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
The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more
prone to developing plantar fasciitis. Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly
evident when oneâs job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.
Plantar fasciitis which usually occurs on one foot at a time typically develops slowly. Some cases can be sudden and severe. If you suspect that you have plantar fasciitis, you should feel a sharp,
stabbing heel pain, usually in the inside bottom part of the heel. The pain will likely be worse when you take the first steps after long periods of rest (especially after sleep). The pain may also
worsen as you stand, climb stairs, or tiptoe. You typically will not feel a lot of pain during exercise, but will feel the ache after. In some cases, the affected heel may even swell.
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
Treatment for plantar fasciitis includes medication, physical therapy, shock wave therapy, or surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are used to treat
the inflammation and pain of plantar fasciitis, but they wonât cure the condition. Corticosteroids can also be used to ease pain and reduce inflammation. Corticosteroids are applied either as a
topical solution in conjunction with a non-painful electric current or through injections to the affected area.
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.
The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally,
they should be performed 2 - 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and
eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in
symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your
foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head until you feel a stretch in the back of your calf, Achilles tendon, plantar fascia or leg. Hold for 5
seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free. Resistance Band Calf Strengthening. Begin this exercise with a resistance band around your foot as
demonstrated and your foot and ankle held up towards your head. Slowly move your foot and ankle down against the resistance band as far as possible and comfortable without pain, tightening your calf
muscle. Very slowly return back to the starting position. Repeat 10 - 20 times provided the exercise is pain free.