Plantar Fasciitis

 Plantar fasciitis is irritation and swelling of the thick tissue on the bottom of the foot. Reference from A.D.A.M.

Causes

The plantar fascia is a very thick band of tissue that covers the bones on the bottom of the foot. This fascia can become inflamed and painful in some people, making walking more difficult. Risk factors for plantar fasciitis include:

• Foot arch problems (both flat foot and high arches)
• Obesity
• Running
• Sudden weight gain
• Tight Achilles tendon (the tendon connecting the calf muscles to the heel)

A typical patient is an active man age 40-70. This condition is one of the most common orthopedic complaints relating to the foot. Plantar fasciitis is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On x-ray, heel spurs are seen in people with and without plantar fasciitis.

Symptoms

The most common complaint is pain in the bottom of the heel, usually worst in the morning and improving throughout the day. By the end of the day the pain may be replaced by a dull aching that improves with rest.

Exams and Tests

Typical physical exam findings include:

• Mild swelling
• Redness
• Tenderness on the bottom of the heel

X-rays may be taken to rule out other problems, but having a heel spur is not significant.

Treatment

Conservative treatment is almost always successful, given enough time. Treatment can last from several months to 2 years before symptoms get better. Most patients will be better in 9 months. Initial treatment usually consists of:

• Anti-inflammatory medications
• Heel stretching exercises
• Night splints
• Shoe inserts

If these fail, putting the affected foot in a short leg cast (a cast up to but not above the knee) for 3-6 weeks is very often successful in reducing pain and inflammation. Alternatively, a cast boot (which looks like a ski boot) may be used. It is still worn full time, but can be removed for bathing. Some physicians will offer steroid injections, which can provide lasting relief in many people. However, this injection is very painful and not for everyone. In a few patients, non-surgical treatment fails and surgery to release the tight, inflamed fascia becomes necessary.

Prognosis

Nearly all patients will improve within 1 year of beginning non-surgical therapy, with no long-term problems. In the few patients requiring surgery, most have relief of their heel pain.

Possible Complications

Complications with surgery include:

• Infection
• Nerve injury
• No improvement in pain
• Rupture of the plantar fascia

With other treatments, a complication is continued pain. A.D.A.M. Copyright The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited. To obtain full text: http://health.nytimes.com/health/guides/disease/plantar-fasciitis/overview.html