The plantar 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.

CAUSES
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.

SYMPTOMS
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.

RELATED PROBLEMS
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.

REDUCE SYMPTOMS
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.

THE PROCEDURE
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 home.

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 directed.

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 foot movement.