Plantar fasciosis is pain at the site of the attachment of the plantar fascia and the calcaneus (calcaneal enthesopathy), with or without accompanying pain along the medial band of the plantar
fascia. Diagnosis is mainly clinical. Treatment involves calf muscle and plantar soft-tissue foot-stretching exercises, night splints, orthotics, and shoes with appropriate heel elevation. Syndromes
of pain in the plantar fascia have been called plantar fasciitis; however, because there is usually no inflammation, plantar fasciosis is more correct. Other terms used include calcaneal enthesopathy
pain or calcaneal spur syndrome; however, there may be no bone spurs on the calcaneus. Plantar fasciosis may involve acute or chronic stretching, tearing, and degeneration of the fascia at its
Training on improper, hard and/or irregular surfaces as well as excessive track work in spiked shoes, or steep hill running, can stress the plantar fascia past its limits of elasticity, leading to
injury. Finally, failure in the early season to warm up gradually gives the athlete insufficient time for the structures of the foot to re-acclimate and return to a proper fitness level for intensive
exercise. Such unprepared and repeated trauma causes microscopic tearing, which may only be detected once full-blown plantar fasciitis and accompanying pain and debilitation have resulted. If the
level of damage to the plantar fascia is significant, an inflammatory reaction of the heel bone can produce spike-like projections of new bone, known as heel spurs. Indeed, plantar fasciitis has
occasionally been refereed to as heel spur syndrome, though such spurs are not the cause of the initial pain but are instead a further symptom of the problem. While such spurs are sometimes painless,
in other cases they cause pain or disability in the athlete, and surgical intervention to remove them may be required. A dull, intermittent pain in the heel is typical, sometimes progressing to a
sharp, sustained discomfort. Commonly, pain is worse in the morning or after sitting, later decreasing as the patient begins walking, though standing or walking for long periods usually brings
renewal of the pain.
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.
If you see a doctor for heel pain, he or she will first ask questions about where you feel the pain. If plantar fasciitis is suspected, the doctor will ask about what activities you've been doing
that might be putting you at risk. The doctor will also examine your foot by pressing on it or asking you to flex it to see if that makes the pain worse. If something else might be causing the pain,
like a heel spur or a bone fracture, the doctor may order an X-ray to take a look at the bones of your feet. In rare cases, if heel pain doesn't respond to regular treatments, the doctor also might
order an MRI scan of your foot. The good news about plantar fasciitis is that it usually goes away after a few months if you do a few simple things like stretching exercises and cutting back on
activities that might have caused the problem. Taking over-the-counter medicines can help with pain. It's rare that people need surgery for plantar fasciitis. Doctors only do surgery as a last resort
if nothing else eases the pain.
Non Surgical Treatment
To alleviate the stress and pain on the fascia, the person can take shorter steps and avoid walking barefoot. Activities that involve foot impact, such as jogging, should be avoided. The most
effective treatments include the use of in-shoe heel and arch cushioning with calf-stretching exercises and night splints that stretch the calf and plantar fascia while the patient sleeps.
Prefabricated or custom-made foot orthotics may also alleviate fascial tension and symptoms. Other treatments may include activity modifications, NSAIDs, weight loss in obese patients, cold and ice
massage therapy, and occasional corticosteroid injections. However, because corticosteroid injections can predispose to plantar fasciosis, many clinicians limit these injections. For recalcitrant
cases, physical therapy, oral corticosteroids, and cast immobilization should be used before surgical intervention is considered. A newer form of treatment for recalcitrant types of plantar fasciosis
is extracorporeal pulse activation therapy (EPAT), in which low-frequency pulse waves are delivered locally using a handheld applicator. The pulsed pressure wave is a safe, noninvasive technique that
stimulates metabolism and enhances blood circulation, which helps regenerate damaged tissue and accelerate healing. EPAT is being used at major medical centers.
When more conservative methods have failed to reduce plantar fasciitis pain, your doctor may suggest extracorporeal shock wave therapy, which is used to treat chronic plantar fasciitis.
Extracorporeal shock wave therapy uses sound waves to stimulate healing, but may cause bruises, numbness, tingling, swelling, and pain. When all else fails, surgery may be recommended to detach the
plantar fascia from the heel bone. Few people need surgery to treat the condition.