Plantar Fasciitis


Plantar fasciitis (PLAN-tar fash-e-I-tis) is a common cause of heel pain. With this condition, you have pain and inflammation of the plantar fascia, which is a thick band of tissue that runs along the bottom of the foot. Fig.1 The pain and inflammation can make walking difficult.

What Is the Plantar Fascia and What Causes the Pain?

The plantar fascia connects the calcaneus (heel bone) to the phalanges (toe bones). It acts as a shock absorber and arch support for the foot. Fig.2 When too much stress is applied to the plantar fascia at the heel bone, it develops tiny tears. When the plantar fascia is torn over and over, it becomes irritated and inflamed. Sometimes, a bone spur forms.

Who Is Affected?

Your age, activities, weight, foot mechanics, job, or shoes can put you at risk for developing plantar fasciitis. The condition can develop at any age, but it most commonly occurs between the ages of 40 and 60 years possibly because the shock-absorbing fat pad in the heel no longer provides enough padding. Before middle age, men and women are affected equally; however, during middle age, more women than men develop it. Participating in certain activities, such as running or prolonged standing or walking; being obese; having a high arch; or being flat-footed can place stress on the heel. Wearing shoes that do not provide good arch support or shock absorption or wearing high-heeled shoes can put you at risk for developing plantar fasciitis.

What Are the Symptoms?

Plantar fasciitis causes sharp pain in the inner part of the heel near the arch of the foot. The pain may be greatest when you take your first step in the morning and may decrease as you walk. However, the pain may return after you walk or stand for a long time or when you rise after sitting for a long time.

What Tests Will I Have?

The doctor may need to take images of your foot to help rule out other causes of pain, such as a stress fracture or bone spur. He or she may use x-rays, MRI, or ultrasound.

How Is It Treated?

Nonoperative

Nonoperative treatment helps most people get better within a few months. This type of treatment can include taking anti-inflammatory medications; stretching the calf muscles; Fig.3 icing the painful area; wearing a splint on your foot at night; having a cortisone injection; Fig.4 participating in physical therapy; or wearing an orthotic insert in your shoe. A walking cast or cast boot may be used to “rest” the fascia and arch for a few weeks. Fig.5 Your doctor may also suggest trying newer therapies that can reduce inflammation or promote healing of the plantar fascia.

Operative

Surgery to treat plantar fasciitis is used only if nonoperative treatment is not effective. This last-resort treatment involves partially releasing the plantar fascia from the heel bone, removing any bone spurs, and cutting away any tissue that is putting pressure on the nerves under the plantar fascia. Recovery takes several weeks, and the result is decreased stiffness in the arch. However, the treatment can lead to other foot problems.

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