Orthopaedic Procedures | Plantar Fasciitis

This condition causes pain on the bottom of the heel when putting weight on the foot. The plantar fascia is a structure that runs from the front of the heel bone (calcaneus) to the ball of the foot. This dense strip of tissue helps to support the longitudinal arch of the foot like a tie beam.

 

When the foot is on the ground a tremendous amount of force is concentrated on the plantar fascia. This can lead to stress on the plantar fascia where it attaches to the calcaneus.

 

The chronic inflammation of the fascia itself may be the source of pain in many cases. If the forces along the plantar fascia are great and the fat pad on the heel is thin, the actual heel bone can break. If it occurs on a microscopic level, this is called a stress fracture.

 

In many cases, the actual source of the painful heel will never be clearly defined without doubt.

 

The heel is usually most painful when first few steps are taken in the morning. It can also be painful to stand and walk. Other patients will complain of pain when standing after a brief rest of sitting.


There are several conditions that can cause heel pain and plantar fasciitis must be distinguished from these conditions. An x-ray is usually not needed. Laboratory investigation occasionally may be necessary in some cases to rule out a systemic illness causing the heel pain, such as rheumatoid arthritis, Reiter's syndrome, or ankylosing spondylitis.

 

The treatment of heel pain/plantar fasciitis usually begins with adjustments to the shoes to try and reduce symptoms.

 

Soft heel cups, and insoles can be helpful to support the arch. Anti-inflammatory medications are sometimes used to decrease the inflammation in the fascia and reduce pain. An injection of cortisone onto the most tender area of the fascia is effective.


Surgery is rarely done as the results are not that good. However this is a self limiting condition that can last for several years.