Plantar fasciitis (inflammation of the plantar fascia) is the most common cause of heel pain seen by an orthopedist. It is common in several sub-groups of people, including runners and other athletes, people who have jobs that require a fair amount of walking or standing (especially if it is done on a hard surface), and in some cases, it is seen in people who have gained a substantial amount of weight, either by dietary indiscretion or pregnancy.
The plantar fascia is a broad ligament-like structure that extends from the heel bone to the base of the toes, acting like a thick rubberband on the bottom arch of the foot. With a few extra pounds, or with exercise, the plantar fascia can develop microtrauma at its insertion into the heel bone or anywhere along its length. This causes pain that can be quite severe at times.
One unfortunate fact about plantar fasciitis is that it sometimes takes many months to resolve. In fact, it takes approximately six months for most (75% of) people to recover from this problem. Ninety-eight percent of people enjoy significant improvement by 12 months.
Treatment of plantar fasciitis consists of three stages:
Stage 1 involves prescribing the patient a heel cushion to decrease shock absorption of the plantar fascia, as well as a short course of medication to decrease inflammation in the heel.
Stage 2 may involve cortisone injections into the heel region, if Stage 1 has failed to bring significant relief. Other modalities in Stage 2 include orthotics, taping, physical therapy, and night splinting.
Stage 3 is for those who have had plantar fasciitis for one year or longer, whose symptoms are severe and preventing them from work or recreation. It involves a surgical release of part of the insertion of the plantar fascia. However, this surgery is rare, as most people do have significant relief from nonsurgical treatment.