Plantar fasciitis is the most common cause of foot and heel pain.  Plantar (not planter – people often mistake the spelling) means the “bottom of the foot” and “itis” means inflammation, so fasciitis means “inflammation of fascia”.  The plantar fascia is the tough, fibrous arch part of the foot that provides strength, structure and support for the bottom of the foot.  

The point where the fascia attaches to the heel bone (calcaneus) is under the most stress when we walk and run; constantly being pulled on and stressed with each step we take causing microscopic tears every day. Our bodies are amazing healing machines and normally the body responds to the everyday stresses by healing these microtears.  If the stress is built up over a gradual enough timeframe, the body will not only heal the fascia, but will also strengthen it so it can withstand the increasing demands.   

However, if you have an injury or you do ‘too much too fast” and overstress the area, then the fascia and the fascial attachment breaks down faster than the body can heal itself.  This results in ongoing (chronic) pain, inflammation and degeneration/break down.  Prolonged standing starts to become more and more painful, eventually leading to pain with every step and often even pain at rest.

Plantar fasciitis is very common in people who stress their feet a lot.  Who is at risk?  Athletes, workers who are their feet all day and/or work on hard surfaces, overweight/obese people, and people who wear ill fitting/non-supportive shoes.   It is also more common as we age being most common between the ages of 40 and 60, but can effect all age categories.  It can be associated with both pes planus (flat feet) and pes cavus (high arches).

Common Symptoms of Plantar Fasciitis

During an orthopedic exam, the most patients will feel pain directly to touch at the plantar fascia insertion site on the calcaneus.  There can be tenderness along all or parts of the “arch”/plantar fascia.  There may also be swelling, but if there is, it is usually subtle.   

Patients with heel pain, often complain of “having a heel spur.” An x-ray may or may not show a heel spur.   A heel spur is a calcium deposit that forms at the insertion site of the plantar fascia on the calcaneus.  This is a result of chronic traction (pulling) stress of the arch attachment on the bone which responds by forming new bone/calcification.  

A heel spur will appear on an X-Ray for about 50% of patients with heel pain/plantar fasciitis.  The actual presence of a heel spur on the x-rays does not necessarily mean the it is the cause of the problem. Rather the heel spur is more the result of the problem.

When all else fails, there are surgical treatments for plantar fasciitis.  Dr. Pietropaoli uses a minimally invasive technique called The Arthrocare Topaz Microtenotomy System as an effective treatment option plantar fasciitis.  In addition, he also uses open surgical techniques such as partial and even complete release of the attachment of the plantar fascia.   

Both PRP and surgical treatments require a mandatory period of rest and physical therapy in order to be successful.  The surgical treatment is not as predictable as other types of surgery like knee arthroscopy for a torn meniscus cartilage or a carpal tunnel release, but as a last resort, definitely has a place in the treatment for plantar fasciitis.  It will usually take, on average, 6-8 weeks to get back to “full duty” type activities, but it can sometimes take 3-6 months depending on what needs to be done.