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.
Currently no single factor has been reliably identified as contributing to the development of plantar fasciitis. The two risk factors with the most support from current research. Decreased ankle
dorsiflexion. Increased Body Mass Index (BMI) in non-athletic populations. These factors are related in that both lead to increased strain on the arch, both lead to increased compression on the heel.
When dorsiflexion range of motion (ankle flexibility) is lacking, the body compensates by increasing movement of the arch. In this way, decreased ankle dorsiflexion influences pronation and places
strain on the underside of the foot. Similarly, having a high BMI causes strain because it places a load on the foot that may be in excess of what the foot can support. As mentioned earlier,
overpronation is thought to be a contributing factor, but studies on this have so far produced mixed results. The second way these factors relate to each other is in the way people stand. A lack of
ankle flexibility and a high BMI can both cause increased pressure on the heel in standing. Keeping weight on the heels causes compression under the heel. But it also means the muscles and ligaments
in the arch are not being used to balance your body weight. Lack of use, I suspect, is a greater danger than overuse. Looking beyond these potential contributors to heel pain though, there is one
major factor that overshadows them all-the way footwear alters the normal function of the foot.
Most patients with plantar fasciitis describe a sharp or stabbing pain on the bottom of the heel that is most severe when they first get up in the morning or after a period of resting. Some may feel
like the heel is bruised while others may describe tightness or even a pulling sensation on the heel or arch.
X-rays are a commonly used diagnostic imaging technique to rule out the possibility of a bone spur as a cause of your heel pain. A bone spur, if it is present in this location, is probably not the
cause of your pain, but it is evidence that your plantar fascia has been exerting excessive force on your heel bone. X-ray images can also help determine if you have arthritis or whether other, more
rare problems, stress fractures, bone tumors-are contributing to your heel pain.
Non Surgical Treatment
Over-the-counter arch supports may be useful in patients with acute plantar fasciitis and mild pes planus. The support provided by over-the-counter arch supports is highly variable and depends on the
material used to make the support. In general, patients should try to find the most dense material that is soft enough to be comfortable to walk on. Over-the-counter arch supports are especially
useful in the treatment of adolescents whose rapid foot growth may require a new pair of arch supports once or more per season. Custom orthotics are usually made by taking a plaster cast or an
impression of the individual's foot and then constructing an insert specifically designed to control biomechanical risk factors such as pes planus, valgus heel alignment and discrepancies in leg
length. For patients with plantar fasciitis, the most common prescription is for semi-rigid, three-quarters to full-length orthotics with longitudinal arch support. Two important characteristics for
successful treatment of plantar fasciitis with orthotics are the need to control over-pronation and metatarsal head motion, especially of the first metatarsal head. In one study, orthotics were cited
by 27 percent of patients as the best treatment. The main disadvantage of orthotics is the cost, which may range from $75 to $300 or more and which is frequently not covered by health
If treatment hasn't worked and you still have painful symptoms after a year, your GP may refer you to either an orthopaedic surgeon, a surgeon who specialises in surgery that involves bones, muscles
and joints, a podiatric surgeon, a podiatrist who specialises in foot surgery. Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is adversely affecting
their career. Plantar release surgery. Plantar release surgery is the most widely used type of surgery for heel pain. The surgeon will cut the fascia to release it from your heel bone and reduce the
tension in your plantar fascia. This should reduce any inflammation and relieve your painful symptoms. Surgery can be performed either as, open surgery, where the section of the plantar fascia is
released by making a cut into your heel, endoscopic or minimal incision surgery - where a smaller incision is made and special instruments are inserted through the incision to gain access to the
plantar fascia. Endoscopic or minimal incision surgery has a quicker recovery time, so you will be able to walk normally much sooner (almost immediately), compared with two to three weeks for open
surgery. A disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you were to
choose open surgery. Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in your foot. As with
all surgery, plantar release carries the risk of causing complications such as infection, nerve damage and a worsening of your symptoms after surgery (although this is rare). You should discuss the
advantages and disadvantages of both techniques with your surgical team. Extracorporeal shockwave therapy (EST) is a fairly new type of non-invasive treatment. Non-invasive means it does not involve
making cuts into your body. EST involves using a device to deliver high-energy soundwaves into your heel. The soundwaves can sometimes cause pain, so a local anaesthetic may be used to numb your
heel. It is claimed that EST works in two ways. It is thought to, have a "numbing" effect on the nerves that transmit pain signals to your brain, help stimulate and speed up the healing process.
However, these claims have not yet been definitively proven. The National Institute for Health and Care Excellence (NICE) has issued guidance about the use of EST for treating plantar fasciitis. NICE
states there are no concerns over the safety of EST, but there are uncertainties about how effective the procedure is for treating heel pain. Some studies have reported that EST is more effective
than surgery and other non-surgical treatments, while other studies found the procedure to be no better than a placebo (sham treatment).