Plantar fasciitis is a disorder that affects the connective tissue in the arch of your feet, called the plantar fascia. The disorder causes pain in your heel and along the bottom of your foot.
Most individuals afflicted with this condition experience their most severe pain while taking their first steps of the day.
Plantar fasciitis treatment may include rest, pain relief treatments, wearing a night splint and stretching exercises.
The plantar fascia is a thick bowstring shaped band of tissue that extends across the bottom of your foot. It connects the heel bone and the area just behind the toes (known as the metatarsal area).
The role of the plantar fascia is to support the arch of your foot. It also absorbs shocks transmitted from the ground due to the impacts while walking.
Although the fundamental cause of plantar fasciitis is far from clear in many cases, the proximate cause is known. It is due to the appearance of small tears in the plantar fascia.
The micro tearing of the plantar fascia eventually causes the development of inflammation and the condition known as plantar fasciitis.
Researchers believe that the trigger for the micro tearing is sometimes repeated pressure due to high impact activities like running. This would make plantar fasciitis one of the most commonly experienced repetitive stress injuries.
However, in other cases, the micro tearing of the plantar fascia can appear with no apparent cause.
Risk factors for chronic cases include the following:
Extensive participation in sports or other recreational activities that require plenty of running, jumping or other high impact activities;
Wearing old and worn out shoes that do not provide sufficient arch support. The risk is even high if you wear such shoes while participating in high impact activity. Wearing such shoes increases the work that must be done by the plantar fascia in supporting the arches of the feet;
Standing for long periods at a time (as required in certain jobs);
Having flat feet (fallen arches or pes planus). Excessively high arches (pes cavus) also appear to increase the risk of developing the disease;
Being overweight, as this increases the shocks transmitted through the plantar fascia ligament by even simple activities such as walking;
Age is also a risk factor, as most cases tend to appear between the ages of 40 and 60; and
Having an abnormal gait pattern that places too much stress on the plantar fascia over time.
Symptoms Of Plantar Fasciitis
The main symptom is pain along the bottom of the foot. This is usually the most severe when taking the first steps of the day.
The pain tends to have the following patterns:
People with plantar fasciitis usually complain that the pain is at its worst during the first few steps of the day;
The pain can also worsen when resuming regular activity after a period of daytime rest;
It is usually aggravated by high impact exercise. However, it tends to worsen after the activity has been completed instead of during it.
A possible long term complication of plantar fasciitis is the development of disorders elsewhere in the body. For example, problems may appear in the knees and back. This is a result of the patient changing his gait pattern to avoid the unpleasant foot pain of the condition.
Plantar fasciitis is marked by its particularly unpleasant pain and the possible long term complications. As a result, we suggest seeing a doctor for a diagnosis if you are experiencing the above symptoms.
To diagnose plantar fasciitis, your doctor will probably review your medical history and ask you questions about your symptoms. He or she may want to know what makes them worse or better, for example.
Your doctor may then need to palpate (examine by touch) the bottom of your foot. This will help him or her to understand the precise location of your foot pain.
That is usually all that is required. Imaging studies are usually unnecessary unless your doctor wants to rule out another condition with similar symptoms.
To treat plantar fasciitis, most doctors will probably suggest a non-invasive home care plan such as described below. If this does not relieve the problem, progressively more invasive steps may be taken.
Home based treatment of plantar fasciitis may include:
Resting the plantar fascia by avoiding high impact activities and allowing it to recover naturally;
Apply ice to the bottom of your foot every 2-3 hours for periods of around 20 minutes. Alternatively use a cold compress. This will help to reduce pain and swelling;
For additional pain control, use an OTC pain killer such as Tylenol. If you need to control both pain and inflammation, consider using non steroidal anti inflammatory drugs instead. Ibuprofen, Naproxen and aspirin are good examples.
Changing your footwear, if fallen arches is a contributing factor. Try using shoes with better arch support;
If your plantar fasciitis is related to poor arch support, consider using shoe inserts with your existing footwear. These may be purchased off the shelf or can be custom made;
If you are overweight, enrollment in a weight loss program will reduce the stress on the plantar fascia; and
Stretching or strengthening physical therapy exercises. These are intended to strengthen your foot muscles and improve the flexibility of calf muscles. We suggest 5 of these exercises here;
Non Invasive Physician Treatment
If the above steps do not relieve the pain, consult with your doctor. He or she may be able to administer the following treatments:
Cortisone injections into the plantar fascia to aggressively combat inflammation there. However, care needs to be taken with this treatment. If over used, it could damage or rupture the plantar fascia.
Doctors can also apply shock wave therapy by directing sound waves at the painful area in order to speed healing;
A new treatment option involves first inserting a needle-like instrument into the injured plantar fascia tissue. Ultrasonic energy is then used to vibrate the instrument rapidly to break up the damaged tissue. Finally, the damaged tissue is then suctioned out of the plantar fascia.
In the past, heel spurs were thought to be a contributory factor to plantar fasciitis. Surgery was done to remove heel spurs as part of the treatment.
However, heel spurs can exist in many patients with no plantar fasciitis signs. This surgical treatment is no longer pursued widely.
A second surgical treatment option is to detach the plantar fascia from the heel bone. This is considered a highly invasive treatment, however. Doctors will usually consider it only when all else has failed and the patient is in extreme pain.
For more discussion of potential treatments for plantar fasciitis, please read this post.
If you would like to avoid experiencing plantar fasciitis pain in the first place, consider the following steps;
Reduce your amount of high impact exercise or sports activity. Consider cross training by substituting low impact activities like swimming or cycling instead;
Maintain a healthy body weight;
Use shoes with high quality arch support, particularly when undertaking high impact activities; and
Avoid using old or worn out shoes with poor arch support.