The job of the plantar fascia is to aid the footâs bone structure to absorb shock that happens during your gait (walking pattern). Even though it goes against common perception you can have a
high-arch foot and get plantar fasciitis as well as the more common low-arch foot posture associated with PF - tightness doesnât discriminate! The plantar fascia is involved in stabilizing your
foot not only at heel strike, when most people experience pain, but also right through until the foot leaves the ground after the stress has moved from the back of the foot to the big and lesser toes
as you âpush offâ - all this increases the stress on the plantar fascia and not just at the point where it is attached to the heel bone. What most people, even medical professionals, donât
realise is that is has been happening for a long time before it becomes evident (you only notice it when your heel starts to hurt when you stand and move).
Identified risk factors for plantar fasciitis include excessive running, standing on hard surfaces for prolonged periods of time, high arches of the feet, the presence of a leg length inequality, and
flat feet. The tendency of flat feet to excessively roll inward during walking or running makes them more susceptible to plantar fasciitis. Obesity is seen in 70% of individuals who present with
plantar fasciitis and is an independent risk factor. Studies have suggested a strong association exists between an increased body mass index and the development of plantar fasciitis. Achilles tendon
tightness and inappropriate footwear have also been identified as significant risk factors.
The most common symptom is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn. The pain is often worse in the morning when
you take your first steps, after standing or sitting for awhile, when climbing stairs, after intense activity. The pain may develop slowly over time, or come on suddenly after intense activity.
Plantar fasciitis is usually diagnosed by your physiotherapist or sports doctor based on your symptoms, history and clinical examination. After confirming your plantar fasciitis they will investigate
WHY you are likely to be predisposed to plantar fasciitis and develop a treatment plan to decrease your chance of future bouts. X-rays may show calcification within the plantar fascia or at its
insertion into the calcaneus, which is known as a calcaneal or heel spur. Ultrasound scans and MRI are used to identify any plantar fasciitis tears, inflammation or calcification. Pathology tests
(including screening for HLA B27 antigen) may identify spondyloarthritis, which can cause symptoms similar to plantar fasciitis.
Non Surgical Treatment
About 90% of plantar fasciitis cases are self-limited and will improve within six months with conservative treatment and within a year regardless of treatment. Many treatments have been proposed for
the treatment of plantar fasciitis. First-line conservative approaches include rest, heat, ice, calf-strengthening exercises, techniques to stretch the calf muscles, achilles tendon, and plantar
fascia, weight reduction in the overweight or obese, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. NSAIDs are commonly used to treat plantar fasciitis, but fail to
resolve the pain in 20% of people. Extracorporeal shockwave therapy (ESWT) is an effective treatment modality for plantar fasciitis pain unresponsive to conservative nonsurgical measures for at least
three months. Corticosteroid injections are sometimes used for cases of plantar fasciitis refractory to more conservative measures. The injections may be an effective modality for short-term pain
relief up to one month, but studies failed to show effective pain relief after three months. Notable risks of corticosteroid injections for plantar fasciitis include plantar fascia rupture, skin
infection, nerve or muscle injury, or atrophy of the plantar fat pad. Custom orthotic devices have been demonstrated as an effective method to reduce plantar fasciitis pain for up to 12 weeks. Night
splints for 1-3 months are used to relieve plantar fasciitis pain that has persisted for six months. The night splints are designed to position and maintain the ankle in a neutral position thereby
passively stretching the calf and plantar fascia overnight during sleep. Other treatment approaches may include supportive footwear, arch taping, and physical therapy.
Surgery is rarely needed in the treatment of plantar fasciitis. The vast majority of patients diagnosed with plantar fasciitis will recover given ample time. With some basic treatment steps, well
over 90% of patients will achieve full recovery from symptoms of plantar fasciitis within one year of the onset of treatment. Simple treatments include anti-inflammatory medication, shoe inserts, and
stretching exercises. In patients where a good effort with these treatments fails to provide adequate relief, some more aggressive treatments may be attempted. These include cortisone injections or
extracorporeal shock wave treatments.