The Causes and Treatment of Plantar Fasciitis
Heel pain is a common complaint among athletes. There are numerous causes for pain in and around the heel area, but by far the most common is a condition called Plantar Fasciitis. The excessive forces that sport activities put on the foot and leg can increase the likelihood of experiencing Plantar Fasciitis at some point in ones life.
The bottom surface of the foot is referred to as the plantar aspect. One of the layers of the plantar surface is called the fascia. The fascia is a thick, strong ligament/tendon type structure that attaches to the heel bone to the forefoot. The fascia has several functions, one of which is to help maintain the long arch of the foot. When a person stands, walks or runs the arch flexes to help absorb shock and accommodate the foot to the grounds surface. Under normal circumstances the stress put on the plantar fascia is easily absorbed. If the foot excessively pronates or supinate due to a high impact injury or repetitive instability, the plantar fascia can become inflamed, thus the term Plantar Fasciitis. This typically occurs where the fascia attaches to bone under the heel and is usually at the site of maximum tenderness. Although the heel is the most common site, plantar fasciitis can occur anywhere along the arch.
Pain typically occurs during the first few steps after the rest, especially in the morning. This is happens when the foot is relaxed and the plantar fascia becomes slack. This allows it to rest and heal the inflammation. The first few steps taken after rest can re-aggravate the condition when the plantar fascia stretches. Pain can also occur with increased activity as the day goes on.
A commonly associated condition occurring with plantar fasciitis is a heel spur. A bone spur can occur anywhere but typically occurs where soft tissue attaches to bone and an excessive tension or pulling has occurred for a long period of time. Many times bone spurs are not painful and people are unaware they have one. The size or presence of a spur does not correlate with the degree of symptoms. A person may have severe heel pain from Plantar Fasciitis with no heel spur or a very large heel spur with no history of heel pain.
Treatment of Plantar Fasciitis with or without a heel spur is effective with conservative care. Most people (90% or more) obtain relief without the need for surgery. Wearing supportive shoes with an orthotic or arch support is standard for initial treatment. Orthotics are available over the counter, supplied form orthopedic supply companies, or prescription custom made. Barefoot walking should be kept to minimum while symptoms are present. A structured stretching program that includes the entire lower extremity is important. Formal physical may be utilized as well. Rest from activities that aggravate symptoms should be considered and a short course of anti-inflammatory medication. Patients with exquisite pain conditions may benefit from a cortisone injection to the painful area. Wearing a night splint when sleeping helps reduce inflammation and speed recovery. On rare occasions it is necessary to put the foot and leg into a cast to completely rest the plantar fascia. If symptoms persist despite conservative standard treatments, surgery may be considered.