The plantar fascia is a thickened fibrous aponeurosis that originates from the medial tubercle of the calcaneus, runs forward to insert into the deep, short transverse ligaments of the metatarsal
heads, dividing into 5 digital bands at the metatarsophalangeal joints and continuing forward to form the fibrous flexor sheathes on the plantar aspect of the toes. Small plantar nerves are invested
in and around the plantar fascia, acting to register and mediate pain.
Currently no single factor has been reliably identified as contributing to the development of plantar fasciitis. The two risk factors with the most support from current research. Decreased ankle
dorsiflexion. Increased Body Mass Index (BMI) in non-athletic populations. These factors are related in that both lead to increased strain on the arch, both lead to increased compression on the heel.
When dorsiflexion range of motion (ankle flexibility) is lacking, the body compensates by increasing movement of the arch. In this way, decreased ankle dorsiflexion influences pronation and places
strain on the underside of the foot. Similarly, having a high BMI causes strain because it places a load on the foot that may be in excess of what the foot can support. As mentioned earlier,
overpronation is thought to be a contributing factor, but studies on this have so far produced mixed results. The second way these factors relate to each other is in the way people stand. A lack of
ankle flexibility and a high BMI can both cause increased pressure on the heel in standing. Keeping weight on the heels causes compression under the heel. But it also means the muscles and ligaments
in the arch are not being used to balance your body weight. Lack of use, I suspect, is a greater danger than overuse. Looking beyond these potential contributors to heel pain though, there is one
major factor that overshadows them all-the way footwear alters the normal function of the foot.
People with this condition sometimes describe the feeling as a hot, sharp sensation in the heel. You usually notice the pain first thing in the morning when you stand. After walking for a period of
time, the pain usually lessens or even disappears. However, sharp pain in the center of the heel may return after resting for a period of time and then resuming activity.
During the physical exam, your doctor checks for points of tenderness in your foot. The location of your pain can help determine its cause. Usually no tests are necessary. The diagnosis is made based
on the history and physical examination. Occasionally your doctor may suggest an X-ray or magnetic resonance imaging (MRI) to make sure your pain isn't being caused by another problem, such as a
stress fracture or a pinched nerve. Sometimes an X-ray shows a spur of bone projecting forward from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed
surgically. But many people who have bone spurs on their heels have no heel pain.
Non Surgical Treatment
Careful attention to footwear is critical. Every effort should be made to wear comfortable shoes with proper arch support, fostering proper foot posture. Should arch supports prove insufficient, an
orthotic shoe should be considered. Fortunately, most cases of plantar fasciitis respond well to non-operative treatment. Recovery times however vary enormously from one athlete to another, depending
on age, overall health and physical condition as well as severity of injury. A broad period between 6 weeks and 6 months is usually sufficient for proper healing. Additionally, the mode of treatment
must be flexible depending on the details of a particular athleteâs injury. Methods that prove successful in one patient, may not improve the injury in another. Early treatment typically includes
the use of anti-inflammatory medication, icing, stretching activities, and heel inserts and splints. Cortisone injections may be necessary to achieve satisfactory healing and retard inflammation. In
later stages of the rehabilitation process, typically after the first week, ice should be discontinued and replaced with heat and massage.
In unusual cases, surgical intervention is necessary for relief of pain. These should only be employed after non-surgical efforts have been used without relief. Generally, such surgical procedures
may be completed on an outpatient basis in less than one hour, using local anesthesia or minimal sedation administrated by a trained anesthesiologist. In such cases, the surgeon may remove or release
the injured and inflamed fascia, after a small incision is made in the heel. A surgical procedure may also be undertaken to remove bone spurs, sometimes as part of the same surgery addressing the
damaged tissue. A cast may be used to immobilize the foot following surgery and crutches provided in order to allow greater mobility while keeping weight off the recovering foot during healing. After
removal of the cast, several weeks of physical therapy can be used to speed recovery, reduce swelling and restore flexibility.