Plantar Faciitis

The plantar fascia is the thick tissue on the bottom of the foot that connects the heel bone to the toes, creating the arch of the foot. When this tissue becomes swollen or inflamed, it is called plantar fasciitis. 

Plantar fasciitis is particularly common in runners. In addition, people who are overweight and those who wear shoes with inadequate support are at risk of plantar fasciitis.

Most patients feel better in 9 months with non-surgical treatments. However, some people need surgery to relieve the pain.

The most common symptom is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn.

Plantar faciitis pain often develops gradually, however, it can come on suddenly after intense activity.

The pain is often worse in the morning or after standing or sitting for a while. Climbing stairs and other activities can also worsen pain.

Plantar fasciitis occurs when the thick band of tissue on the bottom of the foot is overstretched or overused. This can be painful and make walking more difficult.

You are more likely to get plantar fasciitis if you:

• Have foot arch problems (both flat feet and high arches)
• Are a long-distance runner
• Are obese or you experience sudden weight gain
• Have a tight Achilles tendon (the tendon connecting the calf muscles to the heel)
• Wear shoes with poor arch support or soft soles
• Change your activities

Plantar fasciitis is seen in both men and women. However, it most often affects active men ages 40 - 70. It is one of the most common orthopedic foot complaints.

Plantar fasciitis was commonly thought to be caused by a heel spur. However, research has found that this is not the case. On x-ray, heel spurs are seen in people with and without plantar fasciitis.

The health care provider will perform a physical exam. This may show:

• Tenderness on the bottom of your foot
• Flat feet or high arches
• Mild foot swelling or redness
• Stiffness or tightness of the arch in the bottom of your foot.

X-rays may be taken to rule out other problems.

To reduce the pain of plantar fasciitis, try to maintain a healthy weight to minimize stress on the plantar fascia.

Avoid going barefoot and purchase shoes with low heels, arch support and shock absorbency.

Runners should replace running shoes after every 500 miles of use.

Walking and jogging are high impact. Try swimming or other low-impact activities.

To reduce pain and inflammation, try applying ice to the area of pain after activities.

Stretching arches and calf muscles can be beneficial.

Your health care provider will often recommend these steps first:

• Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation
• Heel and foot stretching exercises
• Night splints to wear while sleeping to stretch the foot
• Resting as much as possible for at least a week
• Wearing shoes with good support and cushions

Other steps to relieve pain include:

• Apply ice to the painful area. Do this at least twice a day for 10 - 15 minutes, more often in the first couple of days.
• Try wearing a heel cup, felt pads in the heel area, or shoe inserts.
• Use night splints to stretch the injured fascia and allow it to heal.

If these treatments do not work, your health care provider may recommend:

• Wearing a boot cast, which looks like a ski boot, for 3 - 6 weeks. It can be removed for bathing.
• Custom-made shoe inserts (orthotics)
• Steroid shots or injections into the heel

Sometimes, foot surgery is needed.

Nonsurgical treatments almost always improve the pain. Treatment can last from several months to 2 years before symptoms get better. Most patients feel better in 9 months. Some people need surgery to relieve the pain.