Plantar Fascitis

A few weeks ago my dad complained about in his left heel. He said that this pain always attack in every morning. And a few days ago my mom also complained about the same thing. But the differences is she feels the pain in her right heel.  My dad is 53 years old and my mom is 50 years old. I was wondering if they had a plantar fasciitis. Then I found out about it.
Common Causes of Heel Pain

Heel pain is an extremely common complaint, and there are several common causes. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the cause. If you have heel pain, some causes include:

• Plantar fasciitis, it is the most common condition that causes heel pain. Plantar fasciitis is due to irritation and inflammation of the tight tissue that forms the arch of the foot. Common symptoms of plantar fasciitis include heel pain with prolonged walking and standing.
• Heel Spur, a spur is commonly associated with plantar fasciitis. This problem is most commonly seen in patients who have long standing heel pain due to plantar fasciitis.
• Tarsal Tunnel Syndrome, Tarsal tunnel syndrome causes a large nerve in the back of the foot to become entrapped, or pinched. Similar to carpal tunnel syndrome in the hand, tarsal tunnel syndrome can cause heel pain.
• Stress Fractures, Stress fractures of the calcaneus are an uncommon cause of heel pain. Stress fractures should be considered especially in athletes such as long distance runners who have heel pain.
• Posterior Heel Pain, Posterior heel pain causes symptoms behind the foot, rather than underneath. Posterior heel pain causes include Achilles tendonitis and retrocalcaneal bursitis. Learn about causes of posterior heel pain and what treatments are available.

Because Plantar Fascitis is the most common condition that causes heel pain, so I focus to find out about it.

What is Plantar Fascitis?
Plantar fasciitis is the most common cause of heel pain for which professional care is sought. Various terms have been used to describe it including jogger's heel, tennis heel, Policeman's heel, and an outdated term, gonorrheal heel, which reflected the old thought that it was somehow related to that sexually transmitted disease.
Why did my mom and dad get plantar fasciitis?

The plantar fascia originates on the medial tubercle of the calcaneus and fans out over the bottom of the foot to insert onto the proximal phalanges and the flexor tendon sheaths. It forms the longitudinal arch of the foot and functions as a shock-absorber as well an arch support. The term fasciitis may be somewhat of a misnomer because the disease is actually a degenerative process with or without inflammatory changes, which may include fibroblastic proliferation. This has been proven from biopsies of fascia from people undergoing surgery for plantar fascia release. It is commonly believed to be caused by repetitive microtrauma to the fascia.
Plantar fasciitis occurs because of irritation to the thick ligamentous connective tissue that runs from the heel bone to the ball of the foot. This strong and tight tissue contributes to maintaining the arch of the foot. It is also one of the major transmitters of weight across the foot as you walk or run. Therefore, the stress placed on the this tissue is tremendous.
When a patient has plantar fasciitis, the connective tissue that forms the arch of the foot becomes inflamed (tendonitis) and degenerative (tendinosis)--these abnormalities cause plantar fasciitis and can make normal activities quite painful.
Symptoms of plantar fasciitis are typically worsened early in the morning after sleep. At that time, the arch tissue is tight and simple movements stretch the contracted tissue. As you begin to loosen the foot, the pain usually subsides, but often returns with prolonged standing or walking.
Who gets plantar fasciitis?

Plantar fasciitis is most often seen in middle-aged men and women, but can be found in all age groups. Plantar fasciitis is diagnosed with the classic symptoms of pain well localized over the heel area of the bottom of the foot. Often the pain from plantar fasciitis is most severe when you first stand on your feet in the morning. Pain often subsides quite quickly, but then returns after prolonged standing or walking.
Plantar fasciitis is sometimes, but not always, associated with a rapid gain of weight. Plantar fasciitis is also sometimes seen in recreational athletes, especially runners. In these athletes, it is thought that the repetitive nature of the sports causes the damage to the fibrous tissue that forms the arch of the foot.
What is the best workup for it?
Plantar fasciitis is diagnosed with the classic symptoms of pain well localized over the heel area of the bottom of the foot. But if you need a workup, the best workup for plantar fasciitis is plain radiographs. Plain radiographs can be used to detect calcaneal stress fractures and other bony lesions. MRI is also can detect plantar fasciitis, plantar fascia thickening and surrounding edema can be detected on MRI. But it is so expensive. 
Laboratory studies are not needed if plantar fasciitis is suspected. However, laboratory tests may be used to investigate other causes of heel pain if suspected.
Ultrasonography, although rarely used, can aid in the diagnosis of plantar fasciitis. A marked increase in the thickness of the fascia (5-7 mm; normally 2-4 mm thick) may be noted. Other signs seen on sonogram include hypoechogenicity and edema of the fascia where it inserts into the calcaneus as well as loss of definition between the fascia and the surrounding soft tissue.
What are the treatments for plantar fasciitis?
For the Prehospital Care, ACE wraps may help keep the patient's foot immobilized in case of other injury. For the Emergency Department Care, Medical care in the ED should consist of patient education  and nonsteroidal anti inflammatory drugs (NSAIDs).

What are the medications for plantar fasciitis?
The goals of pharmacotherapy in patients with plantar fasciitis are to reduce morbidity and prevent complications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are indicated to treat this disorder. They should be used for 2-4 weeks.
Nonsteroidal anti-inflammatory drugs (NSAIDs)  
These agents decrease inflammatory responses and systemically interfere with events that lead to inflammation.Ibuprofen (Advil, Motrin) Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. Used for analgesia and anti-inflammatory effect.

• Adult: 200-800 mg PO q6-8h
• Pediatric: 4-10 mg/kg PO q6-8h; not to exceed 50 mg/kg/d

Corticosteroids
These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli. Methylprednisolone (Depo-Medrol) Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

• Adult 40 mg intralesionally is typical dose
• Pediatric Not established

What should I say to my mother and father about their complaint?
I will tell them about some education about plantar fasciitis and give some advice to them like:

• Wear shoes with adequate arch support and cushioned heels. Discard old running shoes and wear new ones.
• Avoid long periods of standing.
• Lose weight.
• Do not exercise on hard surfaces.
• Avoid walking barefooted on hard surfaces.
• Avoid high-impact sports, such as aerobics and volleyball, which require a lot of jumping.
• Go to the doctor to know about specific treatment for their condition.
• Stretch the plantar fascia and Achilles tendon, especially before participating in exercise.
• Use NSAIDs for pain.

References:
Cluett, Jonathan. Heel Pain. http://orthopedics.about.com Updated January 02, 2009.
Cluett, Jonathan. Plantar Fascitis. http://orthopedics.about.com Updated August 20, 2008.
Singh, Deepika. Plantar Fascitis in Emergency Medicine. http://emedicine.medscape.com Updated Dec 6, 2010.