The plantar fascia is a ligament that connects the heel to the toes on the bottom of the foot. It lies just below the skin layers as it passes over the arch of the foot. A common ailment called
plantar fasciitis is the result of this ligament becomes inflamed. This can Foot anatomyhappen from injury, physical stress, or sometimes for no obvious reason. The most common point for this
inflammation is where this ligament joints the heel bone. Typical symptoms are the pain on the bottom of the foot near the heel usually most intense in the mornings when arising or after a long
period with little movement. The pain typically diminishes with movement. Many suffering from plantar fasciitis have heel spurs. Even though they are in the same area they are unrelated and the heel
spurs do not cause the plantar fasciitis. Most times heel spurs will not cause pain and in many go undetected unless they have an x-ray for some other reason.
Excessive stretching of the plantar fascia can result in microtrauma of this structure either along its course or where it inserts onto the medial calcaneal tuberosity. This microtrauma, if
repetitive, can result in chronic degeneration of the plantar fascia fibers. The loading of the degenerative and healing tissue at the plantar fascia may cause significant plantar pain, particularly
with the first few steps after sleep or other periods of inactivity. The term fasciitis may, in fact, be something of a misnomer, because the disease is actually a degenerative process that occurs
with or without inflammatory changes, which may include fibroblastic proliferation. This has been proven from biopsies of fascia from people undergoing surgery for plantar fascia release.
The most common symptom is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn. The pain is often worse in the morning when
you take your first steps, after standing or sitting for awhile, when climbing stairs, after intense activity. The pain may develop slowly over time, or come on suddenly after intense activity.
If you see a doctor for heel pain, he or she will first ask questions about where you feel the pain. If plantar fasciitis is suspected, the doctor will ask about what activities you've been doing
that might be putting you at risk. The doctor will also examine your foot by pressing on it or asking you to flex it to see if that makes the pain worse. If something else might be causing the pain,
like a heel spur or a bone fracture, the doctor may order an X-ray to take a look at the bones of your feet. In rare cases, if heel pain doesn't respond to regular treatments, the doctor also might
order an MRI scan of your foot. The good news about plantar fasciitis is that it usually goes away after a few months if you do a few simple things like stretching exercises and cutting back on
activities that might have caused the problem. Taking over-the-counter medicines can help with pain. It's rare that people need surgery for plantar fasciitis. Doctors only do surgery as a last resort
if nothing else eases the pain.
Non Surgical Treatment
A doctor may prescribe anti-inflammatory medication such as ibuprofen to help reduce pain and inflammation. Electrotherapy such as ultrasound or laser may also help with symptoms. An X-ray may be
taken to see if there is any bone growth or calcification, known as a heel spur but this is not necessarily a cause of pain. Deep tissue sports massage techniques can reduce the tension in and
stretch the plantar fascia and the calf muscles. Extracorporeal shock wave therapy has been known to be successful and a corticosteroid injection is also an option.
If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles
and joints, a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting
their career. Plantar release surgery. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the
tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as, open surgery, where the section of the plantar fascia is
released by making a cut into your heel, endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the
plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open
surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to
choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with
all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the
advantages and disadvantages of both techniques with your surgical team. Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve
making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your
heel. It is claimed that EST works in two ways. It is thought to, have a "numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process.
However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE
states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective
than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).
Making sure your ankle, Achilles tendon, and calf muscles are flexible can help prevent plantar fasciitis. Stretch your plantar fascia in the morning before you get out of bed. Doing activities in
moderation can also help.