Plantar fasciitis is a condition that results from overuse of the Plantar Fascia – the strong band of tissue that connects your heel to your toes and helps support the arch.
Causes
Plantar fasciitis begins with a tiny tear in this tissue from too much activity, too much pressure, or from an acute strain. The tissue attempts to heal eventually breaks down and results in degenerative tearing. As this happens, the tissue thickens and may compresses the nerves on the inside of the heel. This degenerative tissue is often painful to walk on. While the pain starts out hurting only in the mornings, as the nerve become involved, pain can increase throughout the day and even cause problems at night.
Symptoms
Typical symptoms of plantar fasciitis include pain on the bottom of the heel. It is often first described as a tearing pain worse with the first step in the AM. This pain improves after a few steps. Later on, the pain becomes burning in nature and persists after walking and can even cause symptoms at rest. Many patients rub the area to relieve the pain.
Some of the most common risk factors include obesity and overuse activity. It is not surprising to imagine that being overweight can cause injury to the foot but, standing at work without moving around and relieving heel tension, exercise without enough rest, and other overuse activities are also problematic.
Diagnosis & Treatment
Your doctor can diagnosis this condition with an examination and by listening closely to the injury history. X-rays are obtained to evaluate for other mechanical causes of heel pain such as a stress fracture, calcaneal cysts, tumors, and spurs. Ultrasound is an inexpensive testing option to look at the plantar fascia and the soft tissues around the heel. It can be helpful in guiding a cortisone injection and eliminating other causes of nerve entrapment. An MRI of the heel is rarely indicated but may be ordered in recalcitrant cases before proceeding with surgery.
Plantar fasciitis is most often treated non-operatively with:
- Stretching and strengthening exercises
- Physical therapy
- Shoe Inserts and night splints
- NSAIDs and sometimes Cortisone injections
- Casts or cast boots
Almost 90% of cases will resolve with non-operative treatment. But if the pain persists for more than 6 months, surgery can be considered to fix the issue. Surgery for plantar fasciitis consists of removing the degenerative plantar tissue and releasing the entrapped nerves. Recovery from surgery can be prolonged and improvement is noted up to a year. According to many studies, 75-85% of patients rate the surgery good or excellent. In my experience, relieving the nerve compression is the most important factor in pain relief.