Plantar Fasciitis


 

The plantar fascia is a broad band of tissue that runs from the heel to the base of the toes, on the sole of the foot. It helps to support the normal arch of the foot. It is usually under tension, much like the string that holds the bow part of a bow and arrow bent, or arched. The plantar fascia may become partially torn or inflamed at either end.

 

Common Causes

Overuse, seen with a change in running habits, poor running shoes, footwear with poor arch support, walking on hard floors. Associated with weight gain.

 

Symptoms

Pain in the sole of the foot, either at the base of the heel, or in the arch. Patients are generally comfortable sleeping, but report sharp or cramping pain with the first step in the morning. Often they find themselves hobbling around for several minutes. Symptoms typically ease during the day, but may become painful at the end of the day.

 

Physical Findings

Tenderness along the plantar fascia. Often patients have a tight Achilles tendon.

 

Workup

The diagnosis is made primarily by history and physical examination. X-rays of the heel may coincidentally show ‘heel spurs’, but the spur is not part of the problem (the fascia doesn’t even attach to the spur).

 

Non-operative Treatment

A combination of plantar fascia and Achilles tendon stretching, anti-inflammatory medication, arch supports, good shoes, avoiding walking barefoot, and avoiding aggravating activities. Nighttime splints are irritating to wear, but are very helpful. A trial of a single corticosteroid injection may be helpful, but should not be done repeatedly.

 

Surgical Treatment

Plantar fasciotomy.

 

Injury Comment

The good news is that over ninety percent of patients can be successfully treated without surgery. The bad news is that it probably takes between six months and a year for a cure, and exacerbations are common.