Plantar fascitis (heel spur syndrome) is a common problem among people who are active in sports as well as among people who lead sedentary lives. It usually starts as a dull intermittent pain in the heel which may progress to a sharp persistent pain. Classically, it is worse in the morning with the first few steps, after sitting, after standing or walking, and at the beginning of sporting activity.

The plantar fascia is a thick fibrous material on the bottom of the foot. It is attached to the heel bone (calcaneus), fans forward toward the toes, and acts like a bowstring to maintain the arch of the foot. Although the cause of plantar fascitis is basically unknown, it is felt that tension in the plantar fascia causes an overload that produces an inflammation ususally at the point where the fascia is attached to the heel bone. The result is pain. Contributing factors are thought to be flat feet, high arched foot, poor shoe support, a change in activity level or obesity. The inflammatory reaction at the heel bone may produce spike-like projections of new bone called heel spurs. They sometimes show on xray. They do not cause the initial pain, nor do they cause the initial problem; they are the result of the problem. Following treatment, when the pain is gone, the "heel spur" can still be seen on xray.

Treatment
Many treatments have been recommended for plantar fascitis including rest, ice, medication, cortisone shots in the heel, physical therapy, heel pads, special shoes, arch supports, taping and surgery.

Recent studies show that wearing a comfortable jogging shoe, wearing a soft inexpensive arch support and vigorously stretching the calf muscles three times a day will cause the problem to resolve in 85% of patients within 12 weeks. Stretching the calf muscle is by far the most important part of the treatment.

Summary
Plantar fascitiitis (heel spur syndrome) is probably due to tension and inflammation of the plantar fascia although the specific cause is unproven. A vigorous program of calf stretching, wearing a comfortable shoe, and a simple soft arch support will result in relief of the pain within twelve weeks in 85% of patients.