Plantar fasciitis is a painful inflammatory condition of the plantar fascia in the sole of the foot, often caused by overuse. It commonly causes heel pain with the first steps in the morning or after periods of rest. Treatment focuses on reducing inflammation, stretching the fascia, and supporting the arch through various physical therapies, orthotics, and in severe cases, corticosteroid injections or surgery.

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7. Plantar fasciitis
• is a painful inflammatory process of the
plantar fascia, the connective tissue on the
sole (bottom surface) of the foot.
• caused by overuse of the plantar fascia or
arch tendon of the foot.
• common condition and can be difficult to
treat

8. Plantar Fasciitis
• plantar fascia is a thick
fibrous band of connective
tissue originating on the
bottom surface of the
calcaneus (heel bone) and
extending along the sole of
the foot towards the toes.
• It has been reported that
plantar fasciitis occurs in
two million Americans a
year and in 10% of the U.S.
population over a lifetime.

9. Plantar Fasciitis
• It is commonly associated with long
periods of weight bearing.
• Among non-athletic populations, it is
associated with a high body mass
index.
• The pain is usually felt on the
underside of the heel and is often
most intense with the first steps of
the day.
• Another symptom is that the
sufferer has difficulty bending the
foot so that the toes are brought
toward the shin (decreased
dorsiflexion of the ankle).

10. Plantar Fasciosis.
• Longstanding cases of plantar
fasciitis often demonstrate more
degenerative changes than
inflammatory changes
• The suffix "osis" implies a pathology
of chronic degeneration without
inflammation.
• Since tendons and ligaments do not
contain blood vessels, they do not
actually become inflamed.
• usually the result of an accumulation
over time of microscopic tears at the
cellular level.

11. Diagnosis
• The diagnosis of
plantar fasciitis is
usually made by clinical
examination alone.

12. Plantar fasciitis
• commonly causes stabbing
pain that usually occurs
with your very first steps in
the morning.
• Once your foot limbers
up, the pain of plantar
fasciitis normally
decreases, but it may
return after long periods of
standing or after getting up
from a seated position.

13. Plantar fasciitis – at risk
• Runners
• Overweight people
• Pregnant women
• wear shoes with
inadequate support

14. Plantar Fasciitis
• Develops gradually
• Affects just one foot, although it
can occur in both feet at the
same time
• Is triggered by — and is worst
with — the first few steps after
awakening,
• although it can also be triggered
by long periods of standing or
getting up from a seated position
• Feels like a stab in the heel of
your foot

15. Causes
• normal circumstances, your plantar fascia
acts like a shock-absorbing
bowstring, supporting the arch in your foot.
• If tension on that bowstring becomes too
great, it can create small tears in the fascia.
• Repetitive stretching and tearing can cause
the fascia to become irritated or

16. Risk Factors
• Age. Plantar fasciitis is most common between the ages of 40 and
60.
• Sex. Women are more likely than are men to develop plantar
fasciitis.
• Certain types of exercise. Activities that place a lot of stress on
your heel and attached tissue — such as long-distance running,
ballet dancing and dance aerobics — can contribute to an earlier
onset of plantar fasciitis.
• Faulty foot mechanics. Being flat-footed, having a high arch or
even having an abnormal pattern of walking can adversely affect
the way weight is distributed when you're standing and put added
stress on the plantar fascia.

17. Risk Factors
• Obesity. Excess pounds put extra stress on your plantar fascia.
• Occupations that keep you on your feet. Factory workers,
teachers and others who spend most of their work hours walking
or standing on hard surfaces can damage their plantar fascia.
• Improper shoes. Avoid loose, thin-soled shoes, as well as shoes
without enough arch support or flexible padding to absorb shock.
• If you regularly wear high heels, your Achilles tendon — which is
attached to your heel — can contract and shorten, causing strain
on the tissue around your heel.

