Do you have sharp, stabbing, and/or aching pain on the bottom of your heel or arch?
Is the pain more severe when you first get up in the morning or when you first start walking after rest? If this describes your pain then you probably suffer from a condition known as PLANTAR
FASCIITIS. It sounds complicated, but plantar fasciitis is actually one of the most common foot problems. In the past plantar fasciitis has been called by other names, such as heel spur syndrome,
bone spurs or a stone bruise on the heel. The plantar fascia is a long thick ligament that runs along the arch of your foot from your heel bone (the calcaneus) to the ball of the foot. The job of the
plantar fascia is to help support your arch. When the fascia becomes inflamed and painful we call this PLANTAR FASCIITIS. The pain from plantar fasciitis most commonly occurs near the attachment of
the fascia to the calcaneus (heel bone), which is why most people who suffer from plantar fasciitis have pain on the bottom or inside of the heel. However, the pain can be anywhere along the fascia
from the heel to the ball of the foot.
Patients with tight calf muscles will suffer with excessive pulling of the muscle group on the back of the heel. This in turn creates pulling of other structures that are attached to the heel,
including the Plantar Fascia. When the pulling continues for long enough, then inflammation will develop and lead to Plantar Fasciitis. This causes Heel Pain. It is extremely common for patients who
increase their level of activity to develop Plantar Fasciitis. Boot camp, running, zumba, recreational walking or other quick movement sports such as tennis or touch football are typical causes of
Heel Pain. The sharp increase in exercise is too much for the foot to cope with and the stress on the Plantar Fascia causes inflammation. The Heel Pain that is caused by this inflammation is known as
You'll typically first notice early plantar fasciitis pain under your heel or in your foot arch in the morning or after resting. Your heel pain will be worse with the first steps and improves with
activity as it warms up. As plantar fasciitis deteriorates, the pain will be present more often. You can determine what stage your are in using the following guidelines. No Heel Pain, Normal! Heel
pain after exercise. Heel pain before and after exercise. Heel pain before, during and after exercise. Heel pain all the time. Including at rest! This symptom progression is consistent with the four
stages of a typical overuse injury. Ultimately, further trauma and delayed healing will result in the formation of calcium (bone) within the plantar fascia. When this occurs adjacent to the heel bone
it is known as heel spurs, which have a longer rehabilitation period.
Your doctor may look at your feet and watch the way you stand, walk and exercise. He can also ask you questions about your health history, including illnesses and injuries that you had in your past.
The symptoms you have such as the pain location or when does your foot hurts most. Your activity routine such as your job, exercise habits and physical activities preformed. Your doctor may decide to
use an X-ray of your foot to detect bones problems. MRI or ultrasound can also be used as further investigation of the foot condition.
Non Surgical Treatment
Cortisone is a powerful anti-inflammatory and when injected directly into the heel it will work almost immediately. Bear in mind however, that the treatment does not address the root cause of the
inflammation, and needs to be repeated every few months. Also note, these injections are quite painful, and most doctors today will consider other, less invasive treatment options first. ESWT (Extra
Corporeal Shockwave Treatment). A specialist targets therapeutic shockwaves to the affected heel area. This will stimulate a healing response in the affected tissue and ligaments, resulting in
reduced inflammation and pain. This treatment and may take from 3 to 4 months to be fully effective. Extracorpreal Shock Wave Therapy is the latest technology to treat chronic plantar fasciitis. It
is a non-invasive treatment and highly recommended for people who have tried other treatment like cortisone-injections, accupuncture etc with little or no success. Electroacupuncture and standard
acupuncture are used in the treatment of plantar fasciitis and other foot problems such as neuromas and nerve impingement, numbness in the toes etc. In some cases there is nerve entrapment within the
foot combined with referred pain from other areas of the body. Some research suggests that acunpuncture can be effective in the treatment of heel pain. A trigger point is an irritable knot in the
muscle tissue. When pressed trigger points are very tender and can cause pain in that specific spot or elsewhere in the body (referred pain). The response to pushing into the knot is a muscle twitch.
The foot contains 126 muscles, tendons and ligaments, so there are plenty of 'hiding places' for trigger points. Trigger points in the calf muscles often refer pain directly to the bottom of the
foot. Trigger point therapy of the lower leg and foot can therefore be successful in the treatment of plantar fasciitis.
Plantar fasciotomy is often considered after conservative treatment has failed to resolve the issue after six months and is viewed as a last resort. Minimally invasive and endoscopic approaches to
plantar fasciotomy exist but require a specialist who is familiar with certain equipment. Heel spur removal during plantar fasciotomy has not been found to improve the surgical outcome. Plantar heel
pain may occur for multiple reasons and release of the lateral plantar nerve branch may be performed alongside the plantar fasciotomy in select cases. Possible complications of plantar fasciotomy
include nerve injury, instability of the medial longitudinal arch of the foot, fracture of the calcaneus, prolonged recovery time, infection, rupture of the plantar fascia, and failure to improve the
pain. Coblation (TOPAZ) surgery has recently been proposed as alternative surgical approaches for the treatment of recalcitrant plantar fasciitis.
The best way to prevent plantar fasciitis is to wear shoes that are well made and fit your feet. This is especially important when you exercise or walk a lot or stand for a long time on hard
surfaces. Get new athletic shoes before your old shoes stop supporting and cushioning your feet. You should also avoid repeated jarring to the heel. Keep a healthy weight. Do your leg and foot
stretching exercises regularly.