Plantar fasciitis is a common ailment affecting millions of people each year. The disorder is a common complaint of most individuals presenting to their physicians. The disorder is localized to the foot because of the daily weight, stress, ill fitting shoes, poor foot care, and extreme weight that is endured on a daily basis. The heel absorbs all the abuse and with time the surrounding muscles, bone and ligaments get inflamed and cause pain. Occasionally plantar fasciitis is also called “heel spurs” but heel spurs are not always the cause of this condition.

Plantar fasciitis is a painful and progressing disorder that develops when the long, flat ligament on the bottom of the foot develops microscopic tears or gets irritated/inflammation. It is this inflammation which causes the pain in the heel and the foot.

There are a number of possible causes for plantar fasciitis. Extremely tight shoes, improper shoes, poor exercise habits, excessive twisting of the ankle and foot, stress on the arch and weakness of the foot muscle may all be causes of plantar fasciitis. In some individuals, certain foot exercises may place excessive stress on the arch, leading to tears of the ligament. Individuals with either low/high arches or flat feet are also predisposed to developing plantar fasciitis.

The repetitive stress on the heel from daily working activities/exercise/standing or prolonged walking can aggravate the plantar fasciitis. Being overweight and wearing poorly cushioned shoes are major contributing factors in worsening of plantar fasciitis.

The diagnosis of plantar fasciitis is generally made based on the patient’s symptoms and clinical exam. X rays are not required for the diagnosis. When an individual presents with complaints of heel pain first thing in the morning, and that the pain is intense when starting to exercise and gets better during the day, one should suspect plantar fasciitis. Prolonged pain while standing and tender to touch at the heel may be additional clues.

X-rays are not necessary but may reveal a heel spur-indicating that the foot has been under stress for some time. The spur is caused by the stress on the foot and is not a cause of plantar fasciitis. Surgery to remove the heel spur does not help treat the disorder as it does not address the cause of the plantar fasciitis.

Chiropractors can assess the degree of plantar fasciitis by evaluation and examination of the foot. The chiropractic assessment pays careful attention to the mechanics and neurology of the ankle joint, the soft tissues, foot mechanics and the normality of the arch. Each of these systems is then addressed and the appropriate treatment is recommended.

The earlier an individual with plantar fasciitis seeks treatment, the earlier will the symptoms resolve and the better is the prognosis. Once treatment is delayed, the condition can be chronic and most individuals will have continuous and prolonged heel pain.

The principles of treatment should assess the type of shoes the individual wears, relief of stress in the foot, proper foot wear, pain control, correct exercise training habits, use of ice packs, massage of the foot, orthotics, steroid injections, night splints and release of adhesions in the muscles. These treatments may be used in combination with each other and no one treatment has a better success rate than others.

The basic essence of these treatment programs is to break up the adhesions and increase the mobility of the foot. Various toe and foot exercises are carried out for weeks and even months to increase the mobility and decrease the pain. During this time, proper foot use and movements are encouraged. During these treatments, the risk factors are addressed and the patient is made more aware of how to decrease the chance of recurrence.

For pain, non steroidal anti-inflammatory drugs (e.g. aspirin, ibuprofen, etc.) may be recommended. However, these medications only control the pain and do not treat the cause of the condition.

Cortisone injections are one of the options. The injections are administered 2-4 times over a period of 1-2 years. They do have some success but must be combined with the above mentioned modalities for the best results.

Wearing small size shoes may aggravate plantar fasciitis. Shoes with thicker, well-cushioned mid soles and more arch support may help alleviate the problem. Running shoes should be frequently replaced to decrease the arch stress as they lose their shock absorption capabilities. Simply padding the shoe is not effective to support the heel or increase strength of the plantar fascia ligament. Some orthotics shoes with a plaster cast are available and do help correct the anatomical features of the foot, but they are expensive.

Night splints, which are removable braces, allow passive stretching of the calf and plantar fascia during sleep, and minimize stress on the inflamed area. These braces are useful in those individuals who have had plantar fasciitis for more than a year and have significant pain.

Once the appropriate treatment program has started, it may take 2-6 months before the pain decreases. In chronic cases, mild pain may be present for up to 1-2 years. In some cases, the pain is life long.