The plantar fascia is a thickened fibrous aponeurosis that originates from the medial tubercle of the calcaneus, runs forward to insert into the deep, short transverse ligaments of the metatarsal
heads, dividing into 5 digital bands at the metatarsophalangeal joints and continuing forward to form the fibrous flexor sheathes on the plantar aspect of the toes. Small plantar nerves are invested
in and around the plantar fascia, acting to register and mediate pain.
The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more
prone to developing plantar fasciitis. Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly
evident when oneâs job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.
The pain associated with plantar fasciitis is typically gradual in onset and is usually located over the inner or medial aspect of the heel. Occasionally, the pain will be sudden in onset, occurring
after missing a step or after jumping from a height. The pain is commonly most severe upon arising from bed in the morning, or after periods of inactivity during the day. Thus, it causes what is
known as "first-step pain." The degree of discomfort can sometimes lessen with activity during the course of the day or after "warming-up", but can become worse if prolonged or vigorous activity is
undertaken. The pain is also often noted to be more severe in bare feet or in shoes with minimal or no padding at the sole.
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
Stabilize the foot by using uniquely placed wedges, deep heel cups, and "posts" (stabilizers). When the foot is stabilized, it is brought back to a neutral or normal alignment. When the foot is in
its normal alignment, pronation and supination are reduced or completely corrected, and the abnormal pull on the Plantar Fascia is alleviated. This will allow the Plantar Fascia to begin to heal.
When healing occurs, the pain and inflammation gradually subside. Provide the specific amount of arch support that your foot requires. Our custom-made orthotics support not only the arch as a whole,
but each individual bone and joint that forms the arch. Whether your arch is flat or abnormally high, our custom-made orthotics will provide the support that you need. When the arch is properly
supported, the Plantar Fascia is protected and healing can begin. Aid in shock absorption. The primary shock absorbers of our feet, and therefore our body, are the Plantar Fascia and the arch. To aid
these structures, we construct our custom-made orthotics so that they provide semi-flexible support to the arch by "giving" to absorb the shock of each step, rather than our foot absorbing the shock
(our orthotics act in the same way a shock absorber does on an automobile). When your weight is removed from the orthotic, the arch returns to its original height since the material we use has a
built-in "memory." This action will help to keep the Plantar Fascia and arch healthy and pain free. Cushion the heel. Our custom-made orthotics use thin, cushiony, durable, materials to cushion and
protect the heel. This helps to alleviate painful heels.
In cases that do not respond to any conservative treatment, surgical release of the plantar fascia may be considered. Plantar fasciotomy may be performed using open, endoscopic or radiofrequency
lesioning techniques. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. Potential risk factors include flattening of the longitudinal arch and heel
hypoesthesia as well as the potential complications associated with rupture of the plantar fascia and complications related to anesthesia.
There are certain things that you can do to try to prevent plantar fasciitis, especially if you have had it before. These include regularly changing training shoes used for running or walking.
Wearing shoes with good cushioning in the heels and good arch support. Losing weight if you are overweight. Regularly stretching the plantar fascia and Achilles tendon, especially before exercise.
Avoiding exercising on hard surfaces.