18. Imaging tests
• an X-ray or magnetic resonance imaging
(MRI) to rule out another problem, such as a
stress fracture
• Sometimes, an X-ray shows a spur of bone
projecting forward from the heel bone.

19. Heel Spur
• An incidental finding associated with this condition is
a heel spur, a small bony calcification on the
calcaneus heel bone,
• it is the underlying plantar fasciitis that produces the
pain, and not the spur.
• The condition is responsible for the creation of the
spur; the plantar fasciitis is not caused by the spur.

20. Flexor Digitorum Brevis
• ball-of-foot pain is mistakenly
assumed to be derived from plantar
fasciitis.
• A dull pain or numbness in the
metatarsal region of the foot could
instead be metatarsalgia,
• Some current studies suggest that
plantar fasciitis is not actually
inflamed plantar fascia, but merely
an inflamed flexor digitorum brevis
muscle (FDB) belly.
• Ultrasound evidence illustrates fluid
within the FDB muscle belly, not the
plantar fascia.

21. Treatment
• Rest,
• Massage therapy,
• Stretching,
• Night splints,
• Physical therapy,
• Cold therapy,
• Heat therapy,
• Orthotics,
• Anti-inflammatory medications,
• Corticosteroid (Botox) Injections
- US guided
• Surgery in refractory cases.

22. Treatment
• Add arch supports to your shoes.
Inexpensive over-the-counter arch supports
take the tension off the plantar fascia and
help absorb shock.
• Stretch your arches. Simple exercises using
household objects can stretch your plantar
fascia, Achilles tendon and calf muscles.

23. Therapies
• Stretching and strengthening exercises or use of specialized devices may
provide symptom relief.
• exercises to stretch the plantar fascia and Achilles tendon and to
strengthen lower leg muscles, which stabilize your ankle and heel.
• A therapist may also teach you to apply athletic taping to support the
bottom of your foot.
• Night splints. Your physical therapist or doctor may recommend wearing
a splint that stretches your calf and the arch of your foot while you sleep.
This holds the plantar fascia and Achilles tendon in a lengthened position
overnight and facilitates stretching.
• Orthotics. Your doctor may prescribe off-the-shelf or custom-fitted arch
supports (orthotics) to help distribute pressure to your feet more evenly.

24. Taping

25. Foot Orthoses

26. Night Splints

27. Treatment
• Put your feet up. Stay off your feet for several days when the pain
is severe.
• Apply ice. Hold a cloth-covered ice pack over the area of pain for
ice massage. Freeze a water-filled paper cup and roll it over the
site of discomfort for about five to seven minutes.
• Decrease your miles, but it's a good idea to cover shorter
distances until pain subsides.
• Take up a no- or low-impact exercise. Swap swimming or bicycling
in for walking or jogging.

28. Non-Impact Activities

29. Alternative Medicine
• Although some over-
the-counter arch
supports contain
magnets, no reliable
evidence indicates that
arch supports with
magnets relieve heel
pain any better than do
arch supports without
magnets.

30. Surgery
• Risk of nerve injury
• Infection,
• Rupture of the plantar fascia, and
• Failure to improve the pain.
• Traditional surgical procedures, such as
plantar fascia release, are a last resort

31. Coblation Surgery
• (aka Topaz procedure)
has been used
successfully in the
treatment of
recalcitrant plantar
fasciitis. This procedure
utilizes radiofrequency
ablation and is a
minimally invasive
procedure.

32. Extracorporeal shockwave therapy
(ESWT)
• One review found that
the preponderance of
evidence supports the
use of ESWT, but only
after several months of
treatment with more
accepted and proven
therapies have failed, as
a possible alternative to
surgical intervention.

33. Extracorporeal Shockwave Therapy
• The American Academy
of Orthopaedic
Surgeons notes that
ESWT is sometimes
tried before surgery
due to minimal risk
involved, but due to
lack of consistent
results it is not
commonly performed.