Plantar fasciitis is a poorly understood condition. There is little consensus among medical professionals about what causes the problem, and no treatments have been reliably proven to treat it. A
number of theories exists for why plantar fasciitis develops, but the ineffectiveness of conventional treatments suggests something is missing. The plantar fascia is a band of connective tissue that
runs along the underside of the foot from the heel to the toes. The fascia helps maintain the integrity of the arch, provides shock absorption, and plays an important role in the normal mechanical
function of the foot.
Plantar fasciitis is caused by drastic or sudden increases in mileage, poor foot structure, and inappropriate running shoes, which can overload the plantar fascia, the connective tissue that runs
from the heel to the base of the toes. The plantar fascia may look like a series of fat rubber bands, but it's made of collagen, a rigid protein that's not very stretchy. The stress of overuse,
overpronation, or overused shoes can rip tiny tears in it, causing pain and inflammation, a.k.a. plantar fasciitis.
You'll typically first notice early plantar fasciitis pain under your heel or in your foot arch in the morning or after resting. Your heel pain will be worse with the first steps and improves with
activity as it warms up. As plantar fasciitis deteriorates, the pain will be present more often. You can determine what stage your are in using the following guidelines. No Heel Pain, Normal! Heel
pain after exercise. Heel pain before and after exercise. Heel pain before, during and after exercise. Heel pain all the time. Including at rest! This symptom progression is consistent with the four
stages of a typical overuse injury. Ultimately, further trauma and delayed healing will result in the formation of calcium (bone) within the plantar fascia. When this occurs adjacent to the heel bone
it is known as heel spurs, which have a longer rehabilitation period.
Plantar fasciitis is usually diagnosed by a health care provider after consideration of a personâs presenting history, risk factors, and clinical examination. Tenderness to palpation along the
inner aspect of the heel bone on the sole of the foot may be elicited during the physical examination. The foot may have limited dorsiflexion due to tightness of the calf muscles or the Achilles
tendon. Dorsiflexion of the foot may elicit the pain due to stretching of the plantar fascia with this motion. Diagnostic imaging studies are not usually needed to diagnose plantar fasciitis.
However, in certain cases a physician may decide imaging studies (such as X-rays, diagnostic ultrasound or MRI) are warranted to rule out other serious causes of foot pain. Bilateral heel pain or
heel pain in the context of a systemic illness may indicate a need for a more in-depth diagnostic investigation. Lateral view x-rays of the ankle are the recommended first-line imaging modality to
assess for other causes of heel pain such as stress fractures or bone spur development. Plantar fascia aponeurosis thickening at the heel greater than 5 millimeters as demonstrated by ultrasound is
consistent with a diagnosis of plantar fasciitis. An incidental finding associated with this condition is a heel spur, a small bony calcification on the calcaneus (heel bone), which can be found in
up to 50% of those with plantar fasciitis. In such cases, it is the underlying plantar fasciitis that produces the heel pain, and not the spur itself. The condition is responsible for the creation of
the spur though the clinical significance of heel spurs in plantar fasciitis remains unclear.
Non Surgical Treatment
Teatment of plantar fasciitis can be a long and frustrating process for both the coach and athlete. If you do not have a firm grasp of the goals of this rehabilitation program your best advice will
be to find a professional who routinely deals with athletic injuries. The "down time" for plantar fasciitis will be at least six weeks and up to six months of conservative care before drastic
measures like surgery should be considered. The goal of this rehab program is to initially increase the passive flexion of the foot eventually leading to improvements in dynamic balance and
flexibility of the foot and ankle, followed by a full return to function.
The majority of patients, about 90%, will respond to appropriate non-operative treatment measures over a period of 3-6 months. Surgery is a treatment option for patients with persistent symptoms, but
is NOT recommended unless a patient has failed a minimum of 6-9 months of appropriate non-operative treatment. There are a number of reasons why surgery is not immediately entertained including.
Non-operative treatment when performed appropriately has a high rate of success. Recovery from any foot surgery often takes longer than patients expect. Complications following this type of surgery
can and DO occur! The surgery often does not fully address the underlying reason why the condition occurred therefore the surgery may not be completely effective. Prior to surgical intervention, it
is important that the treating physician ensure that the correct diagnosis has been made. This seems self-evident, but there are other potential causes of heel pain. Surgical intervention may include
extracorporeal shock wave therapy or endoscopic or open partial plantar fasciectomy.
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.