What is plantar fasciitis?
Plantar fasciitis is the most common cause of heel pain. The plantar fascia is the flat band of tissue, ligament, which connects your heel bone to your toes. It supports the arch of your foot. If you strain your plantar fascia, it gets weak, swollen, irritated and inflamed. Then your heel or the bottom of your foot hurts when you stand or walk. It is a painful inflammatory process of the plantar fascia, the connective tissue on the sole (bottom surface) of the foot. It is often caused by overuse of the plantar fascia or arch tendon of the foot. It is a very common condition and can be difficult to treat if not looked after properly. Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammation. Since tendons and ligaments do not contain blood vessels, they do not actually become inflamed. Instead, injury to the tendon is usually the result of an accumulation over time of microscopic tears at the cellular level.

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

Sometimes 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, also called capsulitis. The 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 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). A symptom commonly recognized among sufferers of plantar fasciitis is an increased probability of knee pains, especially among runners.

Plantar fasciitis is common in middle-aged people. It also occurs in younger people who are on their feet a lot, like athletes or soldiers. It can happen in one foot or both feet.

What causes plantar fasciitis?
Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling. This is more likely to happen if:
• Your feet roll inward too much when you walk
• You have high arches or flat feet
• You walk, stand, or run for long periods of time, especially on hard surfaces.
• You are overweight
• You wear shoes that don’t fit well or are worn out
• You have tight Achilles tendons or calf muscles

What are the symptoms?
Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time.

If you have foot pain at night, you may have a different problem, such as arthritis, or a nerve problem such as tarsal tunnel syndrome.

How is plantar fasciitis diagnosed?
We will check your feet and watch you stand and walk and ask questions about:
• Your past health, including what illnesses or injuries you have had.
• Your symptoms, such as where the pain is and what time of day your foot hurts most.
• How active you are and what types of physical activity you do.
We may take an X-ray of your foot if we suspect a problem with the bones of your foot, such as a stress fracture.

How is it treated?

No single treatment works best for everyone with plantar fasciitis. But there are many things you can try to help your feet get better:
• The as a Chiropractic physician we are uniquely trained and have specialized set of tools to treat these types condition. Though not everybody responds, those that do enjoy relief from their symptoms, return of normal gait, ability to walk further without discomfort.
• I treats the inflammatory response by utilization of physical medicine modalities to help reduce inflammation and tenderness as well as mobilize the joints and tissues. I use Iontophoresis, various forms of electromedicine, various forms of physical medicine, combined with the art of manipulation of both the osseous articulations, the bones of your foot, as well as, manipulation of the soft tissue and ligamentous structures. Most patients who respond to treatment have immediate relief from the very first therapy. However not everyone responds.
• Sometimes it is necessary in order to achieve a long-term relief to have specialized orthotics made to support the arch of your foot and correct your gait, the way you walk, so as to avoid future injury to the area which will result in a recurrence of the symptoms.
• At times to help reduce pain and swelling, try putting ice on your heel. Or take an over-the-counter pain reliever like ibuprofen (such as Advil or Motrin), naproxen (such as Aleve), or aspirin.
• I also prescribe specific exercises and toe stretches , calf stretches and towel stretches several times a day, especially when you first get up in the morning. In addition there may be specialized stretches for the ball of the foot utilizing various techniques to help stretch out the tissues as well as mobilize, to help prevent reoccurrence of the pain.
• It will be important to wear tennis shoes or shoes that give good arch support and a cushioned sole.
Each case must be evaluated independently and a specific treatment for each individual. Though many individuals have foot pain, plantar fasciitis, many times the causes of the pain differ. It’s important to relieve the pain and return normal mobility back to the patient’s feet, but once this is achieved it is paramount that what cause that condition in the first place is also treated, if not the pain will return.

How long will it take for the pain to go away?

Plantar fasciitis most often occurs because of injuries that have happened over time. With treatment, you will have less pain within a few therapies. But it may take time for the pain to go away completely. Every individual is different. Most patients have symptomatic relief within 3 to 5 therapies. However to properly treat the condition so it does not returned most patients require for up to six weeks worth of therapy. Many patients require orthotics, home exercise, and other types of support to help avoid the condition from returning. Stay with your treatment. If you don’t, you may have constant pain when you stand or walk. The sooner you start treatment, the sooner your feet will stop hurting.

The goals of treatment for plantar fasciitis are to:
• Relieve inflammation and pain in the heel.
• Allow small tears in the plantar fascia ligament to heal.
• Improve strength and flexibility and correct foot problems such as pronation so that you don’t stress the plantar fascia ligament.
• Allow you to go back to your normal activities.

Treatment that you start when you first notice symptoms is more successful and takes less time than treatment that is delayed.

Plantar Fasciitis: Exercises to Relieve Pain.
Avoid using only heat on your foot, such as from a heating pad or a heat pack for at least the first 2 or 3 days. Heat tends to make symptoms worse for some people. If you use contrast baths, which alternate hot and cold water, make sure you end with a soak in cold water. If you try a heating pad, use a low setting.
If your weight is putting extra stress on your feet, you may want to consider try a weight-loss program.

Ongoing treatment
If methods such as rest, ice, and stretching exercises, chiropractic manipulation, physical medicine treatments help relieve your plantar fasciitis symptoms, continue using them. If you have not improved after 6 weeks, you probably