Plantar Fasciitis (heel pain)

What is plantar fasciitis?
Plantar fasciitis is inflammation of the main ligament on the bottom of the foot. Usually, the inflammation occurs at the attachment to the heel bone, causing heel pain. Sometimes growth of bone is noted in the area when looking at an x-ray. This is where the common term "heel spur" comes from.

Symptoms
Plantar fasciitis usually causes pain on the bottom of the heel or arch area, most notably upon arising from rest. Sometimes the pain improves with activity but usually worsens again with too much activity.

Causes
Plantar Fasciitis is one of the most common foot problems in the world. It is caused by overuse of the foot. Excessive exercise, weight gain, inherited foot abnormalities, and poor footwear are good examples of situations where the foot is "overused"

Evaluation
Listening to patients describe their pain, and physical exam findings, lead to a diagnosis of plantar fasciitis. Often x-rays are taken of the foot to rule out other conditions. Sometimes ultrasound can help evaluate the condition of the plantar fascia.

Treatment
Many treatments are available for plantar fasciitis. Most involve ways to support the foot, decrease inflammation, and promote healing of the damaged ligament. Rest is an important part of the treatment plan. Treatments include anti-inflammatory medications, cortisone injections, custom orthotic shoe inserts, stretching and icing techniques, night splint devices, walking casts, tape strappings of the foot, and physical therapy.

A special treatment has recently emerged for plantar fasciitis that is resistant to initial treatment. It is called extra corporeal shockwave therapy (ESWT). Shockwave therapy is a one-time noninvasive treatment performed under local anesthesia in an office setting. Shockwave therapy uses sound waves to stimulate healing. Success rates for shockwave therapy are high and complication rates are extremely low, since there is no cutting of the skin.

In rare cases, invasive outpatient surgery is necessary for severe plantar fasciitis. Most surgical procedures involve making a cut in the plantar fascia ligament to relieve tension on the heel.