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Overview
Plantar fasciitis refers to an inflammation of the plantar fascia, a thick, fibrous band running along the sole of the foot. Such inflammation results from direct injury to the plantar fascia, usually, repeated trauma to the tissue where the fascia attaches to the calcaneus or heel bone. The plantar fascia is critical in maintaining the foot?s complex arch system, also playing a role in balance and fine control of certain phases of the athlete?s gait. Injury to the plantar fascia is particularly painful and disabling for runners and can often prove stubbornly resistant to treatment. Rehabilitation is frequently a lengthy and frustrating process. For these reasons, care should be taken where possible to avoid such injury by means of preventative exercises and sensitivity to early warning signs.


Causes
Plantar fasciitis, another sports injury detailed on this website, is regularly the cause of foot arch pain or strain. This can arise due to faulty biomechanics in your feet, which alone can also provoke foot arch pains. The most prominent biomechanical difficulties are flat feet and high arches. With flat feet (or overpronation) the arches appear to be almost flattened, causing unevenness by forcing the feet roll inwards in order to maintain balance and support the body's weight. This places inordinate pressure on the plantar fascia and arches. If by contrast you have high arches (instep), the ankle can roll outwards, again causing undue strain on the arches. Too much of this strain can lead to stretching of the plantar fascia and pain in the arches. Other causes include overstretching or otherwise pressuring the arches, for example by exercising with fatigued leg muscles which leave the feet with excessive work to do. You are also particularly at risk if in your 40s or 50s and commencing an intense program of training after a long period of inactivity.

Symptoms
Common symptoms of plantar fasciitis include pain in the morning when you first get out of bed, pain and stiffness when you start to walk after sitting for a while, increasing arch or heel pain toward the end of the day, tired feet at the end of the day. Other causes of arch and heel pain include arthritis, infection, fractures and sprains, and even certain systemic diseases. Since there are multiple possible causes, you should see your podiatrist for a thorough evaluation if you are experiencing arch or heel pain that does not respond quickly to early treatment.

Diagnosis
Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray. Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.

Non Surgical Treatment
Depending on your overall health, symptoms and severity of the the flat foot, the condition may be treated conservatively and/or with surgery. Non-surgical treatments for flat feet are centered at decreasing and/or resolving the symptoms (pain). Simple Treatments Patients Can do themselves include wear proper supportive shoes. Use an arch support. Wear shoes with a wide toe box. Modify your activities. Lose weight. Wear shoes with cushion. Non-surgical treatments a doctor might do include Prescribe an oral anti-inflammatory medication. Anti-inflammatory medication is useful to significantly reduce pain and inflammation. Prescribe physical therapy. A physical therapist may perform ultrasound and other techniques to reduce inflammation. You will also be instructed how to stretch your foot and leg properly. Keeping the joint mobile may preserve function. Strengthening weak foot and leg musculature can help prevent further collapse. Prescribe protective pads. Padding and/or cushioning of when areas of bone become prominent on the bottom of the foot, as an effective method of preventing mechanical irritation with shoes. Pads with cutouts may off-weight specific areas of concern. Prescribe custom foot orthotics. A custom foot orthotic is a doctor prescribed arch support that is made directly from a casting (mold) of your feet, and theoretically should provide superior support compared to shoe insert that you would purchase from a pharmacy. In the case of flat feet, specific modifications can be made to the orthotic device to strategically balance the foot. Prescribe custom ankle-foot orthoses. A custom ankle-foot orthotic (AFO) is a doctor prescribed molded arch and lower leg support that stabilizes both the foot and ankle. This is used when the flat foot is significant and provides more support than the simple foot only insert. Give cortisone injection. A articular cortisone injection is a powerful anti-inflammatory medication that is used to rapidly reduce the pain associated with inflammation. Cortisone shots can be extremely effective in alleviating symptoms of flat feet, but will not correct the structure.


Surgical Treatment
The soft tissue surgeries usually would include a lengthening of the Achilles tendon, releasing of the plantar fascia as well as tendon transfers. These procedures are usually done in conjunction with bony procedures such as calcaneal osteotomies (to lower the heel bone and get it more under the leg itself), as well as metatarsal osteotomies. These procedures usually involve either cutting or fusion of the bones, and placement of fixation devices to allow the bones to heal. Healing time is usually at least 6-8 weeks and usually the patient must be non-weight bearing during the healing process. These types of surgical corrections are usually reserved for the more difficult, painful and deformed feet. They can require more surgeries down the line. These procedures are usually the last resort after all other modes of treatment have been exhausted (except in children where it is usually best to treat the deformity early). There are many different degrees of high arched feet and these procedures should be left for the more extreme cases. These cases usually require a very high degree of surgical skill and should only be done by those who frequently perform these types of cases.


Prevention
Maintain a healthy weight, Use insoles to support your arches, Limit how often you wear high heels, Use proper shoes, especially when exercising to evenly distribute weight through your foot.

Stretching Exercises
Stretching your calf and Achilles tendon may also help as a tight Achilles can make your foot overpronate. To stretch your calf and Achilles tendon, step forwards with your left leg and bend it, with your right leg straight and both feet pointing forwards. Push your right heel into the ground while keeping your right leg straight; you should feel the stretch at the back of your right leg, below the knee. Hold the stretch for 15 to 30 seconds and repeat with the opposite leg. Repeat the stretch two to four times on each leg, and repeat the overall exercise three to four times a day.