Plantar Fasciitis/Heel Pain

Anatomy

The plantar fascia is a large ligament originating from the heel bone (calcaneus) and it inserts across the ball of the foot beneath the metatarsal heads. The role of the plantar fascia is to help maintain the arch of the foot.

Condition

Plantar fasciitis is a condition that occurs when there is repetitive micro-trauma along the plantar fascia. This results in build up of scar tissue and impingement of nerve branches to the heel.

Symptoms

1. Pain is commonly felt at the origin of the plantar fascia along the inside of the heel and can also be felt in the arch of the foot or less commonly on the outside of the foot
2. The majority of patients experience pain that is worse 1^st thing in the morning or when walking after a period of rest (post-static dyskinesia). The majority of patients experience improvement in their pain once they start walking. A small percentage of patients experience constant pain
3. The pain is generally sharp or burning in nature and some patients describe it as though their “heel is being stabbed with a knife”

Diagnosis

Diagnosis is made by a comprehensive foot exam by Dr. Stewart along with x-rays of the foot. Imagining studies such as ultrasound and MRI are sometimes required to determine the extent disease to the plantar fascia.

Common causes

1. Overuse, which means there is too much physical activity. This commonly occurs in runners and/or walkers and in such sports as soccer, lacrosse, basketball, tennis, and football
2. Although less common, the condition can occur acutely in weekend warriors
3. Overweight or obesity
4. Inappropriate shoe gear including flats, flip-flops, or backless shoes
5. Barefoot walking
6. Genetic predisposition due to a flatfoot deformity
7. Posterior tibial tendinitis (inflammation of a tendon that helps to support the arch of the foot)

Treatment

Plantar fasciitis generally takes 6-8 weeks to improve and early activity on a healing plantar fascia can result in a set back in recovery. Non-compliance can double the recovery time and can be very frustrating for patients.

Plantar fasciitis is what Dr. Stewart terms a pro-active condition. Although we can never offer a 100% guarantee, the majority of Dr. Stewart’s patients improve with conservative or non-surgical care.

Conservative treatment for plantar fasciitis includes:

1. Modification of physical activity including avoidance of walking, jogging, running, and the elliptical machine for exercise; recommended exercises include circuit training, swimming, and bicycling
2. Stretching exercises with a Theraband and/or against a wall
3. Use of a plantar fascia night splint; this is a static device that holds the foot at approximately 90° to the leg; this stretches the plantar fascia in order to avoid the common painful 1^st few steps in the morning; consistent stretching is one the mainstays of treatment
4. Weight loss and dieting
5. Ice to the heel 2-3 times per day for 20 minutes at the area of maximum tenderness. Elevation is recommended while icing
6. Avoidance of flip-flops, flats, and barefoot walking
7. Supportive shoe gear including a motion control running shoe such as Brooks, Aasics, New Balance, or Saucony; Keen and Merrell style shoes are also recommended
8. Custom foot orthotics
9. Physical therapy
10. Medications including anti-inflammatory medications (NSAIDs), Tylenol, oral steroids, and in some cases narcotic pain medication
11. Steroid injection therapy
12. Compression therapy generally with prescription compression stockings
13. Nerve ablation procedures
14. Shock wave therapy

Surgical treatment for plantar fasciitis includes:

1. Release of the plantar fascia (plantar fasciotomy)
2. Removal of a portion of the plantar fascia (plantar fasciectomy)
3. Removal of the bone spur
4. Decompression of the nerve to the heel