Plantar fasciitis is the most common cause of plantar heel pain. Pain in the arch or heel often indicates inflammation of the long band of tissue under the foot that runs from the heel to the ball of the foot, known as the plantar fascia. Its characteristic features are pain and tenderness, predominately in either the mid arch region or at the inside heel, and less commonly the outside heel. It frequently causes pain upon rising from rest (especially first thing in the morning) and can progress to agony by the end of the day.
This condition is typically found in middle-aged men and women whose feet tend to over-pronate or roll in but can be experienced at all ages. It is commonly associated with the recreational athlete, overweight individuals or abnormal lower limb biomechanics. A sudden increase in frequency or intensity of activity can often spark these symptoms.
Although plantar fasciitis is the most common cause of this pain, a complete differential diagnosis of plantar heel pain is important via a comprehensive history and physical examination to guide an accurate diagnosis.
Symptoms
Symptoms of plantar fasciitis include
- Pain on palpation of the inside of the heel and/or through the arch of the foot
- Pain first thing in the morning or after rising from a period of rest
- Pain at the beginning of exercise that gets better as you warm up
- Pain with prolonged standing or walking
- Sharp, stabbing pain at the bottom or front of the heel bone and can develop to a dull ache
General causes
Assessments are guided towards finding the cause of the injury. The plantar fascia contributes to maintaining the arch of the foot as well as transmitting weight as you walk and run, placing large amounts of tension and stress through this tissue. The most common cause of excess tension in the plantar fascia is abnormal lower limb mechanics.
With continual over-pronation, the plantar fascia is being overstretched causing inflammation, degeneration and pain at the attachment site of the heel and/or the bands of the tissue. In more chronic conditions, continuous pulling of the fascia at its attachment site can cause a bony heel spur which in itself is generally asymptomatic.
During long periods of rest, the plantar fascia shortens and the body begins the repairing process. When you stand again the tissue is rapidly lengthened and results in micro-tears in the tissue. This explains the tremendous pain with the first steps in the morning or after rising from rest.
Other causes include obesity, walking or standing on hard surfaces, unsupportive footwear, inactivity or sudden increases in frequency or intensity of activity.
Management
Diagnosis of plantar fasciitis can usually be made through careful history taking and an examination of the area of pain to determine the extent and cause of the condition. If necessary, further investigation such as x-rays or diagnostic ultrasound may be ordered by your podiatrist to help evaluate the severity of the problem.
Conservative Treatment
Treatment of plantar fasciitis initially involves reducing symptoms and inflammation through icing, topical or oral anti-inflammatory medications, footwear advice and rest from precipitating activity. The podiatrist will conduct a full biomechanical analysis to determine the underlying causes of this condition and to determine the best course of action to reduce the heel pain. This may include stretching exercises, footwear modifications, plantar fascial night splints and customized soft full length orthotics.
Surgical Treatment
While in approximately 90% of cases conservative measures are successful in treating plantar fasciitis, some patients may require more invasive techniques to relieve pain. Surgical treatment is considered for those with persistent, severe symptoms despite all conservative intervention for at least 6 to 12 months.
Expected outcome
Treatment for this acute condition can take time, with most patients pain free within 3-4 months and over 90% within one year. Initial symptom improvement allows most people to return to activity within 1 month.
Despite common belief, heel pain attributable to plantar fasciitis IS curable ! The podiatrists at my FootDr podiatry centres cure this ailment every day.
Read more – The Truth About Heel Pain
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