Plantar Fasciitis is a condition that is sometimes called a heel spur. This condition causes pain on the bottom of the heel when putting weight on the foot. There are probably many underlying causes of heel pain, and some physicians feel that it is probably more accurate to simply make a diagnosis of heel pain rather than try and define an absolute cause in every instance of heel pain. The Plantar Fascia is a structure that runs from the front of the heel bone (calcaneus) to the ball of the foot. This dense strip of tissue helps to support the longitudinal arch of the foot. As you can imagine, when the foot is on the ground a tremendous amount of force is concentrated on the plantar fascia. This can lead to stress on the plantar fascia where it attaches to the calcaneus. Small tears of the tendon can result and are repaired by the body.

Symptoms of Plantar Fasciitis
The symptoms of plantar fasciitis include pain in the center of the heel with weight bearing. This is usually most pronounced in the morning when the foot is first placed on the floor.

Diagnosis of Plantar Fasciitis
The diagnosis of plantar fasciitis is generally made on the history and physical examination. There are several conditions which can cause heel pain and plantar fasciitis must be distinguished from these conditions. An X–ray may be ordered to rule out a stress fracture of the calcaneus, and to see if a bone spur is present that is large enough to actually cause problems.

Treatment of Plantar Fasciitis
Supporting the arch with a well fitted arch support, or orthoses, may help reduce the pressure on the plantar fascia. A special type of insert into the shoe called a heel cup, can reduce the pressure on the sore area and add padding to a heel that has lost some of the fat pad through degeneration.

Anti–inflammatory medications are sometimes used to decrease the inflammation in the fascia and reduce your pain. An injection of cortisone into the area of the fascia is effective. Cortisone should be used sparingly due to the fact that this medication may contribute to the process of degeneration of the fat pad, actually making the problem worse.

• Surgery is a last resort in the treatment of heel pain/plantar fasciitis.
• Remove the bone spur (if present).
• Release the plantar fascia.
• Release pressure on the small nerves in the area.

Usually the procedure is done through a small incision on the side of the foot.

Surgery usually involves identifying the area where the plantar fascia attaches to the heel and releasing the fascia partially from the bone. If a small spur is present this is removed. The small nerves that travel under the plantar fascia are identified and released from anything that seems to be causing pressure on the nerves. This surgery can usually be done as an outpatient. The surgery can be done using a general anesthetic (where you are put to sleep) or some type of regional anesthetic. A regional anesthetic is a type of anesthesia where the nerves going to only a portion of the body are blocked. Injection of medications similar to Novocain are used to block the nerves for several hours.