Plantar fasciitis is one of the most common causes of heel pain. It is caused by inflammation of the plantar fascia, a tough, fibrous band of tissue that runs along the sole of the foot from the heel bone (calcaneus) to the base of the toes. As a result of increased activity or secondary to the normal aging process, inflammation and pain begin in the fascia and cause pain.
Pain typically begins gradually and is located along the inner aspect of the heel on the bottom of the foot. Most commonly, the pain is worse upon arising from bed in the morning, with your first few steps. The discomfort usually lessens during the course of the day or after warming up, but can worsen again after prolonged activity.
As many causes of “heel pain” exist, a detailed history and physical examination is needed to distinguish plantar fasciitis from other diagnoses. Other possible causes include nerve compression, stress fracture of the calcaneus, and loss of the fatty tissue under the heel.
Heel spurs are also often thought to be the primary cause of heel pain. In fact, heel spurs are nothing more than the heel bone's response to traction or pulling forces from the plantar fascia or other muscles in the foot. They are commonly present in patients without pain, and frequently absent from those who have pain. It is a rare occurrence that a heel spur along requires surgery.
Treatment of plantar fasciitis involves mostly conservative modalities, although it may take 6-12 weeks for symptoms to resolve. Treatment includes rest, activity modification, night splints, anti-inflammatory medications, massage and a stretching program. Sometimes in very rare, persistent cases, a cortisone injection may be considered. In extremely rare cases, surgery is indicated.
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