Plantar Fasciitis

Plantar fasciitis, or foot ligament inflammation, can be painful.

The sole of the foot is referred to as the plantar area. Plantar fasciitis is a chronic local inflammation of the "bowstring-like" ligament stretching underneath the sole, also referred to as the plantar fascia, that attaches to the heel.

Plantar fasciitis is most commonly caused by repetitive strain injury to the ligament of the sole of the foot. Such strain injuries can be from excessive running or walking, inadequate footgear, and jumping injuries from landing. Plantar fasciitis can also be caused by certain diseases, including reactive arthritis and ankylosing spondylitis.

Plantar fasciitis causes pain and tenderness in the bottom of the foot. The tenderness is usually toward the heel, but the entire sole of the foot can be affected. A sign of abnormal tension or tightness that can lead to plantar fasciitis is a bony prominence (heel spur) that develops where the inflamed plantar fascia attaches to the heel bone (calcaneus).

Plantar fasciitis can make walking and running difficult. It can make the foot feel particularly stiff and sensitive in the morning or when rising after sitting or getting out of a car. Plantar fasciitis makes it difficult to walk barefoot on hard surfaces. Sometimes the bottom of the foot can feel warm, swollen, and tender.

Plantar fasciitis is diagnosed based on the history of the condition as well as the physical examination. Plantar fasciitis will have localized tenderness along the sole of the foot, most commonly at the inside arch of the heel. Usually, no further testing is necessary.

• X-ray testing can reveal an associated heel spur is present and rule out other causes of heel pain, such as fractures or tumors.
• Ultrasound imaging can also help diagnose plantar fasciitis.

Plantar fasciitis is treated by measures that decrease the associated inflammation and avoid reinjury. Local ice massage applications both reduce pain and inflammation.

• Physical therapy methods, including stretching exercises, are used to treat and prevent plantar fasciitis.
• Anti-inflammatory medications, such as ibuprofen (Advil) or cortisone injections, are often helpful.
• Sports running shoes with soft, cushioned soles can help reduce irritation of inflamed tissues from plantar fasciitis. Custom orthotic shoe inserts are used to reduce the excess motion of the foot and decrease strain on the plantar fascia.

Infrequently, surgery is performed on the chronically inflamed plantar fascia (plantar fasciosis) if conservative treatments fail. Newer treatments for these cases such as cobaltion, PRP, prolotherapy, ESWT, and micro-debridement are utilized as well.

The prognosis for plantar fasciitis is usually very good. Plantar fasciitis generally resolves with the conservative measures described above. However, in some cases, the condition can evolve into plantar fasciosis, which responds to a different set of treatments than those used for plantar fasciitis.

Plantar fasciitis can only be prevented by treating any underlying associated inflammatory disease and wearing optimal footwear, orthotic shoe inserts, and stretching.