The plantar fascia is an inelastic band of tissue that originates on the bottom of the heel and radiates out into the arch and toes.  'Itis' is the Greek suffix added to the term to indicate inflammation of the fascia.  It's important to note that PF is a soft tissue condition and not a condition of bone.  The term heel spur is often misleading suggesting that the pain of PF due to a bone spur.  The symptoms of plantar fasciitis are the result of the tension between the heel bone and plantar fascia when the fascia is loaded (tightens when you stand). 

Plantar fasciitis is described as primary or secondary forms.

Primary plantar fasciitis: The function of the plantar fascia is quite complex, but primarily the fascia supports loads that are applied to the arch.  It's important to recognize that the plantar fascia is actually one part of a larger structure called the CT Band (calf/toes).  The CT Band includes the calf, Achilles tendon and plantar fascia.  The attachment of the plantar fascia to the bottom of the heel is the 'weakest link' in the CT Band.   

Load applied to the arch may vary with our activities. For instance, the duration of time on our feet, frequency of steps and body weight may vary on a day to day basis.  Additional biomechanical load is applied to the plantar fascia when the CT Band is tight.  If the combined load applied to the plantar fascia is greater than what it can accommodate, we develop a recurrent injury of the plantar fascia called primary plantar fasciitis. 

Secondary plantar fasciitis is any form of PF that is not the result of equinus.  Secondary PF may be due to direct trauma or systemic diseases such as rheumatoid arthritis.  

Treating Plantar Fasciitis

The treatment of primary PF is based upon weakening the load applied to the plantar fascia.   Doctors draw upon two fundamental categories of care when treating primary PF; mechanical changes and anti-inflammatories.  Treatment may include a number of different combination of these two categories including stretching, heel lifts, arch supports along with an oral or injectable anti-inflammatory.  90% of all cases respond to conservative care.  Additional care may include endoscopic surgical release or shock wave therapy.

When treating secondary plantar fasciitis, it is important to identify and treat the systemic cause of the condition.  For instance, if secondary PF is due to rheumatoid arthritis, treatment of the arthritis is indicated and will improve the symptoms of heel pain.  If secondary PF is due to trauma, care may include casting or a period of immobilization similar to the treatment of other sprains or fractures.