The plantar fascia (a connective tissue structure) stretches from the toes and ball of the foot, through the arch, and connects to the heel bone in three places: outside, center and inside. Normally
it helps the foot spring as it rolls forward. It also provides support for the arch of the foot. The plantar fascia helps keep the foot on track, cutting down on oscillation. When the foot
over-pronates (rolls to the inside) the plantar fascia tries to stabilize it and prevent excessive roll. In time, the inside and sometimes center connections are overstressed and pull away from their
attachments. The first sign is usually heel pain as you rise in the morning. When you walk around, the pain may subside, only to return the next morning. Inflammation and increased soreness are the
results of long-term neglect and continued abuse. A heel bone spur may develop after a long period of injury when there is no support for the heel. The plantar fascia attaches to the heel bone with
small fibers. When these become irritated they become inflamed with blood containing white blood cells. Within the white blood cells are osteoblasts which calcify to form bone spurs and calcium
deposits. The body is trying to reduce stress on that area by building a bone in the direction of stress. Unfortunately, these foreign substances cause pain and further irritation in the surrounding
Inappropriate footwear is the No. 1 cause of plantar fasciosis. Footwear that possesses toe spring and a tapered toe box holds your big toe in an adducted and extended position. In this position,
your abductor hallucis muscle-the muscle responsible for moving your big toe away from your footâs midline-pulls on a foot structure called the flexor retinaculum and may restrict blood flow
through your posterior tibial artery, the vessel that carries blood to the bottom of your foot. Tissues in the sole of your feet begin to degenerate as blood supply to this area is decreased. Other
recognized causes of or contributors to this health problem include the following, calf muscle shortening, plantar fascia contracture, Obesity, rheumatoid arthritis, reactive arthritis, Psoriatic
arthritis, Corticosteroid injections.
Patients with plantar fasciitis typically experience pain underneath the heel and along the inner sole of the foot. In less severe cases, patients may only experience an ache or stiffness in the
plantar fascia or heel that increases with rest (typically at night or first thing in the morning) following activities which place stress on the plantar fascia. These activities typically include
standing, walking or running excessively (especially up hills, on uneven surfaces or in poor footwear such as thongs), jumping, hopping and general weight bearing activity. The pain associated with
this condition may also warm up with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting
performance. In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Patients with this condition may also experience swelling, tenderness on firmly touching
the plantar fascia (often on a specific spot on the inner aspect of the heel) and sometimes pain on performing a plantar fascia stretch.
The health care provider will perform a physical exam. This may show tenderness on the bottom of your foot, flat feet or high arches, mild foot swelling or redness, stiffness or tightness of the arch
in the bottom of your foot. X-rays may be taken to rule out other problems.
Non Surgical Treatment
Night splints usually are designed to keep a person's ankle in a neutral position overnight. Most individuals naturally sleep with the feet plantar-flexed, a position that causes the plantar fascia
to be in a foreshortened position. A night dorsiflexion splint allows passive stretching of the calf and the plantar fascia during sleep. Theoretically, it also allows any healing to take place while
the plantar fascia is in an elongated position, thus creating less tension with the first step in the morning. A night splint can be molded from plaster or fiberglass casting material or may be a
prefabricated, commercially produced plastic brace. Several studies have shown that use of night splints has resulted in improvement in approximately 80 percent of patients using night splints. Other
studies found that night splints were especially useful in individuals who had symptoms of plantar fasciitis that had been present for more than 12 months. Night splints were cited as the best
treatment by approximately one third of the patients with plantar fasciitis who tried them. Disadvantages of night splints include mild discomfort, which may interfere with the patient's or a bed
partner's ability to sleep.
More invasive procedures to treat plantar fasciitis are usually sought only after other treatment has failed to produce favorable results. Corticosteroid injections deliver medicine into the injured
fascia to reduce pain. However, this treatment may weaken the plantar fascia and result in further damage. In addition, extracorporeal shock wave therapy (ESWT) is a treatment where sound waves are
sent through the damaged tissue in order to stimulate the damaged tissue and encourage healing. This method is relatively new in treating plantar fasciitis and your doctor will be able to tell you if
it is the right method for you. Lastly, surgery is the last option for those suffering from chronic or severe plantar fasciitis.