plantar fasciitis means inflammation of the fascial tissues of the bottom of the
foot. Although the name is used in
many instances when an individual experiences foot or heel pain, the actual
condition does have a rather classical and somewhat specific presentation.
In a true classical case of plantar fasciitis, there is inflammation of
the actual plantar fascia, which is located either on the inside or on the
outside part of the bottom of the foot; or another structure called the plantar
aponeurosis (the hard and tough bands of fibre felt at the middle of the bottom
of the foot), or at times one of the muscles in the foot called flexor digitorum
brevis; all of which have an attachment to the heel bone (calcaneus).
The exact cause of
plantar fasciitis is still not known. The
most acceptable theory is that of a “repetitive Sprain/Strain Injury” (RSI)
and the population most frequently affected by this seems to be endurance
athletes, more specifically runners, followed by basketball players.
Non-athletic women are also likely to develop this condition.
The presentation of
the condition typically follows the pattern of intermittent heel or medial foot
pain of several days to several months duration, which becomes chronic and
recurring in many instances. There
is usually considerable discomfort upon standing up after a night’s rest, or
even after prolonged sitting. This
seems to improve within a few minutes of weight bearing activity but will
usually worsen by the end of the day. There
may also be sensations of achy and tired feet, pinpoint pain at the center of
the heel, and cramping of the calf or foot muscles.
Diagnosis of the
condition is usually made by the history of complaints as reported by the
patient, which will follow the above-mentioned pattern.
There will usually be a painful point under the heel of the affected
foot. The symptoms may also be
increased by rising up on the toes or by bending the ankle, the foot and the
toes back, causing a stretching of the tissues at the bottom of the foot.
If the condition is not resolved properly, there may be excessive bone
growth (calcaneal bone spur) that could develop at the heel.
The spur, if present may not be palpated in most cases. However, it may be visualized on an x-ray or an MRI.
It should be kept in mind that these spurs may be fibrocartilagenous,
calcific, or bony (ossified) in nature. The
difference is that the first two types can, and often do, cause pain at the heel
while the last one in most cases is not symptomatic.
Although the pain may be severe and exquisite in most cases, there is no
bruising or swelling visible to the naked eye as one may suspect.
There are many other
conditions that may cause foot or heel pain (rheumatoid arthritis, stress
fractures, gout, Sever’s disease, Reiters syndrome, calcaneal bursitis, tarsal
tunnel syndrome, etc.), which makes a proper diagnosis, as always, the key to
successful treatment and resolution of the condition. Once the correct diagnosis has been made, several options for
treatment are available. While some
of these treatments will simply help with the reduction of symptoms, others will
actually help address the underlying cause.
Some of the common treatments of plantar fasciitis that can be tried by
the patients (with varying degrees of success/failure) include:
strengthening of the calf and foot muscles (many different
exercises/routines are available and may be tried-some with more success
than others. For example, calf
stretches, rolling a golf ball or a tennis ball under the foot, heel-drops
or toe raises, toe taps and foot curls are only a few of many of the
routines that can be implemented)
(posterior night splints) worn at night to help stretch the calf muscles
Donuts or gel pads
under the heel
Soft arch support
Ice massage (rolling
foot back and forth for a few minutes on a frozen bottle of water)
Rest from the
offending activity (running, jumping or prolonged standing)
methods, which are offered in a clinical setting, may include:
Trigger point massage
medications (frequently ineffective)
Casting (not a common
method and not one I would recommend unless all else has failed)
injections-should be avoided as they cause damage to the tissue and will
weaken it, which may result in the condition becoming worse or even tissue
Custom made orthotics
Taping of the arch or
the plantar aponeurosis
techniques such as Active Release Techniques (A.R.T.) and Graston Technique
have been shown extremely effective
correction of joint function, typically involving joint manipulations of the
foot, ankle, knee, hip or pelvis are usually helpful and often needed
Walking and running
gait analysis and corrections are needed for the athletes with this
Surgery has been
tried with varying results (typically less than optimal outcomes)
For more difficult
cases that may fail to respond to the above combination of treatments a
procedure called “Extracorporeal Lithotripsy” may offer some relief