Plantar Fasciitis, also known as heel spur syndrome, is one of the most common disorders affecting the foot and ankle. It is a painful, overuse condition of the heel usually caused by chronic, repetitive strain or stretching of the muscles and ligaments that support the arch.
Although it can affect anyone, it is most often seen in people who stand or walk for prolonged periods of time each day. It is especially common in active individuals who like to walk or run for exercise on a regular basis.
It usually begins with a gradual onset of sharp pain on the bottom of the heel which tends to progress over time. Typically symptoms are worse when first standing in the morning or after periods of rest. The pain usually improves as the day goes on only to worsen again at the end of the day. Symptoms are usually relieved with rest. As the chronic inflammatory process continues, a heel spur may develop in some individuals.
The diagnosis of Plantar Fasciitis fasciitis is established with the history and physical examination. Certain common foot deformities such as fallen arches (flatfeet) or high arches may predispose individuals to Plantar Fasciitis fasciitis. Weight bearing x-rays of the affected foot are usually taken to evaluate the bony architecture of the foot as well as to rule out a stress fracture of the calcaneus (heel bone) and also to determine if a heel spur is present.
The treatment goals are to reduce the inflammation, which decreases the pain, and to control those factors which led to the development of the condition. Initial measures include relative rest and avoidance of excessive walking and / or running. Ice massage of the affected heel 10-15 minutes two to three times daily helps to decrease the inflammation. Antiinflammatory medications may also be prescribed.
Certain biomechanical abnormalities such as excessive pronation should be controlled with orthotic devices (prescription arch supports) appropriate for the specific disorder. These devices limit abnormal motions and forces which can lead to or aggravate Plantar Fasciitis fasciitis. A calf stretching program is frequently recommended to improve flexibility and limit excessive stress on the inflammed tissues. Night splinting may also be helpful for some patients. A cortisone injection is sometimes necessary to reduce inflammation and pain. Physical therapy modalities such as ultrasound may be required in more resistant cases.
Although Plantar Fasciitis fasciitis may become a chronic condition, most patients will improve significantly with the treatment measures outlined above and will usually be able to return to their preinjury activity level without any residual disability. Surgery is therefore only indicated in those patients whose symptoms fail to resolve with conservative treatment. Surgical treatment usually involves release of the Plantar Fasciitis fascia from the heel bone and removing the bone spur if present. In some cases there can be impingement of one of the small nerves that courses adjacent to the Plantar Fasciitis fascia which may need to be released. This type of surgery is usually done as an outpatient with either general anesthesia or regional anesthesia (spinal block or local foot block).