1) Disease Description (Causes and Symptoms)
- Definition: Plantar fasciitis is a condition that causes heel pain when repeated overloading causes microdamage, inflammation, or degenerative changes in the plantar fascia, a thick band of fibrous tissue that begins at the calcaneus (heel bone) and extends toward the front of the sole.
- Main causes: Excessive walking, running, or jumping (such as climbing stairs, hiking, jogging, and aerobics), a sudden increase in exercise volume, obesity (in middle-aged people), inappropriate footwear (hard soles, heels that are too low, or shoes that are too tight), high heels, flat feet or high arches, trauma, and underlying diseases such as diabetes or arthritis. The incidence is higher in women than in men (approximately twice as high).
- Pathophysiology: Repeated tension causes microtears and fibrosis (degenerative changes) in the plantar fascia. An inflammatory response may accompany the acute phase, but as the condition becomes chronic, signs of inflammation decrease and degenerative changes predominate. If shortening of the Achilles tendon is present, additional stress is placed on the plantar fascia.
- Typical symptoms: Severe heel pain, particularly in the medial heel area, and localized tenderness when taking the first step in the morning or during the first few steps after a long period of rest. As the condition progresses, pain worsens after prolonged walking or exercise. Atrophy of the heel fat pad or shortening of the Achilles tendon may also occur.
- Differential diagnosis: Plantar fat-pad atrophy, retrocalcaneal bursitis, calcaneal (heel-bone) stress fracture, Achilles tendon rupture/tendinitis, neuropathy, or neuroma.
2) Treatment Methods
- Conservative treatment (effective in most patients; recovery in approximately 90% or more)
- Rest and activity modification: Reduce activities that provoke pain (such as long-distance running and jumping) and replace them with low-impact exercise (swimming and cycling).
- Weight management: Reduce the load on the feet through weight loss.
- Footwear and assistive devices: Wear roomy shoes with cushioning and a slight heel. Custom insoles (orthotics) may be prescribed depending on whether the patient has flat feet or high arches.
- Plantar fascia and Achilles stretching: Perform regular stretching and massage several times a day, as well as self-acupressure.
- Night splint: Keep the plantar fascia stretched overnight to reduce morning pain — continuous use for 2–3 months is generally recommended.
- Taping (Achilles/plantar fascia taping) and silicone heel cups: May help relieve acute pain.
- Physical therapy: Manual therapy may be performed together with adjunctive treatments such as contrast baths, ultrasound, and electrotherapy.
- Medication: Short-term pain control with nonsteroidal anti-inflammatory drugs (NSAIDs) (in the early stage when inflammatory pain is suspected).
- Interventional treatment
- Steroid injections: Used on a limited basis — although effective, they should be used cautiously because repeated injections carry a risk of plantar fascia rupture and heel fat-pad atrophy.
- Extracorporeal shock wave therapy (ESWT): Considered when there is no response to conservative treatment — pain improvement has been reported in some patients.
- PRP (platelet-rich plasma) and others: May be considered selectively because study results vary.
- Surgical treatment
- If severe pain and functional impairment persist despite at least 6 months of conservative (non-surgical) treatment, surgery such as partial fasciotomy (plantar fascia release) may be considered. Postoperative complications, including sensory abnormalities, wound problems, and insufficient symptom relief, are possible.
- Precautions, risk of complications, and self-care considerations
- Repeated steroid injections can cause plantar fascia rupture and fat-pad atrophy, so they should be minimized.
- If the pain is severe, do not force yourself to continue activities; discuss the treatment plan with a doctor.
- Long-term weight loss, wearing appropriate footwear, and regular stretching are necessary to reduce recurrence.
- If the condition becomes chronic, changes in gait may place additional stress on other joints (the knees, hips, and lower back).
3) Checklist Before an Outpatient Visit (Including Example Questions)
- Items to prepare (recommended to bring)
- A list of medications currently being taken (including anticoagulants and antiplatelet agents) and a history of allergies.
- A history of previous orthopedic treatment, physical therapy, or injection treatment (when and what treatment was received).
- Recent photos of shoes (shoes usually worn) and whether insoles are being used.
- A pain diary (when the pain is severe, pain with the first step in the morning, after activity, pain intensity (VAS), and duration).
- Results of previous tests, if available (X-ray, ultrasound, MRI, etc.).
- Information to provide to the doctor during the outpatient visit
- When the symptoms began and their course (acute vs. gradual), aggravating factors, and relieving factors.
- Occupation (whether standing for long periods), and exercise habits (amount of exercise per week and types of exercise).
- Items the doctor may ask about during the outpatient visit
- Location of the pain (exact location), foot shape (flat feet or high arches), nighttime/morning pain patterns, and response to previous treatment.
4) Examples of General Questions to Ask the Doctor
- What are the expected effects and common side effects of this medication (or injection)?
- What is the prognosis for my condition, and how long does recovery usually take?
- What activities should I avoid in daily life, and what exercises are recommended?
- When do you recommend additional tests (X-ray, ultrasound, or MRI)?
- How long should I continue conservative treatment (footwear modification, insoles, stretching, etc.) consistently?
5) Examples of Condition-Specific Questions
- Would custom insoles (orthotics) designed for my foot shape (flat feet/high arches) be helpful? If needed, what type would you recommend?
- I have already received a steroid injection, but the pain has recurred. Is another injection safe, or should other interventions (ESWT or PRP) be considered?
End.