Plantar fasciitis is a very common condition resulting in pain under the heel which often radiates into the foot. We explain free of charge everything you need to know to cure your pain and prevent
it from returning.
Plantar fasciitis can be confused with a condition called tarsal tunnel syndrome. In tarsal tunnel syndrome, an important nerve in the foot, the tibial nerve, is trapped and pinched as it passes
through the tarsal tunnel, a condition analogous to carpal tunnel syndrome in the wrist. This may cause symptoms similar to the pain of a plantar fasciitis. There are also other less common problems
such as nerve entrapments, stress fractures, and fat pad necrosis, all of which can cause foot pain. Finally, several rheumatologic conditions can cause heel pain. These syndromes such as Reiter's
syndrome and ankylosing spondylitis can cause heel pain similar to plantar fasciitis. If your symptoms are not typical for plantar fasciitis, or if your symptoms do not resolve with treatment, your
doctor will consider these possible diagnoses.
The pain associated with plantar fasciitis is typically gradual in onset and is usually located over the inner or medial aspect of the heel. Occasionally, the pain will be sudden in onset, occurring
after missing a step or after jumping from a height. The pain is commonly most severe upon arising from bed in the morning, or after periods of inactivity during the day. Thus, it causes what is
known as "first-step pain." The degree of discomfort can sometimes lessen with activity during the course of the day or after "warming-up", but can become worse if prolonged or vigorous activity is
undertaken. The pain is also often noted to be more severe in bare feet or in shoes with minimal or no padding at the sole.
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
Anti-inflammatory agents used in the treatment of plantar fasciitis include ice, NSAIDs, iontophoresis and cortisone injections. Ice is applied in the treatment of plantar fasciitis by ice massage,
ice bath or in an ice pack. For ice massage, the patient freezes water in a small paper or foam cup, then rubs the ice over the painful heel using a circular motion and moderate pressure for five to
10 minutes. To use an ice bath, a shallow pan is filled with water and ice, and the heel is allowed to soak for 10 to 15 minutes. Patients should use neoprene toe covers or keep the toes out of the
ice water to prevent injuries associated with exposure to the cold. Crushed ice in a plastic bag wrapped in a towel makes the best ice pack, because it can be molded to the foot and increase the
contact area. A good alternative is the use of a bag of prepackaged frozen corn wrapped in a towel. Ice packs are usually used for 15 to 20 minutes. Icing is usually done after completing exercise,
stretching, strengthening and after a day's work.
In cases that do not respond to any conservative treatment, surgical release of the plantar fascia may be considered. Plantar fasciotomy may be performed using open, endoscopic or radiofrequency
lesioning techniques. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. Potential risk factors include flattening of the longitudinal arch and heel
hypoesthesia as well as the potential complications associated with rupture of the plantar fascia and complications related to anesthesia.