Plantar Fasciitis

Heel pain affects over 2 million Americans each year and can be responsible for mild discomfort or even debilitating pain.

The two most common causes of pain in the bottom of the heel, the arch, or both the heel and the arch, are plantar fasciitis and heel spurs.

Plantar fasciitis is an inflammation of the plantar fascia. The plantar fascia is a thick ligamentous/fibrous band on the bottom of the foot that is attached to the heel, and runs forward to insert into the ball of the foot. Plantar fasciitis is a painful inflammation of this band, which usually occurs at its attachment to the heel; however, the inflammation and pain of plantar fasciitis can occur anywhere on the plantar fascia.

A Heel Spur is a piece of calcium or bone that sticks out from the bottom of the heel bone, and lies within the fibers of the plantar fascia. When walking, the spur may apply undue pressure to the plantar fascia. This produces inflammation and pain in the heel, which at times may radiate into the arch

Plantar fasciitis and heel spur pain usually begins in the bottom of the heel, and frequently radiates into the arch. At times, however, the pain may be felt only in the arch. The pain is most intense when first standing, after any period of rest. Most people with this problem experience their greatest pain in the morning, with the first few steps after sleeping. After several minutes of walking, the pain usually becomes less intense and may disappear completely, only to return later with prolonged walking or standing. If a nerve is irritated due to the swollen plantar fascia, this pain may radiate into the ankle.

In the early stages of Plantar Fasciitis and Heel Spurs, the pain will usually subside quickly with getting off of the foot and resting. As the disease progresses, it may take longer periods of time for the pain to subside.

Each time we take a step forward, all of our body weight first rests on the heel of one foot. As our weight moves forward, the entire foot begins to bear the body’s weight, and the foot flattens and this places a great deal of pressure and strain on the plantar fascia. There is very little elasticity to the plantar fascia, so as it stretches only slightly; it pulls on its attachment to the heel. If the foot is properly aligned this pull causes no problems. However, if the foot is "pronated"(the foot rolls outward at the ankle, causing a break down of the inner side of the shoe), the arch falls excessively, and this causes an abnormal stretching of the relatively inflexible plantar fascia, which in turn pulls abnormally hard on the heel.

The same pathology occurs with "supination" (the rolling inward of the foot, causing a break down of the outer side of the shoe). Supinated feet are relatively in flexible; usually have a high arch, and a short or tight plantar fascia. Thus as weight is transferred from the heel to the remainder of the foot, the tight plantar fascia hardly stretches at all, and pulls with great force on its attachment to the heel.

In both cases, the abnormal stress placed on the attachment of the plantar fascia to the heel usually causes pain, inflammation, and possibly swelling. If this process continues, the plantar fascia partially tears away from the heel. The body will fill in this torn area with calcium; eventually it becomes bone, and a heel spur results.

We can think of the longitudinal arch as a shock absorber with body weight and gravity applying downward pressure on the foot or more specifically on the arch. The ground applying plantar pressure causing stress on the fascia bands. When this procedure is repeated daily, it is sometimes thought that an adventitious bursa forms around the area of origination of the fascia at the heel bone. This mechanism is a protective bursa. The pain on the first weight bearing explains this concept of distention of the bursa when non-weight bearing and compression of the bursa on first weight bearing. This theory could explain the first weight bearing pain and relief upon ambulation.

Predisposing Factors: Those factors that increase your chances of developing Plantar Fasciitis and Heel Spurs are:

Custom-made orthotics are one of the most effective conservative treatments for Plantar Fasciitis and Heel Spurs. This has been the treatment of choice for many people suffering with this condition and has proven to be highly effective.

How Custom-Made Orthotics Work: Our custom-made orthotics for Plantar Fasciitis and Heel Spurs are constructed of thin, comfortable, shock-absorbent materials which gently and effectively:

When these things are achieved, the inflammation and pain of Plantar Fasciitis and Heel Spurs will gradually subside. Custom-made orthotics is also very effective in preventing recurrences of these painful problems.

Our Custom-Made Orthotics for Plantar Fasciitis and Heel Spurs are constructed from the impressions of your feet that you make with our Foam Impression Kit. Using these impressions and the information you provide us, we design and construct a pair of orthotics that will help to stabilize your feet, reduce pronation or supination, reduce the abnormal pull on your Plantar Fascia, cushion the heel, and help to alleviate your foot pain. These orthotics will fit in most shoes with a heel height up to 1 1/2 inches.

Ovation Night Splint

While custom-made orthotics provides treatment for Plantar Fasciitis and Heel Spurs during the day, The Ovation Night Splint helps to treat these problems while we sleep. This uniquely comfortable and effective night splint stretches the Plantar Fascia while sleeping. Plantar Fasciitis and Heel Spur pain are usually worse with the first steps in the morning. This is due to the Plantar Fascia tightening up, or contracting while we sleep. To prevent these pain producing contractures of the plantar fascia, the foot must be held in its normal or neutral position while we sleep. This optimal position of the foot is maintained with our comfortable and supportive Night Splint. When foot contractures are prevented during sleep, the "first step pains" of Plantar Fasciitis and Heel Spurs will gradually subside.

The following self-help treatments have been found to be most effective when used in conjunction with our Custom-Made Orthotics or other helpful products:

Stretching Aid: StretchRite makes it easy to stretch the foot and plantar fascia.

If you are unsure of the nature of your foot problem, if your pain is intense and does not subside, if you are a diabetic or have other medical problems, if your pain is due to an injury, if an open sore is present, if a mass can be felt, or if you think that you may have an infection, we suggest that before beginning any of the above treatments you consult with your doctor.

If conservative treatments fail, and the symptoms of plantar fasciitis have not been relieved, your podiatrist near me may recommend one of the following treatments:

Injections of Corticosteroids (Cortisone Injections): Cortisone, or corticosteroids, is medications that reduce inflammation. Cortisone is usually mixed with local anesthetics and injected into the plantar fascia where it attaches to the heel bone. In many cases this reduces the inflammation present and allows the plantar fascia to begin healing. Local injections of corticosteroids may provide temporary or permanent relief. Recurrence of symptoms may be lessened by combining steroid injections with other forms of treatment such as orthotics, changes in shoe gear, weight loss, stretching exercises, and rest. Repeated cortisone injections may result in rupture of the plantar fascia, thinning of the heel’s fat pad, and other tissue changes.

Extracorporeal Shockwave Therapy (ESWT): Extracorporeal Shock Wave Therapy (ESWT) devices generate pulses of high-pressure sound that travel through the skin. For reasons that are not fully understood, soft tissue and bone that are subjected to these pulses of high-pressure energy heal back stronger. There is both a high-energy and low-energy form of ESWT; and both forms of shock wave therapy can be used in the treatment of plantar fasciitis. Research studies indicate ESWT is a safe and effective treatment option for plantar fasciitis. The recovery period is shorter than traditional invasive surgery and the procedure eliminates many of the risks associated with traditional surgery.

Surgery: Most studies indicate that 95% of those afflicted with plantar fasciitis are able to relieve their heel pain with nonsurgical treatments. If you are one of the few people whose symptoms don’t improve with other treatments, your doctor may recommend plantar fascia release surgery. Plantar fascia release involves cutting part of the plantar fascia ligament in order to release the tension and relieve the inflammation of the ligament. Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. While the success rate is very high following surgery, one should be aware that there is often a prolonged postoperative period of discomfort similar to the discomfort experienced prior to surgery. This pain usually will abate within 2-3 months. One should always be sure to understand all the risks associated with any surgery they are considering.