Foot pain affects nearly all people at one time or another. It can also lead to other musculoskeletal problems such as ankle, knee and back pain (Hill et al., 2008). This pain negatively affects
oneâs quality of life and ability to enjoy workouts and/or maintain a regular program of exercise. One of the most common sources of foot pain is plantar fasciitis, a condition where the connective
tissue on the underside of the foot becomes irritated and painful as a result of an injury, overuse or misuse. The plantar fascia is a system of connective tissue that runs from your heel to just
behind your toes. During weightbearing activities, such as walking or running, your body weight is transferred onto your foot from your heel to your toes (which results in your toes moving away from
your heel). This spreading out of the foot places tension on the plantar fascia because it connects those two parts. If the tension on this structure is too great or is not dispersed evenly, the
plantar fascia can develop microtears and become irritated and painful, resulting in a condition called plantar fasciitis.
Plantar fasciitis is usually not the result of a single event but more commonly the result of a history of repetitive micro trauma combined with a biomechanical deficiency of the foot. Arthritic
changes and metabolic factors may also playa part in this injury but are unlikely in a young athletic population. The final cause of plantar fasciitis is "training errors." In all likelihood the
injury is the result of a combination of biomechanical deficiencies and training errors. Training errors are responsible for up to 60% of all athletic injuries (Ambrosius 1992). The most frequent
training error seen with plantar fasciitis is a rapid increase in volume (miles or time run) or intensity (pace and/or decreased recovery). Training on improper surfaces, a highly crowned road,
excessive track work in spiked shoes, plyometrics on hard runways or steep hill running, can compromise the plantar fascia past elastic limits. A final training error seen in athletics is with a
rapid return to some preconceived fitness level. Remembering what one did "last season" while forgetting the necessity of preparatory work is part of the recipe for injury. Metabolic and arthritic
changes are a less likely cause of plantar fasciitis among athletes. Bilateral foot pain may indicate a metabolic or systemic problem. The definitive diagnosis in this case is done by a professional
with blood tests and possibly x-rays.
Patients experience intense sharp pain with the first few steps in the morning or following long periods of having no weight on the foot. The pain can also be aggravated by prolonged standing or
sitting. The pain is usually experienced on the plantar surface of the foot at the anterior aspect of the heel where the plantar fascia ligament inserts into the calcaneus. It may radiate proximally
in severe cases. Some patients may limp or prefer to walk on their toes. Alternative causes of heel pain include fat pad atrophy, plantar warts and foreign body.
After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs. A high arch, an area of maximum tenderness on the bottom of your
foot, just in front of your heel bone. Pain that gets worse when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down. Limited "up" motion
of your ankle. Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in
ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not
routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.
Non Surgical Treatment
The plantar fascia is a band of tissue, much like a tendon, that starts at your heel and goes along the bottom of your foot. It attaches to each one of the bones that form the ball of your foot. The
plantar fascia works like a rubber band between the heel and the ball of your foot to form the arch of your foot. If the band is short, you'll have a high arch, and if it's long, you'll have a low
arch, what some people call flatfeet. A pad of fat in your heel covers the plantar fascia to help absorb the shock of walking. Damage to the plantar fascia can be a cause of heel pain.
Like every surgical procedure, plantar fasciitis surgery carries some risks. Because of these risks your doctor will probably advise you to continue with the conventional treatments at least 6 months
before giving you approval for surgery. Some health experts recommend home treatment as long as 12 months. If you canât work because of your heel pain, canât perform your everyday activities or
your athletic career is in danger, you may consider a plantar fasciitis surgery earlier. But keep in mind that there is no guarantee that the pain will go away completely after surgery. Surgery is
effective in many cases, however, 20 to 25 percent of patients continue to experience heel pain after having a plantar fasciitis surgery.