Although this is the classic description of plantar fasciitis, it is not the only presentation of this condition. Some individuals will only experience pain in their heel when they run, walk or hike. Others will only experience pain in the arch after long periods of standing. Many people will complain only of pain in their heels at the end of a long workday. Classic descriptive terms for plantar fasciitis include stone bruise, sharp dagger, deep throbbing and dull ache. These all represent plantar fasciitis type pain. Another name for this condition is “heel spur syndrome.”

What is plantar fasciitis? Plantar fasciitis is the inflammation of the fascia, a long ligament type structure in the bottom of the foot. This is a result of small microtears in the fascia. A spur can develop as a result the traction force from the fascia, but the heel spur is rarely the cause of pain. In the image to the right the plantar fascia is shown. There are three parts to the plantar fascia, the medial band, the central band and the lateral band, all seen here in the plantar fascia diagram.

In the X-rays shown here, heel spurs are seen on the bottom of the heel bones. The heel spur on the X-ray on the left is quite large, but this individual has never experienced any heel pain. The existence of a heel spur on the bottom of the foot does not necessarily mean the individual will experience heel pain. Many individuals with heel pain and plantar fasciitis, will not have a heel spur. The heel spur does not cause the heel pain.

Why does plantar fasciitis happen?
Most people have abnormal motion in their feet, usually pronation. When the feet turn in and collapse, the fascia takes on an extra stress at the heel. It only takes a small change in activity or change in shoes to cause microscopic tears in the plantar fascia. A change in activity could be running more on hills or starting the soccer season. But, it commonly occurs when walking in a pair of poor quality shoes, such as flimsy sandals or an old pair of gardening shoes. Even working at a new job on your feet or on a new type of surface in a new type of shoe can easily contribute to the development of microscopic tearing in the plantar fascia. Plantar fasciitis is not something that develops after working on your feet for years. In fact, someone working at a desk job for 25 years who switches to a job on their feet is much more likely to develop the problem.

Once the fascia is weakened, it tears more and then it becomes more inflamed, and then tears more. The constant weight of the body on the feet puts a tremendous force load through the feet. Think of how many steps you take throughout the day on your feet. Think of how many steps you take on your feet in the morning before you leave for work. Each step is on an injured foot. When the foot is injured, the injury becomes worse with each step. A vicious cycle develops. This makes the condition very difficult to treat. As the heel pain progresses, the inflammation dissappears, the plantar fascia thickens and starts to degenerate (deteriorate). Many would like to term this condition plantar fasciosis for this reason.

How Is Plantar Fasciitis Diagnosed
The history is the most important tool for diagnosis of plantar fasciitis. On exam, the patient usually has pain with palpation (pressure) at the inside of the heel, and sometimes along the inside of the arch. These two points are the portions of the fascia under the greatest stress, and these areas have the most pain because they have the most inflammation (swelling at a small level).

X-rays are generally (but not always) taken to rule out other conditions. Some of these conditions are stress fractures, bone tumors (usually benign) and fractures of the heel spur. Although these are usually not common, they do need to be ruled out. Also, the X-ray will allow the doctor to better assess the position of the foot. The X-rays should be taken while standing. Ultrasound is becomming a more popular diagostic tool to evaluate the thickness of the fascial band. An MRI is only sometimes indicated for this condition. In most cases, an MRI is only needed to rule out other conditions, but can be used to evaluate the level of inflammation or the thickness of the fascial band.

What You Can Do For Plantar Fasciitis
The treatments for plantar fasciitis are usually conservative. The following are the most important treatments you can do:

1. Decrease your activity.
   Stop running, jogging or walking for exercise. Try biking or swimming. Avoid hills and minimize walking up and down stairs. Try not to carry any heavy items. More about decreasing activity. Ideas for athletes.
   
   
2. Ice massage your arch and heel.
   

   Fill a sports water bottle with water and when frozen, place on the floor and roll your foot over it for 15 minutes at least twice a day. This will ice massage the arch, decreasing inflammation along the plantar fascia. Another option is to ice directly on the heel with an ice pack for 15 minutes, two to three times a day. The more icing the better. Icing 10+ times a day in the initial stages of plantar fasciitis will accelerate healing.

