fascia is a ligament-like band running from your heel to
the ball of your foot. This band pulls on the heel bone,
raising the arch of your foot as it pushes off the ground.
But if your foot moves incorrectly, the plantar fascia may
become strained. The fascia may swell, and its tiny fibers
may begin to fray, causing plantar fasciitis.
Plantar fasciitis is often caused by poor foot mechanics.
If your foot flattens too much, the fascia may overstretch
and swell. If your foot flattens too little, the fascia
may ache from being pulled too tight.
With plantar fasciitis, the bottom of your foot may hurt
when you stand, especially first thing in the morning. Pain
usually occurs on the inside of the foot, near the spot
where your heel and arch meet. Pain may lessen after a few
steps, but it comes back after rest or with prolonged movement.
A heel spur is an extra piece of bone that may grow near
the spot where the plantar fascia attaches to the heel.
The heel spur may form in response to the tug of the plantar
fascia on the heel bone.
Bursitis is the swelling of a bursa, a fluid-filled sac
that reduces friction between a ligament and a bone. Bursitis
may develop if a swollen plantar fascia presses against
a plantar bursa.
X-rays of your foot may be taken, or you may have a bone
scan to confirm a suspected heel spur or a stress fracture
of the heel bone.
Reducing symptoms is the physician's first goal. If your
pain is due to poor foot mechanics, custom-made shoe inserts
(orthotic devices) may help. To relieve mild symptoms, aspirin
or other anti-inflammatory medications may be effective.
Rubbing ice on the affected area may also help.
To reduce severe pain and swelling, your physician may prescribe
medications or injections. Physical therapy, such as ultrasound,
may also be recommended. To reduce symptoms caused by poor
foot mechanics, your foot may be taped. This supports the
arch and temporarily controls movement. Night splints may
also help by stretching the fascia. If taping helps, your
physician may prescribe orthotic
devices. Built from plaster casts of your feet, these
inserts control the way your foot moves. As a result, your
symptoms should be relieved.
If surgery is needed, and other types of treatment do not
control your pain, cutting the plantar fascia to release
the tension can be performed. As you heal, fibrous tissue
fills the space between the heel bone and the plantar fascia.
You can not stay off your feet altogether, but you can reduce
overuse and the risks that come with it. Also, be sure to
follow your physician's treatment plan. Take medications
as directed, and wear orthoses if you have them.
Every time your foot strikes the ground, the plantar fascia
is stretched. You can reduce the strain on the plantar fascia
and the possibility of overuse by following these suggestions:
lose any excess weight, avoid running hard on uneven ground,
and wear shoes that support your arch.
ENDOSCOPIC PLANTAR FASCIOTOMY (EPF)
Endoscopic Plantar Fasciotomy (EPF) is a surgery used to
treat severe strain of the plantar fascia. The plantar fascia
is a ligament-like band that runs along the bottom of your
foot. If this band is strained, you may have pain on the
inside of your foot where the arch and heel meet. Walking
and even standing may hurt. Your doctor may suggest EPF
if your symptoms are not reduced by medication and orthotic
devices to control foot moveme.
EPF is an outpatient procedure that may be performed at
a hospital or same-day surgical facility. It takes about
an hour to perform. After the procedure, you will be taken
to a recovery area where you will be watched until you can
sit up and drink liquids. Although you may feel fine when
you are discharged, it is best to have someone drive you
During the procedure the physician makes an incision, less
than 1/2 an inch long, on each side of your heel. A special
scope and camera are then slipped under the fascia to allow
the physician to watch on a nearby monitor. The physician
will then cut the fascia near the heel bone. If you are
awake, you may hear people talking, and feel pressure, but
you should not feel pain.
As with any surgery, there are certain risks and complications
including infection, slow healing, nerve entrapment, an
ache on the outside of the foot, and a return of symptoms.
If necessary, your surgeon may change to a more traditional
surgery that requires a larger incision.
AFTER THE PROCEDURE
You may be able to walk right after surgery, but don't overdo
it. Your physician may want you to rest and recover at home
for a few days. If a compression dressing is used to control
swelling, you may need to wear a special shoe. The dressing
will probably be removed at your first postoperative visit
to the doctor.
Expect your foot to feel numb immediately after the surgery.
As the local anesthetic wears off, you will probably feel
a little pain. To control the pain and swelling, put ice
on the foot for 10-15 minutes at a time, several times a
day. Also, elevate the foot above the level of the heart.
If you've been given pain medication, take it exactly as
As your foot heals, new tissue fills in the gap where the
fascia was cut. This lengthens the fascia, and reduces strain
during foot movement. For best results, see your physician
as directed. Physical therapy or stretching exercises are
often prescribed to improve recovery.
Wearing the right shoes can reduce the amount of strain
placed on the plantar fascia. Choose low or flat shoes that
lace up. Shoes that support the heel and arch are good choices.
Your doctor may also prescribe orthotic
devices (custom-made shoe inserts) to help control your