Plantar Fasciitis

Plantar fasciitis, or foot ligament inflammation, can be painful.

• Plantar fasciitis (inflammation of the plantar fascia ligament) is most commonly caused by strain injury causing micro-tears to the ligament as it attaches to the heel bone or other areas of tightness on the sole of the foot.
• The plantar fascia is the largest ligament in the human body.
• The main symptoms of plantar fasciitis include
  • heel pain,
  • foot pain,
  • stiffness, and
  • tenderness.
• Plantar fasciitis is diagnosed based on the history of the condition as well as the physical examination.
• Plantar fasciitis can occur alone or be related to underlying diseases.
• Plantar fasciitis is treated by measures that decrease the associated inflammation and avoid reinjury.
• Plantar fasciitis is commonly mistaken for Baxter's neuritis, which is a nerve entrapment in the heel.
• Chronic plantar fasciitis (over one year) can become plantar fasciosis due to avascular scarring of the plantar fascia. It is painful due to poor blood supply to the scarred tissues and is resistant to treatment that reduces inflammation typically applied for plantar fasciitis.

The sole of the foot is referred to as the plantar area. Plantar fasciitis is a chronic local inflammation of the "bowstring-like" ligament stretching underneath the sole, also referred to as the plantar fascia, that attaches at the heel.

Plantar fasciitis is most commonly caused by repetitive strain injury to the ligament of the sole of the foot. Such strain injury can be from excessive running or walking, inadequate footgear, and jumping injury from landing. Plantar fasciitis can also be caused by certain diseases, including reactive arthritis and ankylosing spondylitis.

Plantar fasciitis causes pain and tenderness of the bottom of the foot. The tenderness is usually toward the heel, but the entire sole of the foot can be affected. A sign of abnormal tension or tightness that can lead to plantar fasciitis is a bony prominence (heel spur) that develops where the inflamed plantar fascia attaches to the heel bone (calcaneus).

Plantar fasciitis can make walking and running difficult. It can make the foot feel particularly stiff and sensitive in the morning or when rising after sitting or getting out of a car. Plantar fasciitis makes it difficult to walk barefoot on hard surfaces. Sometimes the bottom of the foot can feel warm, swollen, and tender.

Plantar fasciitis is diagnosed based on the history of the condition as well as the physical examination. Plantar fasciitis will have localized tenderness along the sole of the foot, most commonly at the inside arch of the heel. Usually, no further testing is necessary. X-ray testing can reveal an associated heel spur is present and rule out other causes of heel pain, such as fractures or tumors. Ultrasound imaging can also help diagnose plantar fasciitis.

Plantar fasciitis is treated by measures that decrease the associated inflammation and avoid reinjury. Local ice massage applications both reduce pain and inflammation.

• Physical therapy methods, including stretching exercises, are used to treat and prevent plantar fasciitis.
• Anti-inflammatory medications, such as ibuprofen (Advil) or cortisone injections, are often helpful.
• Sports running shoes with soft, cushioned soles can help reduce irritation of inflamed tissues from plantar fasciitis. Custom orthotic shoe inserts are used to reduce the excess motion of the foot and decrease strain on the plantar fascia.

Infrequently, surgery is performed on the chronically inflamed plantar fascia (plantar fasciosis) if conservative treatments fail. Newer treatments for these cases such as cobaltion, PRP, prolotherapy, ESWT, and micro-debridement are utilized as well.

The prognosis for plantar fasciitis is usually very good. Plantar fasciitis generally resolves with the conservative measures described above. However, in some cases, the condition can evolve into plantar fasciosis, which responds to a different set of treatments than those used for plantar fasciitis.

Plantar fasciitis can only be prevented by treating any underlying associated inflammatory disease and wearing optimal footwear, orthotic shoe inserts, and stretching.