Plantar fasciitis was previously believed to be inflammation of the fascia near its insertion on the heel bone. The suffix (-itis) means inflammation. Studies, however, reveal that changes in the
tissue associated with the injury are degenerative and not related to inflammation, at least not in the way most people typically think of inflammation. Sudden onset of heel pain may indeed be
related to acute inflammation. For persistent heel pain the condition more closely resembles long-standing degeneration of the plantar fascia near its attachment than inflammation. This could explain
why anti-inflammatory medications and injections have been unsuccessful at treating it. But there is more to heel pain than just the plantar fascia.
Because the plantar fascia supports your foot and gets used every time you take a step, it has to absorb a large amount of stress and weight. If too much pressure is put on the plantar fascia, the
fibers can become damaged or start to tear. The body responds by causing inflammation in the affected area. This is what causes the pain and stiffness of plantar fasciitis. Things that can increase
the risk of plantar fasciitis include tight calf muscles. Tight calves make it harder to flex your foot, and this puts more stress on the plantar fascia. Weight. Carrying a few extra pounds puts
added pressure on your feet every time you take a step. Activities that put a lot of stress on the feet. This includes things like running, hiking, dancing, and aerobics. Bad shoes. Footwear that
doesn't give your foot the support it needs increases your risk of plantar fasciitis. You'll want to ditch any shoes that have thin soles or inadequate arch support, or ones that don't fit your feet
properly. Routinely wearing high heels can also cause your Achilles tendon to contract over time, making it harder to flex your foot. Jobs that involve a lot of standing or walking on hard surfaces.
Jobs that keep you on your feet all day, like waiting tables or working in a store, can cause damage to your plantar fascia. High arches, flat feet, or other foot problems. The shape of your foot can
affect the way your weight is distributed on your feet when you stand. If weight distribution is a bit off, it can add to a person's risk of plantar fasciitis. How someone walks can increase the
stress on certain parts of the foot too.
Heel pain is the most common symptom associated with plantar fasciosis. Your heel pain may be worse in the morning or after you have been sitting or standing for long periods. Pain is most common
under your heel bone, but you also may experience pain in your foot arch or on the outside aspect of your foot. Other common signs and symptoms of plantar fasciosis include mild swelling and redness
in your affected area, tenderness on the bottom of your heel, impaired ability to ambulate.
Plantar fasciitis is one of many conditions causing "heel pain". Some other possible causes include nerve compression either in the foot or in the back, stress fracture of the calcaneus, and loss of
the fatty tissue pad under the heel. Plantar fasciitis can be distinguished from these and other conditions based on a history and examination done by a physician. It should be noted that heel spurs
are often inappropriately thought to be the sole cause of heel pain. In fact, heel spurs are common and are nothing more than the bone's response to traction or pulling-type forces from the plantar
fascia and other muscles in the foot where they attach to the heel bone. They are commonly present in patients without pain, and frequently absent from those who have pain. It is the rare patient who
has a truly enlarged and problematic spur requiring surgery.
Non Surgical Treatment
Heel cups are used to decrease the impact on the calcaneus and to theoretically decrease the tension on the plantar fascia by elevating the heel on a soft cushion. Although heel cups have been found
to be useful by some physicians and patients, in our experience they are more useful in treating patients with fat pad syndrome and heel bruises than patients with plantar fasciitis. In a survey of
411 patients with plantar fasciitis, heel cups were ranked as the least effective of 11 different treatments.
In very rare cases plantar fascia surgery is suggested, as a last resort. In this case the surgeon makes an incision into the ligament, partially cutting the plantar fascia to release it. If a heel
spur is present, the surgeon will remove it. Plantar Fasciitis surgery should always be considered the last resort when all the conventional treatment methods have failed to succeed. Endoscopic
plantar fasciotomy (EPF) is a form of surgery whereby two incisions are made around the heel and the ligament is being detached from the heel bone allowing the new ligament to develop in the same
place. In some cases the surgeon may decide to remove the heel spur itself, if present. Just like any type of surgery, Plantar Fascia surgery comes with certain risks and side effects. For example,
the arch of the foot may drop and become weak. Wearing an arch support after surgery is therefore recommended. Heel spur surgeries may also do some damage to veins and arteries of your foot that
allow blood supply in the area. This will increase the time of recovery.