a large amount of time is spent in bed during sleeping hours, it is important to ensure that the sheets at the foot of the bed do not constrict the foot, leading to plantar flexion in which the foot is bent straight out with the toes pointing. This constricts and thereby shortens the gastroc complex, worsening the condition. A heating pad placed under the muscles of the calf for a few minutes prior to rising may help loosen tension, increase circulation in the lower leg and reduce pain. Also during sleep, a night splint may be used in order to hold the ankle joint in a neutral position. This will aid in the healing of the plantar fascia and ensure that the foot will not become flexed during the night.
Surgery may be considered in very difficult cases. Surgery is usually only advised if your pain has not eased after 12 months despite other treatments. The operation involves separating your plantar fascia from where it connects to the bone; this is called a plantar fascia release. It may also involve removal of a spur on the calcaneum if one is present. Surgery is not always successful. It can cause complications in some people so it should be considered as a last resort. Complications may include infection, increased pain, injury to nearby nerves, or rupture of the plantar fascia.
Every time your foot strikes the ground, the plantar fascia is stretched. You can reduce the strain and stress on the plantar fascia by following these simple instructions: Avoid running on hard or uneven ground, lose any excess weight, and wear shoes and orthotics that support your arch to prevent over-stretching of the plantar fascia.