Plantar fasciitis is a common condition in which patients complain of discomfort on the bottom of the heel. Classically, the pain is most noted the first thing in the morning on rising. The patients state that they can hardly walk for the first 5 or 10 steps, but after that it seems to diminish in intensity and they are able to go on with their day. However, later in the day, if they sit down in a chair and then stand up again, the same process repeats itself.

Historically, most patients have presented with these complaints to their general physician. They point to the bottom of their heel and often and x-ray is obtained, which shows an area of calcification-the so-called "heel spur." For years, physicians felt that this prominence of bone was the cause of the patients’ pain and many recommended removal of the spur. Now, anatomic studies have clearly shown that the spur is not the cause of the pain. The majority of these painful conditions are caused by the stretch of the inflamed plantar fascial fibers as they enter the bone on the bottom of the heel.

The plantar fascia is the anatomic structure on the bottom of the foot that inserts on the calcaneus and extends all the way out to the toes, giving the arch of the foot its normal tension. The causes of plantar fasciitis are felt to be age, trauma, or (in some cases) related to systemic disease such as rheumatoid arthritis or gout. Many cases however, occur spontaneously and there is no definite cause found.

The treatment of plantar fasciitis is primarily non-surgical. Statistical studies have shown that all of these problems will resolve in time. Unfortunately, some of the studies have shown that the symptoms can wax and wane for as long as three to four years. Most patients are advised to wait this out and avoid surgery if they possibly can.

Non-surgical treatment includes physical therapy, including instructions on stretching exercises as well as local heat and modality treatment. Other treatments include non-steroidal anti-inflammatory medications and shoe modifications. Any shoe modification that elevates the heel, such as small, inexpensive, over-the-counter heel lifts or cups is sufficient.

Surgical treatment is only recommended for cases that do not improve. Most authors feel that patients should try at least one year of conservative non-surgical treatment before considering surgery. The surgery consists of partial release of the plantar fascia at its attachment at the heel. Decompression of branches of local nerves in the area has also been recently recommended because of the feeling that pressure on the nerve might be implicated as a cause of the symptoms.