Plantar fasciitis is an inflammation of a thick, fibrous ligament in the arch of the foot called the plantar fascia. The plantar fascia attaches into the heel bone and fans out toward the ball of the foot, attaching into the base of the toes. If this ligament is stretched excessively it will become inflamed and begin to cause pain.
It commonly is painful the first few steps in the morning or after rest. It tends to get worse the longer one stands during the day. It is caused by subtle changes in foot structure that occurs over time. These changes result in the gradual flattening of the arch. As this occurs a thick ligament (the plantar fascia) that is attached to the bottom of the heel and fans out into the ball of the foot is stretched excessively. This ligament acts as a shock absorber while walking. As the foot flattens, it stretches. If it stretches too much it gets inflamed and causes pain.
Over time, the pull of the ligament creates a spur on the heel bone. It is important to realize that it is not the spur that causes the pain and therefore the spur does not need to be removed in most cases. This condition may also cause generalized arch pain called plantar fasciitis. This is an inflammation of the plantar fascial ligament.
A common factor that contributes to this condition is tightness of the calf muscles. Women who wear high heels and people who walk for exercise will often develop this problem because of the tightness that results in the calf muscle as a result of these activities. A non-supportive shoe also contributes to this problem. Weight gain is another factor in developing heel pain.
In severe instances the ligament can rupture, resulting in immediate severe pain. If the ligament ruptures, the pain is so great that the patient can not place weight on the foot. Should this happen, the foot should be elevated and an ice pack applied. An appointment with your foot doctor should be made at your earliest convenience. Sports such as tennis, racketball, and aerobics can cause extreme tension on the plantar fascia resulting in small tears or rupture of the ligament. However, other less stressful activities can result in tears or rupture of the plantar fascia under the right set of circumstances. (For a more through discussion of the cause of plantar fasciitis see heel pain) One consequence of small tears in the plantar fascia is the formation of firm nodules within the plantar fascia, called fibromas.
Plantar Fasciitis Diagnosis and Treatment
Taking a through history of the course of the condition and physical exam makes the diagnosis of plantar fasciitis. Treatment of plantar fasciitis is similar to that for heel pain. Cortisone injections may be used for the treatment of plantar fasciitis. The main emphasis of treatment is to reduce the forces that are causing the plantar fascia to stretch excessively. This includes calf muscle stretching, night splints, over-the-counter arch supports, and orthotics.