Plantar fasciitis is an extremely common cause of foot pain and is encountered regularly in the clinic. This extremely painful condition affects athletes, particularly runners and dancers. It also affects workers who spend much of their day on their feet.
Characteristically, patients will complain of pain at their heel and will point to a spot directly under the sole of the foot near the heel (calcaneus). This corresponds to the origin of the plantar fascia. The fascia becomes thickened in a process similar to that of tendonosis that may affect a tendon. The pain is often felt worse first thing in the morning on initially putting your foot to the floor as the plantar fascia is forced to stretch out. The plantar fascia, a thick band of fibrous tissue that functions to support the sole of the foot, tightens up at night as you sleep and is extremely painful on attempting to stretch out the next morning. Similarly, if the patient sits for a period they will experience sharp pain on getting up to walk again. Plantar fasciitis sufferers may or may not develop associated heel spurs. In bad cases of the condition sufferers may also develop pain extending further along the plantar fascia towards the toes.
Diagnosis of the condition is easily made based on clinical history and examination of the patient. Xray may indicate the presence of associated heel spurs but is not normally necessary since it normally doesn’t alter the treatment.
Initially treatment should focus on avoiding aggravating activities, stretching of the plantar fascia and calf muscles, taping and biomechanical assessment may also be necessary to identify and correct predisposing factors in the development of the condition. Various self massage and stretching techniques for the plantar fascia may be taught. Occasionally, it’s necessary to have custom orthotic insoles fitted to correct underlying causes of the condition.
Should management of plantar fasciitis along these lines not produce a satisfactory outcome, corticosteroid injection may be considered.