Plantar fasciitis is the most common cause of heel pain in runners, eventually affecting 10 percent of the running community. While running, the plantar fascia works with the Achilles tendon to store
and return energy. Because of its powerful attachment to the base of the toe, the plantar fascia stabilizes the inner forefoot as forces peak during pushoff. Unlike bone spurs and stress fractures of
the heel, plantar fasciitis tends to produce pain during the pushoff phase while running, not during initial contact. A simple way to tell if you have plantar fasciitis versus a heel spur/stress
fracture is to walk on your toes: heel spurs and heel stress fractures feel better while you walk on your toes, while plantar fasciitis typically produces more discomfort when you shift your weight
onto your toes.
Inappropriate footwear is the No. 1 cause of plantar fasciosis. Footwear that possesses toe spring and a tapered toe box holds your big toe in an adducted and extended position. In this position,
your abductor hallucis muscle-the muscle responsible for moving your big toe away from your footâs midline-pulls on a foot structure called the flexor retinaculum and may restrict blood flow
through your posterior tibial artery, the vessel that carries blood to the bottom of your foot. Tissues in the sole of your feet begin to degenerate as blood supply to this area is decreased. Other
recognized causes of or contributors to this health problem include the following, calf muscle shortening, plantar fascia contracture, Obesity, rheumatoid arthritis, reactive arthritis, Psoriatic
arthritis, Corticosteroid injections.
The heel pain characteristic of plantar fasciitis is usually felt on the bottom of the heel and is most intense with the first steps of the day. Individuals with plantar fasciitis often have
difficulty with dorsiflexion of the foot, an action in which the foot is brought toward the shin. This difficulty is usually due to tightness of the calf muscle or Achilles tendon, the latter of
which is connected to the back of the plantar fascia. Most cases of plantar fasciitis resolve on their own with time and respond well to conservative methods of treatment.
Your GP or podiatrist (a healthcare professional who specialises in foot care) may be able to diagnose the cause of your heel pain by asking about your symptoms and examining your heel and foot. You
will usually only need further tests if you have additional symptoms that suggest the cause of your heel pain is not inflammation, such as numbness or a tingling sensation in your foot, this could be
a sign of nerve damage in your feet and legs (peripheral neuropathy) your foot feels hot and you have a high temperature (fever) of 38C (100.4F) or above - these could be signs of a bone infection,
you have stiffness and swelling in your heel, this could be a sign of arthritis. Possible further tests may include blood tests, X-rays - where small doses of radiation are used to detect problems
with your bones and tissues, a magnetic resonance imaging (MRI) scan or ultrasound scan, which are more detailed scans.
Non Surgical Treatment
Night splints usually are designed to keep a person's ankle in a neutral position overnight. Most individuals naturally sleep with the feet plantar-flexed, a position that causes the plantar fascia
to be in a foreshortened position. A night dorsiflexion splint allows passive stretching of the calf and the plantar fascia during sleep. Theoretically, it also allows any healing to take place while
the plantar fascia is in an elongated position, thus creating less tension with the first step in the morning. A night splint can be molded from plaster or fiberglass casting material or may be a
prefabricated, commercially produced plastic brace. Several studies have shown that use of night splints has resulted in improvement in approximately 80 percent of patients using night splints. Other
studies found that night splints were especially useful in individuals who had symptoms of plantar fasciitis that had been present for more than 12 months. Night splints were cited as the best
treatment by approximately one third of the patients with plantar fasciitis who tried them. Disadvantages of night splints include mild discomfort, which may interfere with the patient's or a bed
partner's ability to sleep.
Most patients have good results from surgery. However, because surgery can result in chronic pain and dissatisfaction, it is recommended only after all nonsurgical measures have been exhausted. The
most common complications of release surgery include incomplete relief of pain and nerve damage.
Stretching the plantar fascia and the calf muscle area can help to prevent inflammation. Slowly increasing the amount or intensity of athletic activities by graded progression can also help to
prevent injury. Recommended Stretches: Taking a lunge position with the injured foot behind and keeping your heels flat on the floor, lean into a wall and bend the knees. A stretch should be felt in
the sole and in the Achilles tendon area. Hold the stretch for 20-30 seconds. Also try this stretch with the back leg straight.