   
   
3. Stretch! Stretch! Stretch!
   

   This is one of the most important treatments. Try to stretch your calf and bottom of your foot multiple times throughout the day. Stretch your calf BEFORE you get out of bed in the morning. Take a stretch band, belt or towel and place it around the ball of your foot and pull towards you with your leg extended. Stretch for a few minutes every hour throughout the day. More information on stretching.

   
   
4. Take anti-inflammatories/NSAIDS.
   NSAIDS stands for non-steroidal anti-inflammatory medications, for example ibuprofen. This is not a mandatory step. Many individuals will improve without taking any anti-inflammatory medication. DON’T TAKE IF YOU HAVE A STOMACH ULCER. It's important to realize that anti-inflammatory medications can mask the pain. If you take anti-inflammatory medications (over the counter or prescribed by your doctor) and do not make any other changes and do not try any other treatments, you will most likely get worse. It is also important to note that most cases of plantar fasciitis only are inflammatory during the first few months after the development of heel pain. The condition then gradually progresses to deterioration of the plantar fascia, hence the term plantar fasciosis. At this point, the condition won't respond to anti-inflammatory medications.
   
   
5. Try heel lifts or heel cups.
   

   In combination with the other therapies mentioned above, heel cups and heel lifts can be beneficial. Heel lifts take pressure off of the arch, the fascia and the calf. Heel cups help to cushion the heel and provide shock absorption to limit the impact on a painful heel. Try at least a ¼ inch heel lift. Any type will work, but foam seems to be the most comfortable. For individuals with very sore heels, for those who complain of their heel feeling like a “stone bruise” heel cups will provide relief. Tuli’s heel cups provide a lift and help take pressure off of the arch and the fascia while providing shock absorption. Heel cups generally work best in the early phases of plantar fasciitis when the heel is very inflamed and very tender.
   	Heel Lift
   	Heel Cup

   
   
6. Use a night splint.
   

   A night splint stretches out the plantar fascia while you sleep. Imagine that! Doing therapy while you sleep. When night splints work well, they reduce all of the morning pain and accelerate the healing of the plantar fascia, decreasing overall healing time. In some patients they are the key to treatment. The main problem with night splints is comfort. Many patients have difficulty sleeping in a splint. If you have trouble sleeping, then the night splint may not be right for you. But, many patients will wear a night splint in the evening for a few hours instead of sleeping in it. This is a considerable amount of stretching and can be extremely beneficial for therapy.
   For a rigid, plastic night splint, try the Langer Comfort Night Splint. For a softer night splint, try the Strassburg Sock or the Thermoskin Plantar FXT.

   	To better understand how the night splints work, look at the image to the left. When we fall asleep, the foot relaxes which puts the Achilles tendon and the plantar fascia in a relaxed position.
   	The plantar fascia starts to heal in this shortened and tighened position.
   	At the first step in the morning, the tightened plantar fascia tears, causing people to limp and hobble and grab on to the wall or the dresser or anything they can to balance themselves.
   	The night splints hold the foot at 90 degrees during the night. This keeps the plantar fascia and calf muscle stretched out during the night. The socks will pull up at the toes, specifically stretching the plantar fascia. Most plastic night splints have a wedge for added stretch.

   
   
7. Place orthotics in your shoes.  
   Orthotics are not insoles. Insoles are generally soft and cushy supports which slip into the shoe and add comfort and cushion. They are great for that purpose, but will not help treat plantar fasciitis. The stress on the fascia needs to be decreased to allow the fascial band to heal. More rigid inserts and custom made orthotics will help do this. Many people will respond to prefabricated (prefabs) semi-rigid inserts.
   
