If your first step in the morning often feels like it involves a rusty nail being inserted into your heel, you’re not alone. Heel pain resulting from plantar fasciitis is the most prevalent condition treated in podiatric clinics, and an additional 1 million Americans annually are seen by medical doctors for the condition, according to the Centers for Disease Control and Prevention. The plantar fascia is the ligament that runs from the heel bone across the entire bottom of the foot and connects at the base of the toes. Ligaments connect bone to bone, and don’t really constrict or contract, but can become thickened because of inflammation. Inflammation of the plantar fascia can cause strain when you walk, specifically heel pain that is especially bad for the first few steps after prolonged inactivity. It then typically loosens up once you’re up and about.
There are several possible causes of plantar fasciitis, including wearing high heels, gaining weight, increased walking, standing, or stair-climbing. If you wear high-heeled shoes, including western-style boots, for long periods of time, the tough, tendonlike tissue of the bottom of your foot can become shorter. This layer of tissue is called fascia. Pain occurs when you stretch fascia that has shortened. This painful stretching might happen, for example, when you walk barefoot after getting out of bed in the morning. If you gain weight, you might be more likely to have plantar fasciitis, especially if you walk a lot or stand in shoes with poor heel cushioning. Normally there is a pad of fatty tissue under your heel bone. Weight gain might break down this fat pad and cause heel pain. Runners may get plantar fasciitis when they change their workout and increase their mileage or frequency of workouts. It can also occur with a change in exercise surface or terrain, or if your shoes are worn out and don't provide enough cushion for your heels. If the arches of your foot are abnormally high or low, you are more likely to develop plantar fasciitis than if your arches are normal.
A sharp pain in the center of your heel will most likely be one of the biggest symptoms of plantar fasciitis. A classic sign of plantar fasciitis is when the pain is worst during the first steps you take in the morning.
Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your plantar fasciitis they will investigate WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts. X-rays may show calcification within the plantar fascia or at its insertion into the calcaneus, which is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests (including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.
Non Surgical Treatment
The following recommendations are appropriate. Wear shoes with adequate arch support and cushioned heels; discard old running shoes and wear new ones; rotate work shoes daily. Avoid long periods of standing. Lose weight. Stretch the plantar fascia and warm up the lower extremity before participating in exercise. For increased flexibility, stretch the plantar fascia and the calf after exercise. Do not exercise on hard surfaces. Avoid walking barefooted on hard surfaces. Avoid high-impact sports that require a great deal of jumping (eg, aerobics and volleyball). Apply ice for 20 minutes after repetitive impact-loading activities and at the end of the day. Limit repetitive impact-loading activities such as running to every other day, and consider rest or cross-training for nonrunning days.
Most practitioners agree that treatment for plantar fasciitis is a slow process. Most cases resolve within a year. If these more conservative measures don't provide relief after this time, your doctor may suggest other treatment. In such cases, or if your heel pain is truly debilitating and interfering with normal activity, your doctor may discuss surgical options with you. The most common surgery for plantar fasciitis is called a plantar fascia release and involves releasing a portion of the plantar fascia from the heel bone. A plantar fascia release can be performed through a regular incision or as endoscopic surgery, where a tiny incision allows a miniature scope to be inserted and surgery to be performed. About one in 20 patients with plantar fasciitis will need surgery. As with any surgery, there is still some chance that you will continue to have pain afterwards.
Stretching exercises for the Achilles tendon and plantar fascia are recommend to relieve pain and aid in the healing process. Sometimes application of athletic tape is recommended. In moderate or severe cases of plantar fasciitis, your doctor may recommend you wearing a night splint, which will stretch the arch of your foot and calf while you sleep. This helps to lengthen the Achilles tendon and plantar fascia for symptom relief. Depending on the severity of your plantar fasciitis, your physician may prescribe a store-bought orthotic (arch support) or custom-fitted orthotic to help distribute your foot pressure more evenly.