Introduction

The plantar fascia is a long, thin ligament present 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 is a condition where 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 and is one of the most common orthopaedic complaints, especially in active men between 40 and 70 years of age.

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:

• High or low foot arch
• 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, do not fit well or offer poor arch support

Symptoms

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

• In the morning when you step out of bed
• Walking after sitting or standing for some time
• Climbing stairs
• After exercise

Diagnosis

Your doctor diagnoses plantar fasciitis after reviewing your medical history and conducting a physical examination of the foot to check for tenderness, stiffness or redness of the sole. Your doctor may watch how you stand and walk, and evaluate related conditions such as high arches.

X-rays of the foot can be taken if your doctor suspects a stress fracture, a hairline fracture in the bone, or other related conditions such as a heel spur, which is extra calcium deposit on the heel bone.

Treatment

Treatment involves conservative measures to resolve the condition. Conservative treatment measures include:

• Rest: Rest is the first step that is considered for reducing pain and preventing further damage to the ligament
• Ice: Rolling your foot over ice can be very 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
• A steroid injection may be administered into the plantar fascia for reducing pain and inflammation
• Supportive shoes and orthotics may also be recommended to reduce the pain while walking or standing
• Night splints can be suggested by your doctor to help stretch the plantar fascia while sleeping
• Physical therapy may be recommended for instruction on stretching exercises, massage and ice treatments
• PT may use extracorporeal shockwave therapy (ESWT), which uses high-energy shockwave impulses to stimulate healing of the damaged plantar fascia tissues

Surgery

Surgical treatment is considered only if conservative therapy does not provide effective relief after 12 months. There are two surgeries your surgeon may perform and will depend on your particular situation.

• Gastrocnemius recession- Tight calf muscles or gastrocnemius muscles can strain the plantar fascia. To release this stress, your surgeon will surgically lengthen the calf muscle, and increase the motion of the ankle. The surgery can be performed by open incision or endoscopically through a small incision by using an endoscope, which is a long instrument with a small camera attached.
• Plantar fascia release- If you have normal range of ankle motion, but continue to have heel pain, a partial release procedure is recommended. Your surgeon will partially cut the plantar fascia ligament to relieve the tension. The surgery can be performed endoscopically but open incision is easier to perform and is associated with lower risk of nerve damage.

Risks and Complications

Complications are rare following surgery to treat plantar fasciitis, but as with any surgical procedure, they can occur. Some complications include:

• Infection
• Nerve Damage
• Unresolved Pain

Summary

Plantar fasciitis is inflammation of the plantar fascia along the base of the foot resulting in pain and impaired movement of the foot. Pain can be relieved effectively by different non-surgical methods and usually resolves within 10 months. For severe cases that are unresolved, surgery may be considered.