Symptoms of plantar fasciitis include intense heel pain in the morning with first steps after getting out of bed, and pain after periods of rest, known as post static dyskinesia.  Many patients will say this pain feels as if a needle is being driven into the heel, and in most cases the pain will decrease or improve with prolonged movement as the plantar fascia is stretched. As the condition progresses, however, these symptoms may not abate, even after prolonged walking or periods of activity. 

Related problems with plantar fasciitis include the obvious inability of the patient to perform normal daily activities, along with more severe problems such as plantar heel bursitis and formation of a heel spur.  The dreaded plantar heel spur is formed by the constant pull of the plantar fascia on the medial tubercle of the calcaneus. This constant pull will, over time, pull bone away from the calcaneus, forming these plantar spurs, which are evident on later radiographs.  Even though the findings of heel spur on radiographs may indicate progression of the condition, these spurs are NOT the cause of the pain in most cases.   As we now know, in most cases the pain is caused by inflammation in the area produced by overuse of the band.

Treatment options for plantar fasciitis include conservative treatment such as icing, stretching and anti-inflammatories, and surgical treatment such as plantar fascia release.  Conservative treatment is attempted first and is very successful in most cases, with statistics showing that 80 to 90 percent of patients will get relief with conservative treatment.  Conservative treatment consists of icing the area involved, as well as oral and local anti-inflammatories, such as corticosteroid injections to the area, in addition to simple at-home stretching exercises to help reduce inflammation at the insertion. It is important to note that the use of corticosteroids in the diabetic population have to be done carefully, as they may alter blood glucose levels, especially in the oral form, such as Medrol dose pack, while not as much with the injectable form. Another important component is the use of inserts, OTC or custom, which adjusts the motion of the foot during gait to prevent further pressure or stretching of the plantar fascia at its insertion on the calcaneus. Since this is an overuse injury, weight will also contribute; carrying a few pounds of excess weight, multiplied by the average 10,000 steps per day an average person takes, will greatly increase the overuse to this structure.

Surgical treatment consists of the release of the plantar fascia at its insertion at the medial calcaneal tubercle to prevent further pulling and inflammation, thus eliminating pain. This can be accomplished via an instep plantar fasciotomy.

Plantar fasciitis is one of the most common conditions seen in a podiatric practice. The vast majority of patients will be successfully treated with conservative therapy.  It is important to reduce the chance of recurrence by avoiding overuse of the structure, which is commonly seen with obesity, as excess weight will add strain/pull to the fascia at its insertion. Thus it is important to discuss the sensitive subject of obesity and weight loss with patients.  The patient needs to take a more proactive approach in the treatment plan, not only by avoiding excess weight but also by wearing proper shoe gear, the use of inserts, daily icing and stretching.

Dr. MacEvoy practices at Wolf River Family Footcare in Bartlett and Millington.  He graduated from the Ohio College of Podiatric Medicine in Cleveland and completed a three-year podiatric surgery residency at the Wade Park VA Medical Center in Cleveland.  

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