   

   Prolab orthotics are the prefabricated orthotic which most closely matches a custom made orthotic. They are semi-rigid, designed to control motion and are available in posted (more motion control) and non-posted inserts. The posted orthotic is shown here.
   Superfeet orthotics have a shock absorbing heel and supportive midfoot bed and help to decrease the stress on the fascia with each step. These prefabricated orthotics are also designed to control motion, but are a little more forgiving. The Superfeet green sport orthotics are shown here.
   Arch Molds have a deep heel cup, aggressive arch support and are heat moldable. Both help to control motion and decrease stress on the plantar fascia.
   If you have severe flatfeet or chronic plantar fasciitis, it is recommended that you see a podiatrist for custom made orthotics.

8. Lose weight.
   “AHHHHHHH. Don’t say that! How am I suppose to lose weight when I can’t walk?” Yes, you are right, and as the saying goes, you are caught between a rock and a hard place. It is very difficult to lose weight when you are told to decrease your activity and you are in pain. In fact, most people gain weight when they develop plantar fasciitis. Unfortunately, the increased weight gain puts even more stress through the arch and the heel, making the problem worse.  This is why it is so important to take the necessary steps to lose some weight. Even losing five or ten pounds will make a difference. Click here to read more information on why weight loss is important and how to take the steps necessary to start losing. Sorry, no magic pills for sale, only information and sensible advice from a Nutritionist.
   
   
9. Wear supportive shoes.
   This may sound obvious, but many people wear thin, flimsy shoes and wonder why they have heel pain. Your shoes should have a supportive sole which is rigid from the heel to the ball of the foot. The shoe should only bend at the toes, not in the middle. To test this, take your shoe and grab the heel. Place the toe box on the floor and press down. If the shoe collapses, it is way too flexible and should be thrown away.
   This may sound extreme, but if you have read this far, it means you have been dealing with a considerable amount of pain. If you developed plantar fasciitis once, you may very well develop it again down the road and a poor quality shoe (or even a poorly designed expensive shoe) can be the aggravating factor. Right now, the poorly designed shoe could be keeping you from getting better.
   
   
10. Try Taping.
    

    The goal in taping your foot is to take some of the stress off of the plantar fascia. Using tape adherent and 1 inch sports tape, wrap a strap around the foot, starting at the 5th toe joint (5th MPJ), back around the heel and to the big toe joint (1st MPJ).

    When attaching the tape to the big toe, make sure to press down on the big toe joint - mimic a high arch. Using 2 inch sports tape, start on the outside of the foot and wrap straps along the arch while holding down the big toe joint. You will need at least 3 straps of the 2 inch tape on the bottom and another locking strap around the foot of the 1 inch tape. Taping can be difficult to do on your own, so it may be best to see a podiatrist for this. This is only one of many taping methods.

What about massage? Massage can be a useful technique in the treatment regimen for plantar fasciitis, but it can also cause problems when used at the wrong time. In the early stages of plantar fasciitis, when the heel is very tender, massage is not recommended. Massage will only aggravate the area. In the later stages, after a few weeks or even months have passed, massage can help break up any scar tissue and increase blood flow to the area. Deep friction massage is commonly used by physical therapists in the later stages of plantar fasciitis.

If your pain persists after trying the therapy recommended above, make an appointment to see a podiatrist.

The most important treatment for plantar fasciitis is stretching. The more stretching you can do, the faster the healing time. For those who have pain at the first step in the morning, remember to stretch BEFORE you get out of bed and take a step down.

Do this by taking a stretch band (or a belt or towel) and place it by your bedside. When you wake up, place the band around the ball of your foot and pull. Keep your knee extended (straight). If you are flexible enough, grab your toes with your hand and pull towards you. This stretch can help even if you are using a night splint. Hold this stretch for 60 seconds. You should also do this stretch before getting up out of chairs, off the couch and even out of a car. If you cannot do the stretch with a band, then use a coffee table, chair or car door to do the stretch, by placing your forefoot on a stable object and pushing your heel down.

