The Plantar Fascia is a strong ligament-like structure under the arch of the foot that runs from the heel bone to the ball of the foot. If we could see it in isolation it has a triangular shape when
looked at from underneath but has a curved shape when looked at from the side - much like a sail boatâs sail billowing in the wind. The most functional piece is from the front-bottom-inside area of
the heel bone (calcaneous) to the joint of the big toe (hallux) and this is where the majority of stress of walking (and running and jumping) is taken by the fascia. How your plantar fascia reacts to
and recovers from this stress is what determines the extent and nature of your plantar fasciitis.
Plantar Fasciitis is simply caused by overstretching of the plantar fascia ligament under the foot. So why is the ligament being overstretched? There are different factors, over-use, too much sports,
running, walking or standing for long periods (e.g. because of your job) weight gain, our feet are designed to carry a 'normal' weight. Any excess weight places great pressure on the bones, nerves,
muscles and ligaments in the feet, which sooner or later will have consequences. Even pregnancy (in the last 10 weeks) can cause foot problems! age, as we get older ligaments become tighter &
shorter and msucles become weaker; the ideal circumstances for foot problems, unsupportive footwear, 'floppy' shoes with no support as well as thongs affect our walking pattern, walking barefoot,
especially on hard surfaces like concrete or tiles, low arch and flat feet or over-pronation. An important contributing factor to Plantar Fasciitis is 'excess pronation' (or over-pronation). This is
a condition whereby the feet roll over, the arches collapse and the foot elongates. This unnatural elongation puts excess strain on the ligaments, muscles and nerves in the foot. When the foot is not
properly aligned, the bones unlock and cause the foot to roll inward. With every step taken your foot pronates and elongates, stretching the plantar fascia and causing inflammation and pain at the
attachment of the plantar fascia into the heel bone. Re-alignment of the foot should therefore an important part of the treament regime.
Plantar fasciitis commonly causes a stabbing pain in the heel of the foot, which is worse during the first few steps of the day after awakening. As you continue to walk on the affected foot, the pain
gradually lessens. Usually, only one foot is affected, but it can occur in both feet simultaneously.
If you see a doctor for heel pain, he or she will first ask questions about where you feel the pain. If plantar fasciitis is suspected, the doctor will ask about what activities you've been doing
that might be putting you at risk. The doctor will also examine your foot by pressing on it or asking you to flex it to see if that makes the pain worse. If something else might be causing the pain,
like a heel spur or a bone fracture, the doctor may order an X-ray to take a look at the bones of your feet. In rare cases, if heel pain doesn't respond to regular treatments, the doctor also might
order an MRI scan of your foot. The good news about plantar fasciitis is that it usually goes away after a few months if you do a few simple things like stretching exercises and cutting back on
activities that might have caused the problem. Taking over-the-counter medicines can help with pain. It's rare that people need surgery for plantar fasciitis. Doctors only do surgery as a last resort
if nothing else eases the pain.
Non Surgical Treatment
Over-the-counter arch supports may be useful in patients with acute plantar fasciitis and mild pes planus. The support provided by over-the-counter arch supports is highly variable and depends on the
material used to make the support. In general, patients should try to find the most dense material that is soft enough to be comfortable to walk on. Over-the-counter arch supports are especially
useful in the treatment of adolescents whose rapid foot growth may require a new pair of arch supports once or more per season. Custom orthotics are usually made by taking a plaster cast or an
impression of the individual's foot and then constructing an insert specifically designed to control biomechanical risk factors such as pes planus, valgus heel alignment and discrepancies in leg
length. For patients with plantar fasciitis, the most common prescription is for semi-rigid, three-quarters to full-length orthotics with longitudinal arch support. Two important characteristics for
successful treatment of plantar fasciitis with orthotics are the need to control over-pronation and metatarsal head motion, especially of the first metatarsal head. In one study, orthotics were cited
by 27 percent of patients as the best treatment. The main disadvantage of orthotics is the cost, which may range from $75 to $300 or more and which is frequently not covered by health
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.