Plantar Fasciitis

Plantar fasciitis is the most common cause of heel pain. Pain from plantar fasciitis is often most noticeable during the first few steps after getting out of bed in the morning. The plantar fascia is a thick band of tissue in the sole of the foot. Microtearing at the origin of the plantar fascia on the heel bone (calcaneus) can occur with repetitive loading. This microtearing leads to an inflammatory response (healing response) which produces the pain. Risk factors for plantar fasciitis include: excessive standing, increased body weight, increasing age, a change in activity level, and a stiff calf muscle. Plantar fasciitis can be managed non-operatively in the vast majority of patients. The main components of an effective non-operative treatment program are: calf stretching with the knee straight, plantar fascia stretching, activity modification (to avoid precipitating activities), and comfort shoe wear.

The most common cause of heel pain is plantar fasciitis. The origin of the plantar fascia on the heel bone [calcaneus] is subject to repetitive loading with each step. This can result in microtearing. As the body attempts to heal this microtearing in the fascia an inflammatory response occurs leading to significant pain symptoms.

Patients with plantar fasciitis almost universally, give a history of pain with the first few steps in the morning. Pain is often also associated with first steps after periods of inactivity such as sitting for lunch, or after getting out of car. This pain is located in the heel and can be sharp. It will often improve after some movement or stretching. However, it will tend to recur as the day progresses, particularly if the patient has been doing significant weight-bearing activities such as walking or standing. Plantar Fasciitis is associated with:

• Middle age
• A recent increase in activity level (ex. new running program)
• Jobs that require significant standing
• Increased weight
• Stiff calf muscles

Clinical examination will often localize the pain to the plantar medial heel region. Pain can also occur with direct pressure (palpation). There is often an associated equinus contracture (stiffness) of the calf demonstrated with the knee straight. Symptoms may also be exacerbated by stretching the plantar fascia by placing the toes in a dorsiflexed position. There is an association between flatfeet and the development of plantar fasciitis. However, any foot type can develop this condition.

Treatment

Non-Operative Treatment

There is excellent non-operative treatment available for plantar fasciitis. The vast majority of patients will have their symptoms resolve with non-operative treatment. The main elements of non-operative treatment are as follows:

• Calf Stretching
• Plantar Fascia Specific Stretch

With resolution of the heel pain symptoms, it is important to continue calf stretching and plantar fascia stretching on a semi-regular basis (3-4 times per week) so as to minimize the risk of recurrence. These treatment modalities treat the symptoms, but do not fully address the underlying biomechanical predisposing factors. Therefore, ongoing management of this condition is essential!

• Over-the-counter Orthotics
• Comfort Shoes
• Anti-Inflammatory Medication (NSAIDs)
• Activity Modification
• Plantar Fascia Night Splint
• Weight Loss
• Local Injection

Operative Treatment

The majority of patients, about 90%, will respond to appropriate non-operative treatment measures over a period of 3-6 months. Surgery is a treatment option for patients with persistent symptoms, but is NOT recommended unless a patient has failed a minimum of 6-9 months of appropriate non-operative treatment.