Calf stretches can be done by using the wall for support. Both stretches below involve placing the affected leg back, balancing on the wall and keeping the heels down. Hold each stretch for 60 seconds and repeat three times. Do these stretches 2-3 times throughout the day.
Place your hands and arms against a wall and place your affected leg or foot back behind your body. Bend the your front leg and align your shin almost parallel with the wall. Lean forward. Both heels should stay on the ground. You should feel a stretch in the back of the calf on the affected side and you may also feel the stress in your hamstring.	Place your hands against the wall and place your affect leg behind your body. Instead of keeping this knee straight, bend at both knees. The heels should stay on the ground. You should feel a stretch in the lower area of the calf.

	In the stretch demonstrated in the image on the left, the heel should be on the ground and the toes on the wall. Place the unaffected foot behind you. Keep the legs straight and move the entire body forward. Do not move your upper body forward and stick your backside out. You should feel a very strong stretch in the back of the calf and some stretch in the arch.
To increase the stretch, move your heel closer to the wall and increase the angle of your foot. To decrease the stretch, move your heel back and lower your toes. Hold for 60 seconds and repeat 3 times.

	You can do this same stretch by using a large book. Stand on the book with your toes and drop your heels to the ground, supporting yourself against the wall. In the very inflamed stage, this stretch can aggravate the pain, so be cautious in the early stages of plantar fasciitis. Don't hang your heels off the back of a step to stretch your calf, this can overstretch the calf muscle.

Do not stretch through pain. None of these stretches should be painful.

