Plantar fasciitis is characterized by stiffness and inflammation of the main fascia (fibrous connective [ligament-like] tissue) on the bottom of the foot. It is occasionally associated with a bone
spur on the heel. Occasionally there may be a partial or complete tear of the fascia of the bottom of the foot. Bone spurs themselves usually do not cause symptoms.
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.
Plantar fasciosis is characterized by pain at the bottom of the heel with weight bearing, particularly when first arising in the morning; pain usually abates within 5 to 10 min, only to return later
in the day. It is often worse when pushing off of the heel (the propulsive phase of gait) and after periods of rest. Acute, severe heel pain, especially with mild local puffiness, may indicate an
acute fascial tear. Some patients describe burning or sticking pain along the plantar medial border of the foot when walking.
Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You
will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot, this could be
a sign of nerve damage in your feet and legs (peripheral neuropathy) your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone infection,
you have stiffness and swelling in your heel, this could be a sign of arthritis. Possible further tests may include blood tests, X-rays - where small doses of radiation are used to detect problems
with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.
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
Most patients have good results from surgery. However, because surgery can result in chronic pain and dissatisfaction, it is recommended only after all nonsurgical measures have been exhausted. The
most common complications of release surgery include incomplete relief of pain and nerve damage.
Being overweight can place excess pressure and strain on your feet, particularly on your heels. Losing weight, and maintaining a healthy weight by combining regular exercise with a healthy, balanced
diet, can be beneficial for your feet. Wearing appropriate footwear is also important. Ideally, you should wear shoes with a low to moderate heel that supports and cushions your arches and heels.
Avoid wearing shoes with no heels.