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Plantar Fasciitis

The plantar fascia is the ligament that runs across the bottom of the foot, connecting the heel bone to the ball of your foot. This ligament acts as a shock absorber and supports the arch. When there is repetitive stress and tearing, this thick band of tissue becomes inflamed causing stabbing pain and tenderness in the heel area, making it difficult to bear weight and walk.

What causes plantar fasciitis?

Plantar fasciitis is normally a chronic condition that can be triggered by wearing unsupportive footwear, running or sometimes no specific reason. Contributing factors include:

  • Age – usually begins around the age of 40
  • Exercise that puts stress on the heel that involves running, jumping and dancing
  • Foot anatomy - flatfeet, high arches or alignment issues
  • Obesity – extra weight adds stress to the feet
  • Jobs that require long hours of standing or walking

How do I know if I have plantar fasciitis?

The main symptom of plantar fasciitis is intense pain in the heel area that is often worse in the morning and improves throughout the day. The pain is generally concentrated where the ligament meets the base of the heel.

diagram of foot and plantar fasciitis heel pain

An ultrasound, X-ray or MRI may be necessary to diagnosis the condition and rule out other possibilities, such as a stress fracture or a heel spur.

Plantar fasciitis is sometimes confused with a heel spur, which is a bone spur on the bottom of the calcaneus (heelbone). Although the two conditions can both be present and connected, they can also occur independently. In other words, one person may have plantar fasciitis despite having no heel spur, while another may have a heel spur but have no inflammation of the fascia or any heel pain.

How to treat plantar fasciitis

The initial treatment for plantar fasciitis involves rest, ice, stretching and nonsteroidal anti-inflammatories (NSAIDs) like naproxen or ibuprofen. The use of massage and stretching of the foot, Achilles tendon and calf muscle helps relieve the tension and provide relief. Many patients find it helpful to roll a frozen water bottle under the foot.

If the plantar fasciitis persists or worsens, a foot specialist might recommend:

  • Physical therapy – exercises and movements that can help stretch and strengthen your feet and protect you from inflammation
  • A night splint – a splint holds the calf in a stretched position at rest
  • Orthotics – custom orthotics can help with any anatomical issues while walking and exercising to distribute pressure more evenly
  • Steroid injections – this would be injected into the most inflamed area and should ease the pain for about a month and decrease the amount of inflammation dramatically
  • Extracorporeal shock wave therapy – those who do not respond to physical therapy and other methods might be eligible for this nonsurgical technique that uses the same waves that break up kidney stones

Is surgery recommended for plantar fasciitis?

Most people with plantar fasciitis (roughly 95%) do not need surgery. It could take months or years to treat it successfully using nonsurgical means, and even then, it could possibly reoccur. For those with a very serious case, there are several surgical procedures that could reduce tension on the ligament:

  • Tenex – a minimally invasive procedure that removes scar tissue from the plantar fascia
  • Plantar fasciitis release – either an open surgery with an incision or endoscopic procedure with very small incisions where the surgeon cuts part of the fascia to release tension and swelling.

Like with any surgery, there are risks involved that your surgeon should go over before making the decision to have plantar fasciitis surgery. Recovery depends on the type of surgical procedure, but can take up to 6-10 weeks and 3 months for rigorous activity.

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