Anatomy & Background
The foot possesses over 30 joints. These joints are held together by groups of connective tissues. One type of connective tissue that holds the joints of the foot together are ligaments. Ligaments are made of collagen and attach bone to bone. On the outside side of the ankle, are three major ligaments, and there are several more ligaments on the inside of the ankle joint. These ligaments extend into the foot and are crucial in defining the range of motion of the foot. Ligaments in the foot include the plantar calcaneonavicular ligament, the deltoid ligament, the long plantar ligament, and the plantar calcaneocuboid.
The plantar fascia is a thick connective tissue in the foot that runs from the heel bone to the base of the toes. The plantar fascia is located in the sole of the foot, and helps support the arch. The plantar fascia may become inflamed, causing a condition known as plantar fasciitis.
Plantar Fasciitis typically occurs when the plantar fascia becomes overstretched or overused. This condition often effects men, 40-70 years old, and is one of the common causes of foot pain.
- Underlying problems with the arch of the foot
- Obesity or a sudden weight gain
- Injuries to or tightness of the Achilles tendon
- Poor arch support in footwear
- Overuse injuries
Symptoms of Plantar Fasciitis
- Pain and stiffness on the bottom of the foot or the heel
- An aching or burning sensation on the bottom of the foot
- Pain in the morning, (especially when taking the first steps of the day)
- Difficulty with activities such as climbing stairs
- Mild swelling or redness on the bottom of the foot
Treating Plantar Fasciitis
The first line of treatment for Plantar Fasciitis is to avoid the activities and positions that cause any pain. Your pain management specialist can evaluate your foot with a physical exam. This will allow him/her to diagnose whether or not it is Plantar Fasciitis and to determine a course of treatment. This condition can often be treated by non-surgical means, however in severe cases, surgery may be needed. Surgery is normally required to release the tissue if it becomes too tight for regular interventions to be successful.
Procedures that your physician may recommend and perform may include:
- REST and ICE
- Pain medication to reduce discomfort
- NSAIDS (Non-steroidal Anti Inflammatory Drugs)
- Steroid shots or injections into the heel
- Surgery to correct underlying pathology or the cause of the Plantar Fasciitis (in extreme cases)
- Orthotic devices or special shoes
- Wearing a boot-like cast to support the foot and immobilize the injured area
- Night splints to stretch the injured tissue and allow it to heal
Most people recover full function following a course of conservative care that includes pain relief and possible physical therapy. It is important that once the pain is reduced, and range of motion and strength are restored, the patient gradually return to daily activities.
Instruction in daily activities or sports will be given by your pain management specialist, for reducing the re-occurrence of Plantar Fasciitis. Non-surgical methods are typically effective and reduce the pain associated with this condition. Treatment can take several months before symptoms improve.