Decreasing activity is easier said than done, especially considering the average active person take 10,000 steps a day. The idea is to be aware of the stress put on the feet and to be aware of the daily activities that may aggravate the activity. The following is a list of ideas to help decrease the stress on your feet and help accelerate the healing of plantar fasciitis. Stop running, jogging or walking. Swim or bike instead. If you work out on a treadmill, stop! This is the worst activity for your heels. Avoid the stair stepper. The stair stepper puts a lot of stress through your arch. If you are up and down at work a lot, try to limit it, and get up only once an hour, or once every 2 hours. At home, avoid going up and down the stairs multiple times. Have your spouse, significant other or child run up or down for you. Try to avoid steep hills. Stairs are better than hills. Do not lift or carry heavy items. This adds to the total amount of force that goes through your feet. This also increases the total impact on your heel. Do not lift your kids and carry them. Use a stroller, have them walk, or let your spouse/significant other carry them. Don’t lift weights. If you do, make sure you are seated. The elliptical machine at the gym can also aggravate plantar fasciitis. If you must exercise with this, lower the platform adjustment to it’s lowest level. For Athletes As an athlete, competitive or recreational, the hardest part of all injuries is the healing. Taking time off of training or exercising can be extremely frustrating. The biggest mistake many active people make is trying to push through the pain and hope that the condition will just go away on it’s own. Trying to “walk off” plantar fasciitis is a big mistake. Act quickly! Start treatment immediately. The best approach, when signs of plantar fasciitis are developing, is to rest the foot for 10-14 days. Cross train by road or mountain biking, swimming or weight lifting. Do all the therapy outlined above. Be aggressive about this treatment, stretching as much as possible throughout the day and icing or contrasting between hot and cold as much as your schedule allows. Here are some guidelines. If the pain has decreased considerably during this time, it is safe to return to your original activity. Let’s take running as an example. For a runner training at 35 miles a week, working towards a half marathon, the first day of running should be a short, flat, slow 2-3 mile run. Stretching should be done before and after the run and ice should be applied for 15 minutes immediately after the run. (Make sure to warm up before stretching with at least a 5-10 minute walk, otherwise you risk injury to the Achilles tendon or calf muscle. Don't overstretch. The following day should be a rest day. For individuals running 5-7 miles on hills, this run may seem extremely short. But, the key is not to over do it. DO NOT return to the regimen you were running prior to the development of the plantar fasciitis. This is the most common cause for a recurrence. Every other day the length or intensity of the run should be increased if there is minimal or no pain. By the second week, hills can be incorporated. By the third week a return to the original running routine can be expected. If the heel pain did not resolve after the 2 weeks of rest and cross training, see a podiatrist. For individuals who have been exercising on a sore heel for months, the chances of resolving the plantar fasciitis in 2 weeks is unrealistic. Plan for a number of months of conservative therapy for complete healing. A modified training program can be incorporated into this treatment regimen. Here a few guidelines for modified activity and cross training: Swim for exercise, or bike at low resistance at the gym and avoid the recumbent bike. If you bike outside, spin up the hills (use the lowest gears). Of course it is better to avoid hills if possible. Do not drop your heel while cycling, this puts excess stress through the Achilles tendon and the arch. Wear cycling shoes, or rigid shoes while cycling. Consider weight lifting. Avoid standing while lifting weights. Avoid squats, calf lifts and quad bench presses. There are many areas that we tend to avoid when we focus on specific training, especially the upper body. Try to readjust your focus for a few weeks. If you have pain at any time during the return, taper your routine accordingly. If you have a small amount of pain, then don't increase the mileage or intensity, or give it a day's break to rest and ice and stretch. If you have a lot of pain when you return, then you should take a full two weeks off from the activity and see your physician to consider more aggressive therapy. Physical therapy and orthotics would be good treatments to add. Taping for Plantar Fasciitis There are many methods of taping for plantar fasciitis. The example below is called a Low Dye Strapping. There are variations on this technique as well, including longitudinal strips of tape or a criss cross pattern on the bottom. Typically, the taping is done at the doctor's office or by a physical therapist. Taping for plantar fasciitis can be difficult to do on one's own foot, but it is possible. You need tape adherent (look for sports tape adherent at your local drug store, sports store or medical supply outlet) and 1 - 1 1/2 " and 2"- 3" sports tape. The tape in the pictures below has striations, this is not necessary, any type of sports tape will work. Do not use bandage tape, it will not stay on the skin for any length of time. The goal of the taping is to take stress off the plantar fascia by holding it in a relaxed position. To accomplish this, the big toe joint (1st MPJ) must be held down and a high arch created in order to decrease the tension on the plantar fascia. Step 1 Plantar Fasciitis Taping Spray tape adherent on the bottom and sides of the foot (unless you have sensitive skin or an allergy). Take a strip of 1" tape and start at the 5th MPJ (5th toe joint). Wrap