If your first step in the morning often feels like it involves a rusty nail being inserted into your heel, youâre not alone. Heel pain resulting from plantar fasciitis is the most prevalent
condition treated in podiatric clinics, and an additional 1 million Americans annually are seen by medical doctors for the condition, according to the Centers for Disease Control and Prevention. The
plantar fascia is the ligament that runs from the heel bone across the entire bottom of the foot and connects at the base of the toes. Ligaments connect bone to bone, and donât really constrict or
contract, but can become thickened because of inflammation. Inflammation of the plantar fascia can cause strain when you walk, specifically heel pain that is especially bad for the first few steps
after prolonged inactivity. It then typically loosens up once youâre up and about.
Excessive stretching of the plantar fascia can result in microtrauma of this structure either along its course or where it inserts onto the medial calcaneal tuberosity. This microtrauma, if
repetitive, can result in chronic degeneration of the plantar fascia fibers. The loading of the degenerative and healing tissue at the plantar fascia may cause significant plantar pain, particularly
with the first few steps after sleep or other periods of inactivity. The term fasciitis may, in fact, be something of a misnomer, because the disease is actually a degenerative process that occurs
with or without inflammatory changes, which may include fibroblastic proliferation. This has been proven from biopsies of fascia from people undergoing surgery for plantar fascia release.
If you have Plantar Fasciitis, you will most likely feel a sharp pain under the ball of you heel and it will often give pain when standing after a period of rest. For example when you get out of bed
in the mornings or after being sat down. Some patients describe this feeling as a stone bruise sensation, or a pebble in the shoe and at times the pain can be excruciating. Patients with Plantar
Fasciitis can experience pain free periods whereby the think they are on the mend, only for the heel pain to come back aggressively when they appear to have done nothing wrong. If your plantar
fasciitis came on very suddenly and the pain is relentless, then you may have Plantar Fascial Tears. We will be able to differentiate between these 2 conditions, sometimes with ultra sound imaging.
The treatment for each of these conditions will need to be very different.
Your doctor will check your feet and watch you stand and walk. He or she will also ask questions about your past health, including what illnesses or injuries you have had. Your symptoms, such as
where the pain is and what time of day your foot hurts most. How active you are and what types of physical activity you do. Your doctor may take an X-ray of your foot if he or she suspects a problem
with the bones of your foot, such as a stress fracture.
Non Surgical Treatment
Reducing inflammation in the plantar fascia ligament is an important part of treatment, though this does not address the underlying damage to the ligament. Initial home treatment includes staying off
your feet and applying ice for 15 to 20 minutes three or four times a day to reduce swelling. You can also try reducing or changing your exercise activities. Using arch supports in your shoes and
doing stretching exercises may also help to relieve pain. Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (i.e. Motrin or Advil) and naproxen (i.e. Aleve), are often used to reduce
inflammation in the ligament. If home treatments and over-the-counter anti-inflammatory drugs donât ease the pain, an injection of a corticosteroid directly into the damaged section of the ligament
can be given. Your doctor can do this in his or her office. Your doctor may use an ultrasound device to help determine the best place for the injection. Corticosteroids can also be administered on
the skin of your heel or the arch of your foot, and then a painless electrical current is applied to let the steroid pass through your skin and into the muscle. Physical therapy is an important part
of treatment for planter fasciitis. It can help stretch your plantar fascia and Achilles tendons. A physical therapist can also show you exercises to strengthen your lower leg muscles, helping to
stabilize your walk and lessen the workload on your plantar fascia. If pain continues and other methods arenât working, your doctor may recommend extracorporeal shock wave therapy. Sound waves are
bombarded against your heel to stimulate healing within the ligament. This treatment can result in bruises, swelling, pain, and numbness, and has not been proven to be consistently effective in
Most studies indicate that 95% of those afflicted with plantar fasciitis are able to relieve their heel pain with nonsurgical treatments. If you are one of the few people whose symptoms don't improve
with other treatments, your doctor may recommend plantar fascia release surgery. Plantar fascia release involves cutting part of the plantar fascia ligament in order to release the tension and
relieve the inflammation of the ligament. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. While the success rate is very high following surgery,
one should be aware that there is often a prolonged postoperative period of discomfort similar to the discomfort experienced prior to surgery. This pain usually will abate within 2-3 months. One
should always be sure to understand all the risks associated with any surgery they are considering.