Plantar fasciitis is the most common cause of pain on the bottom of the heel. Approximately 2 million patients are treated for this condition every year. Plantar fasciitis occurs when the strong band
of tissue that supports the arch of your foot becomes irritated and inflamed. The plantar fascia is a long, thin ligament that lies directly beneath the skin on the bottom of your foot. It connects
the heel to the front of your foot, and supports the arch of your foot.
Far and away the most common cause of plantar fasciitis in an athlete is faulty biomechanics of the foot or leg. Faulty biomechanics causes the foot to sustain increased or prolonged stresses over
and above those of routine ground contacts. Throughout the phase of ground contact, the foot assumes several mechanical positions to dissipate shock while at the same time placing the foot in the
best position to deliver ground forces. With heel landing the foot is supinated (ankle rolled out). At mid-stance the foot is pronated (ankle rolled in). The foot is supinated again with toe-off. The
supination of the foot at heel strike and toe-off makes the foot a rigid lever. At heel strike the shock of ground contact is transferred to the powerful quads. During toe-off forward motion is
created by contraction of the gastroc complex plantar flexing the rigid lever of the foot pushing the body forward.
Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But
your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time. If you have foot pain at night, you may have a different problem, such as
arthritis , or a nerve problem such as tarsal tunnel syndrome.
Diagnosis of plantar fasciitis is based on a medical history, the nature of symptoms, and the presence of localised tenderness in the heel. X-rays may be recommended to rule out other causes for the
symptoms, such as bone fracture and to check for evidence of heel spurs. Blood tests may also be recommended.
Non Surgical Treatment
Plantar fasciitis is usually controlled with conservative treatment. Following control of the pain and inflammation an orthotic (a custom made shoe insert) will be used to stabilize your foot and
prevent a recurrence. Over 98% of the time heel spurs and plantar fasciitis can be controlled by this treatment and surgery can be avoided. The orthotic prevents excess pronation and prevents
lengthening of the plantar fascia and continued tearing of the fascia. Usually a slight heel lift and a firm shank in the shoe will also help to reduce the severity of this problem. The office visit
will be used for careful examination and review to distinguish plantar fasciitis and plantar heel pain syndrome from other problems, many of which are outlined below. It is important to distinguish
between a stress reaction of the calcaneus and plantar fasciitis. A feature of many calcaneal stress fractures is pain on lateral and medial compression of the calcaneus.
If you consider surgery, your original diagnosis should be confirmed by the surgeon first. In addition, supporting diagnostic evidence (such as nerve-conduction studies) should be gathered to rule
out nerve entrapment, particularly of the first branch of the lateral plantar nerve and the medial plantar nerve. Blood tests should consist of an erythrocyte sedimentation rate (ESR), rheumatoid
factor, human leukocyte antigen B27 (HLA-B27), and uric acid. Itâs important to understand that surgical treatment of bone spurs rarely improves plantar fasciitis pain. And surgery for plantar
fasciitis can cause secondary complications-a troubling condition known as lateral column syndrome.
Calf stretch. Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your
hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch.
Plantar fascia stretch. This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you
in a controlled fashion. If it is difficult to reach your foot, wrap a towel around your big toe to help pull your toes toward you. Place your other hand along the plantar fascia. The fascia should
feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or