the tape around the heel and bring the tape around to the arch side of the foot. Step 2 Plantar Fasciitis Taping After bringing the tape around the heel, press the 1st MPJ (big toe joint) down and try to mimic a high arch. Bring the tape to the 1st MPJ and attach. Cut off any excess. Pressing down on the big toe joint is one of the most important steps. Once the tape has been secured, the higher arch should be maintained. Step 3 Plantar Fasciitis Taping Repeat step 2 two more times with 1" sports tape. Remember to press down on the big toe joint while securing the tape down. Bring one piece a little higher on the big toe joint and one piece slightly lower. There should be three pieces of 1" sports tape wrapped from the little toe joint to the big toe joint. Step 4 Plantar Fasciitis Taping Using the 2" sports tape, start on the outside of the foot, towards the heel, at the line of the 1" tape. Wrap the 2" tape around, under the foot to the arch side. Step 5 Plantar Fasciitis Taping Wrap the 2" tape around and adhere to the medial side of the foot at the line of the 1" tape. Again, make sure the 1st MPJ is pressed down, so that a high arch is created. Step 6 Plantar Fasciitis Taping A second 2" strap is wrapped around, starting on the outside of the foot and ending on the arch side, holding down the 1st MPJ each time. Overlap the tape. Step 7 Plantar Fasciitis Taping Repeat step 6 two or more times until the 2" tape reaches the 1st MPJ. Don't forget to hold down the 1st MPJ each time the tape is brought around to the inside of the foot.     Step 8 Plantar Fasciitis Taping Cut off the excess tape at the top of the foot. Step 9 Plantar Fasciitis Taping Optional steps are locking straps. One locking strap can go around the heel from the little toe joint to the big toe joint. The other locking strap can go over the top of the foot as seen in the picture here. Step 10 Plantar Fasciitis Taping Shown here is the final taping without the locking strap on top. The tape should stay on for 3-5 days, but can sometimes last for a week or two. It is ok to shower with the tape on, just pat the tape down with a towel and air dry before putting on socks.   Heel Pain Treatments at the Doctor's Office plantar fasciitis treatments by the doctor Steroid Injections These are not the type of steroids which build up muscle, but the type which decrease inflammation. The steroid is injected right into the area of the most inflammation, at the heel. A steroid injection does not heal the fascia, it decreases the inflammation. It is important to remember this. Steroid injections work the best when they are used in conjunction with all the conservative therapy mentioned above. Steroid injections may not be very helpful in chronic conditions of plantar fasciitis. As mentioned previously, in chronic cases there tends to be more thickening and degeneration of the plantar fascia than inflammation and the steroid injection may do more harm than good. Does the injection hurt? The short answer is yes, it does. But, the good news is that the injections are quick and the pain you feel when you get out of bed in the morning is far worse. The side effects associated with steroid injections at the heel include fat pad atrophy (shrinking of the padding at the heel), hyperpigmentation (brown spots at the injection site) and plantar fascia rupture. All of these are rare, especially the plantar fascia rupture, but they can occur. Allergic reactions are also possible, but systemic effects from the injections are uncommon. Taping Taping for plantar fasciitis can be an effective way to reduce stress on the plantar fascia. One of the most common methods is called Low Dye Strapping. There are many variations on this method, but most involve using 1" and 2" sports tape and wrap 1" tape around the heel from the little toe joint to the big toe joint. The 2" straps go across the arch. The big toe joint is pressed down while the straps or applied. When applied correctly, the taping can last a week or two before needing to be reapplied. Taping can be difficult to perform on yourself, so many will have this treatment done at the doctor's office or by a physical therapist. Custom made orthotics Custom made orthotics are devices which are molded specifically to your feet. A plaster mold is taken while you are sitting or lying on your stomach. Another method for casting is placing the foot in a foam box and taking a mold. The most common type of foot needing an orthotic is a flatfoot. But, any foot with abnormal motion may benefit from a custom made orthotic. To know if you need an orthotic, you should visit a podiatrist and be evaluated. Custom made orthotics are rigid devices, with a soft cover. The rigidity is necessary to hold the weight of the body and control the abnormal motion, generally pronation. A soft orthotic will collapse under the weight of the body and be no better than a cushion. Most individuals need a week or two to get used to the orthotics, but kids adapt very quickly. Adults may develop knee, hip or back achiness the first few weeks. But this should always work itself out. Physical therapy Physical therapists play an integral part in the treatment of plantar fasciitis. Most therapists are well trained in treatment of this condition because it is so common. Physical therapy may involve ice baths, contrast soaks, stretching, strengthening, ultrasound and iontophoresis. Some therapy can be done at home, other therapy may involve twice weekly visits to the therapist for a number of months for good results. Hard casts and Cast Boots A fiberglass cast and crutches or a walking cast boot can be used in severe cases of plantar fasciitis in the initial inflamed stage. It is only used in certain types of cases which have not responded to other treatments. The idea is to take all the pressure off of the heel and allow the plantar fascia to heal. This can take 4-6 weeks. Acupuncture It is difficult to truly present acupuncture as a therapy