Plantar Fasciitis Overview
Plantar fasciitis is the inflammation of the ligament (plantar fascia) that runs from the heel bone to the ball of the foot. This ligaments functions to stabilize and support the arch.
The plantar fascia is made of multilayered, fibrous aponeurosis broad band which is surrounded by fibrofatty subcutaneous tissue, intrinsic muscle and neurovascular structures. The plantar fascia originates from the calcaneus (heel bone) and fibers of fascia divide into the metatarsophalangeal (MTP) joint.
In the United states of America more than two million people receive treatment for plantar fasciitis 1. One out of ten people will develop heel pain in their lifetime 2.
Studies have shown that about 50% to 75 % of patients who have plantar fasciitis also have a heel spur 3-5. Although the heel spur can occur with plantar fasciitis, it is not considered the cause.
The cause of plantar fasciitis is controversial but can include:
- Pes planus (flat feet)
- Pes cavus (high arch)
- Equinus (tight calf muscle)
- Overuse or plantar fascia rupture
- The most common cause of plantar fasciitis is due to biomechanics
Symptoms of plantar fasciitis can include:
- Dull, achy, sharp, throbbing and inflammation of the heel.
- Pain on the bottom of the heel mostly when taking the first steps in the morning or after prolong period of sitting or walking.
Diagnosis of plantar fasciitis is based on medical history and clinical examination. Diagnostic imaging studies such as x-rays or other imaging modalities such as a MRI,CT scan, NCV or Bone Scan can be utilized to rule out other pathologies.
How is Plantar Fasciitis Treated?
(90 % of the time plantar fasciitis does not require surgery and can be treated by conservative therapy)
- Orthotics (inserts)
- Heel cups
- Night splint
- Walking boot
- Supportive shoe gear
- Anti–inflammatory Medications (NSAIDS)
- Cortisone Injection
- Physical therapy
- Stretching exercises
- Decreasing activity.
- Topical pain relieving gel
Other Treatments for Plantar Fasciitis:
There are numerous surgical procedures available to treat plantar fasciitis. These procedure includes:
- Minimal Invasive surgery (endoscopic plantar fascia release or small incision approach)
- Percutaneous coblation of the fascia
- Traditional open fasciotomy
- Extracorporal shock wave therapy (ESWT)
- Platelet Rich Plasma (PRP) injections.
1. Pfeffer G, Bacchetti P, Deland J, et al: Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot Ankle Int 20(4):214-221, 1999.
2. Crawford F, Thomson C: Interventions for treating plantar heel pain. Cochrane Database Syst Rev 3:CD000416, 2003.
3. Shmokler RL, Bravo AA, Lynch FR, et al: A new use of instrumentation in fluoroscopy controlled heel spur surgery. J Am Podiatr Med Assoc 78:194-197, 1988.
4. Snook GA, Chrisman OD: The management of subcalcaneal pain. Clin Orthop 82:163-168, 1972.
5. Williams PL, Smibert JG, Cox R, et al: Imaging study of the painful heel syndrome. Foot Ankle 7:345-349, 1987.