Plantar fasciitis (Plan – TAR fash – ee – I – tis) is the medical term used to describe the most common cause of heel pain. Plantar means bottom of the foot. Fascia is defined as a band of connective tissue, similar in composition to a ligament, which sits below the skin and separates different layers of tissue. “Itis” means inflammation. The plantar fascia originates on the bottom of the heel bone and extends towards the bases of the toes. Plantar fasciitis has been classically described as microscopic tearing and subsequent inflammation of the plantar fascia.
The problem with this terminology is that the inflammation generally only lasts for a few weeks. Most of the research has demonstrated that after this point, there is degeneration of the plantar fascia and very little inflammation. The plantar fascia is made of well-organized, longitudinally oriented collagen fibers. Degeneration means that the collagen bands become disorganized and some undergo chemical changes involving conversion to a gelatinous substance (myxoid degeneration) while the blood vessels which supply the area slowly decrease.
The reason the terminology is important is because the treatment protocols in the past have championed anti-inflammatory medications, icing and steroid injections. These are all anti-inflammatory measures and many patients will certainly respond to these treatments, especially in the early stages of plantar fasciitis. But, most patients will progress beyond this and will not only not improve, but many will worsen. Although this treatment protocol may be appropriate during the initial stages of the condition, long term treatment with anti-inflammatory measures alone may be simply masking symptoms and can potentially contribute to worsening of the condition.
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