PLANTAR FASCIITIS
The plantar fascia is a thick, broad, inelastic band of fibrous tissue that courses along the bottom (plantar surface)
of the foot. It is attached to the heel bone (calcaneus) and
fans out to attach to the bottom of the metatarsal bones in the
region of the ball of the foot. Because the normal foot has
an arch, this tight band of tissue (plantar fascia) is at the
base of the arch. In this position, the plantar fascia acts like
a bowstring to maintain the arch of the foot.
Plantar fasciitis refers to an inflammation of the
plantar fascia. The inflammation in the tissue is the result
of some type of injury to the plantar fascia. Typically, plantar
fasciitis results from repeated trauma to the tissue where it
attaches to the calcaneus. 
This repeated trauma often results
in microscopic tearing of the plantar fascia at or near the point
of attachment of the tissue to the calcaneus. The result of the
damage and inflammation is pain. If there is significant injury to the plantar fascia,
the inflammatory reaction of the heel bone may produce spike-like
projections of new bone called heel spurs. The spurs are not the
cause of the initial pain of plantar fasciitis, they are the result
of the problem. Most heel spurs are painless. Occasionally,
they are associated with pain and discomfort and require medical
treatment or even surgical removal Plantar fasciitis (heel-spur syndrome) is a common
problem among people active in sports, especially runners. It
typically starts as a dull, intermittent pain in the heel and
may progress to sharp, constant pain. Often, it is usually worse
in the morning or after sitting, and then decreases as the patient
begins to walk around. In addition, the pain usually increases
after standing or walking for long periods of time, and at the
beginning of a sporting activity. Often people who develop plantar fasciitis have several
risk factors for doing so. They include:
Fortunately, the majority of cases of plantar fasciitis
respond favorably to non-operative treatment. However, the recovery
time varies tremendously from patient to patient. While some
patients may be healed after 6 weeks of treatment, others may
require 6 months or longer for recovery. In addition, the methods
of treatment that may work for one patient, may not be successful
in another patient. Typically, the methods of treatment that
are attempted include anti-inflammatory mediation, icing, stretching,
activity modification, and heel inserts. 
In addition, it is necessary to avoid the activities that are known to
aggravate the fasciitis. This includes any activity that involves repeated impact of the heel on a hard surface, such as running. Sometimes, cortisone injections are necessary to achieve satisfactory healing. If the pain persists, it may be necessary to run
additional diagnostic studies to rule other, less common, causes
of heel pain such as stress fractures, nerve compression injuries,
or collagen disorders of the skin. Rarely, surgical treatment is necessary. However,
when the nonsurgical treatments have been tried and they have
failed, surgery may be indicated for the relief of heel pain.
Most of these surgical procedures can be completed on an outpatient
basis in less than one hour. The surgery can be accomplished
under local anesthesia or minimal sedation administrated by a
trained anesthesiologist.
Surgical treatment options include:
Immediately after either operation, a cast may or
may not be used to support and immobilize the foot for two or
three weeks. Crutches may be helpful for greater comfort and
mobility while the foot heals.
When the cast has been removed, three to four weeks
of physical therapy will speed healing and reduce swelling.
To Make An Appointment:
THIS MATERIAL DOES NOT CONSTITUTE MEDICAL ADVICE. IT IS INTENDED FOR INFORMATIONAL PURPOSES ONLY. PLEASE CONSULT A PHYSICIAN FOR SPECIFIC TREATMENT RECOMMENDATIONS.
THE CENTER FOR ORTHOPAEDICS AND SPORTS MEDICINE
1211 JOHNSON FERRY RD.; MARIETTA, GA., 30068
770-565-0011
http://www.arthroscopy.com
