Plantar Fasciitis

Plantar Fasciitis is one of the most common conditions seen in a Podiatric office.  If affects all ages, from the young to the very old.  It has been seen increasingly as our society strives to become more healthy.  It is a by-product of our exercise programs, which focus more on strengthening than flexibility.  It is caused by the straining of the plantar fascia, due to excessive pronation caused by tight calf muscles.  Excessive pronation is the rotational flattening of the foot.  The major cause of this flattening is the calf muscles, specifically the gastroc muscles.  The gastroc muscles become increasingly tightened as we do our daily activities:  walking, running, golf, tennis, etc.  As we do these activities, we forget the need for flexibility and no longer do stretching exercises.  Over the long haul, the gastrocs shorten, gaining mechanical advantage over the function of the feet.
Symptoms are:  pain and swelling at the bottom heel or arch area that is worse after sitting or resting for a period.  The worst pain is usually experienced in the morning upon awakening.  Pain eases after ten to fifteen minutes, as the plantar fascia stretches.  This condition can be chronic, being painful for several weeks to several months.  This condition is very treatable with conservative care.  Surgery is rarely an option.  Conservative care includes a combination approach of supportive measures for the plantar fascia, which may be taping or arch supports, anti-inflammatories, either orally or by injection and physical therapy.  Physical therapy has to include stretching of the gastroc muscles, thereby addressing the cause of the condition, not just the symptom.  Adjunctive therapy may include night splints, heel cushions, ice, slant boards and non-weight casting.  Resistant cases can be treated by shock wave therapy or surgery  These surgeries should not be contemplated unless you have had one year of failed conservative care.  X-ray findings may include a plantar heel spur, but the spur is a sign of the problem, not the cause.
Historically, it was believed that the spur was the cause of the problem and surgery was performed to remove the spur.  As a result of the surgery, the plantar fascia was cut, thereby releasing the strain on the plantar fascia and resolving the symptoms.  It has since been found that the spur is not an intrical part of the problem and by stretching the gastroc muscles, while supporting the plantar fascia, the symptoms are relieved.