Plantar fasciitis (PF) is a very common cause of foot pain; in fact it is the most common cause of heel pain on the plantar surface or sole of the foot. Almost two million people seek treatment for PF each year in the United States. Originally thought to be an inflammatory condition, PF is now recognized as a degenerative process likely related to repetitive stresses at the origin of the plantar fascia on the calcaneus (heel bone). The plantar fascia is a thick inelastic band of fibrous tissue in the sole of the foot that originates on the calcaneus and inserts on each of the five toes.
Patients presenting with PF are typically between the ages of 40 and 60 years. Conditions or characteristics that predispose to the development of PF include running athletes, pes planus (flat feet), occupations that require prolonged standing, limited ankle motion and obesity. In many patients, PF affects both feet. Patients usually report pain in the heel that is most pronounced with the first few steps in the morning or with prolonged standing. Symptoms often decrease with activity. Diagnosis is usually made easily with a careful history and physical examination.
Many treatments are available for patients with PF. Anti-inflammatory medications can provide symptomatic improvement in many cases. Physical therapy or a home stretching program is often successful in treatment of PF. Various types of inserts from prefabricated heel cups to custom arch supports are used successfully for patients with PF. Night splints are helpful in relieving morning pain by keeping the plantar fascia stretched overnight. Injections of steroid usually mixed with local anesthetic can provide relief in cases refractory to other measures. Use of shock wave therapy (acoustic impulses) has been shown recently to be helpful in severe cases of PF. The majority of patients with PF respond well to conservative measures; in select severe cases not responsive to other treatments, surgery may be helpful to gain relief. To properly diagnose and treat PF, an evaluation by an orthopedic surgeon is recommended.
