Plantar fasciitis

Overview

Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of each foot and connects the heel bone to the toes, known as the plantar fascia.

Plantar fasciitis commonly causes stabbing pain that often occurs with your first steps in the morning. As you get up and move, the pain normally decreases, but it might return after long periods of standing or when you stand up after sitting.

The cause of plantar fasciitis is poorly understood. It is more common in runners and in people who are overweight.

Symptoms

Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually the worst with the first few steps after awakening, although it also can be triggered by long periods of standing or when you get up from sitting.

Causes

The plantar fascia is a band of tissue, called fascia, that connects your heel bone to the base of your toes. It supports the arch of the foot and absorbs shock when walking.

Tension and stress on the fascia can cause small tears. Repeated stretching and tearing of the facia can irritate or inflame it, although the cause remains unclear in many cases of plantar fasciitis.

Risk factors

Even though plantar fasciitis can develop without an obvious cause, some factors can increase your risk of developing this condition. They include:

• Age. Plantar fasciitis is most common in people between the ages of 40 and 60.
• Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing and aerobic dance — can contribute to the onset of plantar fasciitis.
• Foot mechanics. Flat feet, a high arch or even an atypical pattern of walking can affect the way weight is distributed when you're standing and can put added stress on the plantar fascia.
• Obesity. Excess pounds put extra stress on your plantar fascia.
• Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can be at increased risk of plantar fasciitis.

Complications

Ignoring plantar fasciitis can result in chronic heel pain that hinders your regular activities. You're likely to change your walk to try to avoid plantar fasciitis pain, which might lead to foot, knee, hip or back problems.

Diagnosis

Plantar fasciitis is diagnosed based on your medical history and physical exam. During the exam, your health care professional will check for areas of tenderness in your foot. The location of your pain can help determine its cause.

Imaging tests

Usually no tests are needed. Your health care professional might suggest an X-ray or MRI to make sure another problem, such as a stress fracture, is not causing your pain.

Sometimes an X-ray shows a piece of bone sticking out from the heel bone. This is called a bone spur. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain.

Treatment

Most people who have plantar fasciitis recover in several months with conservative treatment, such as icing the painful area, stretching, and modifying or staying away from activities that cause pain.

Medicines

Pain relievers you can buy without a prescription such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) can ease the pain and inflammation of plantar fasciitis.

Therapies

Physical therapy or using special devices might relieve symptoms. Treatment may include:

• Physical therapy. A physical therapist can show you exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles. A therapist also might teach you to apply athletic taping to support the bottom of your foot.
• Night splints. Your care team might recommend that you wear a splint that holds the plantar fascia and Achilles tendon in a lengthened position overnight to promote stretching while you sleep.
• Orthotics. Your health care professional might prescribe off-the-shelf or custom-fitted arch supports, called orthotics, to distribute the pressure on your feet more evenly.
• Walking boot, canes or crutches. Your health care professional might suggest one of these for a brief period either to keep you from moving your foot or to keep you from placing your full weight on your foot.

Surgical or other procedures

If more-conservative measures aren't working after several months, your health care professional might recommend:

• Injections. Injecting steroid medicine into the tender area can provide temporary pain relief. Multiple shots aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture. Platelet-rich plasma obtained from your own blood can be injected into the tender area to promote tissue healing. Ultrasound imaging during injections can assist in precise needle placement.
• Extracorporeal shock wave therapy. Sound waves are directed at the area of heel pain to stimulate healing. This is for chronic plantar fasciitis that hasn't responded to more-conservative treatments. Some studies show promising results, though this therapy hasn't been shown to be consistently effective.
• Ultrasonic tissue repair. This minimally invasive technology uses ultrasound imaging to guide a needlelike probe into the damaged plantar fascia tissue. The probe tip then vibrates rapidly to break up the damaged tissue, which is suctioned out.
• Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It is generally an option only when the pain is serious and other treatments have failed. It can be done as an open procedure or through a small incision with local anesthesia.

Lifestyle and home remedies

To reduce the pain of plantar fasciitis, try these self-care tips:

• Maintain a healthy weight. Extra weight can put extra stress on your plantar fascia.
• Choose supportive shoes. Buy shoes with a low to moderate heel, thick soles, good arch support and extra cushioning. Don't wear flats or walk barefoot.
• Don't wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet.
• Change your sport. Try a low-impact sport, such as swimming or bicycling, instead of walking or jogging.
• Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 minutes three or four times a day to help reduce pain and swelling. Or try rolling a frozen bottle of water under your foot for an ice massage.
• Stretch your arches. Simple home exercises can stretch your plantar fascia, Achilles tendon and calf muscles.

Preparing for an appointment

Your health care professional might refer you to someone who specializes in foot disorders or sports medicine.

What you can do

Make a list of:

• Your symptoms, and when they started.
• Key personal information, including your and your family's medical history and activities you do that could have contributed to your symptoms.
• Medicines, vitamins or other supplements you take, including doses.
• Questions to ask the health care team.

For plantar fasciitis, basic questions to ask your health care team include:

• What's likely causing my symptoms?
• What tests do I need?
• Is my condition likely temporary or chronic?
• What's the best course of action?
• Are there other treatment options than the one you're suggesting?
• Are there restrictions I need to follow?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your health care professional is likely to ask you questions, such as:

• Do your symptoms tend to occur at a specific time of day?
• What types of shoes do you usually wear?
• Are you a runner, or do you take part in any sports that involve running?
• Do you have a physically demanding job?
• Have you had problems with your feet before?
• Do you feel pain anywhere besides your feet?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?