for plantar fasciitis when there are no solid studies showing the effectiveness of acupuncture on heel pain. The papers written on acupuncture and heel pain are for the most part anecdotal. You may want to discuss this treatment with your doctor. If you do seek this type of therapy, consider that you are not truly addressing the problems 1. inflammation and 2. abnormal motion (usually pronation). If acupuncture does help the pain, then consider other therapies, which address the problem in addition to acupuncture. Shockwave therapy The term shockwave therapy usually makes people jump. No, this is not electric shock therapy. It is extracorporeal shockwave therapy (ESWT). Shockwaves are sound waves that create vibrations. The theory is that the vibrations cause controlled injury to the tissue, in this case the plantar fascia and surrounding structures at the heel. The body responds by increasing it’s healing ability at that area, stimulating a repair process. The FDA approved ESWT for the treatment for plantar fasciitis in the year 2000, but it still remains under investigation and many insurance companies will not cover this treatment. Patients need to try most of the conservative therapies listed above for 6-12 months before being considered for ESWT. The procedure is typically done at a surgery center and in most cases does involve using anesthesia or some sedation. Full healing time after the procedure can take 2-3 months. There are very few complications associated with ESWT, but a few that have been reported include bruising, hematomas, skin erosion, swelling and paresthesias (abnormal nerve sensations). A recent Study in the Journal of Foot & Ankle Surgery (Malay DS, et al. Extracorporeal Shockwave Therapy Versus Placebo for the Treatment of Chronic Proximal Plantar Fasciitis: Results of a Randomized, Placebo-Controlled, Double-Blinded, Multicenter Intervention Trial. J Foot Ankle Surg 45(4):196-209, 2006) compared ESWT versus a sham procedure in 172 patients. The researchers found a statistically significant benefit of ESWT over the sham treatment and the patients experienced no significant complications or side effects. More studies like this will need to be performed to help further assess the true effectiveness and safety of ESWT in plantar fasciitis. Coblation Therapy Coblation Therapy is a bipolar radiofrequency-based technology that uses low temperatures to stimulate the release of hydrogen, oxygen and growth factors from tissues and stimulate the formation of new blood vessels within the tissue. The idea is to jump start the body's own healing response. Coblation therapy is not a new therapy, but has recently emerged onto the scene for treating plantar fasciitis, or more appropriately termed plantar fasciosis. Plantar Fasciosis Many in the foot related health care field are pushing for "plantar fasciiitis" to be renamed "plantar fasciosis." "Itis" means inflammation and many studies have shown that after the first few weeks following injury and development of plantar fasciitis, the inflammation decreases. After a few months, the blood flow which was increasing the inflammation initially, has disappeared and the fascial band starts to thicken and lose blood supply. The exact point of this transition is unique to each individual and still up for some debate. The idea of plantar fasciosis is important in that much of our treatment efforts in the past have focused on decreasing inflammation. Although decreasing inflammation is important in the first few weeks to few months of the development of heel pain, treatment of chronic plantar fasciitis (plantar fasciosis) should not focus on anti-inflammatory measures. The results from Coblation Therapy are promising with patients back into regular shoe gear within 2 weeks and a low risk of complications. There have been reports of infections and small wound dehiscences, but this is expected with any surgical procedure. EPF: Endoscopic Plantar Fasciotomy EPF is a minimally invasive surgical treatment for chronic plantar fasciitis. The procedure involves making a small incision on the inside and outside of the heel. A small camera is inserted into the heel which allows the surgeon to visualize the plantar fascia. The success rate with this procedure ranges from 80-90% good to excellent results and the complications are reduced in comparison to an open heel surgery. Open Heel Surgery Over 90% of patients will improve without surgery. Surgery is the last resort and very few people will need to have surgery. Usually 6-12 months of conservative care is attempted before surgery is considered. A small incision is made at the heel, cutting the fascia and sometimes removing the bone spur, if there is a large spur (remember that the bone spur is rarely a cause of pain). This type of surgery usually involves a walking cast, a cast boot or sometimes crutches for 4-6 weeks. No surgery is free of complications. Complications from either the EPF of the open heel surgery include nerve problems, infection, slow healing, pain on the outside of the foot (cuboid syndrome & lateral column overload), tendon rupture (posterior tibial tendon) and recurrence of the problem and instability of the foot associated with a collapsing arch. Although these problems are relatively rare, they need to be taken into consideration when undergoing the procedure. The success of the surgery depends on many things: the time the patient has had the problem, how much scar tissue has developed (difficult to assess), the type and area of pain, the type of surgery performed, the healing ability of the patient and the compliance of the patient. Considering all these factors it is no surprise that the success rate reported has ranged from 60-95%.

Disclaimer: The advice on this website is not intended to substitute for a visit to your health care provider. We will not be held liable for any diagnosis made or treatment recommended. Consult your doctor if you feel you have a medical problem.