Table 1 Etiologies of Plantar Heel Pain
Achilles tendon and the plantar fascia are anatomically connected, stretching the Achilles and gastrocnemius will help with symptoms of plantar fasciitis. Indeed, very strong association exists between patients with plantar fasciitis and those with isolated gastrocnemius tightness, suggesting that managing gastrocnemius tightness may be effective at alleviating symptoms of plantar fasciitis.8 Although Achilles tendon stretching programs alone may provide some symptom relief, tissue-specific plantar fascia stretching programs in combination with Achilles tendon stretching programs are markedly more effective at improving plantar fasciitis symptoms.9,10 Furthermore, a tissue-specific plantar fascial stretching program, on its own, has been demonstrated to be more effective in relieving pain symptoms and improving function than an Achilles tendon stretching program alone among patients with chronic plantar fasciitis.7,11 Custom orthoses are not required for most patients, and the use of an over-the-counter orthotic device can provide symptomatic relief by splinting the plantar fascia and gathering the heel pad fat, thereby decreasing the contact of the irritated plantar fascia with the weight-bearing surface.12 Oral NSAIDs also are helpful for symptom relief.
value of treating plantar fasciitis through an isolated open partial or complete release is uncertain.20 Denervation of the heel, including division of the calcaneal nerves, also has been attempted. Division of only the medial plantar fascia has had variable outcomes. With the advent of endoscopy, partial release of the plantar fascia has been recommended but can lead to complications including laceration of the tibial nerve or vascular structures.22