Plantar Fascitis (Heel Pain)

Plantar fasciitis is one of the most common causes of heel pain. It involves inflammation of a thick, weblike band of tissue (ligament) that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia). Plantar fascia acts as a shock absorber and supports the arch of your foot, helping you walk.

Your plantar fascia ligaments experience a lot of wear and tear in your daily life. Plantar fasciitis commonly causes stabbing pain that usually 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.

Plantar fasciitis is more common in runners. People who are overweight and those who wear shoes with inadequate support also have an increased risk of plantar fasciitis.

Contents

Overview

What are the symptoms of plantar fasciitis?

Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. It usually affects just one foot, but it can affect both feet.

Pain from plantar fasciitis develops gradually over time. The pain can be dull or sharp. Some people feel a burning or ache on the bottom of the foot extending outward from the heel.

The pain is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or when you get up after sitting. The pain is usually worse after exercise, not during it

Why does plantar fasciitis occur?

Your plantar fascia is in the shape of a bowstring, supporting the arch of your foot and absorbing shock when you walk. If tension and stress on this bowstring become too great, small tears can occur in the fascia. Repeated stretching and tearing can irritate or inflame the fascia, although the cause remains unclear in many cases of plantar fasciitis.

Who all are at risk for plantar fasciitis?

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

• Age and Sex. Plantar fasciitis is most common between the ages of 40 and 60. It’s also slightly more common in women than men. Women who are pregnant often experience bouts of plantar fasciitis, particularly during late pregnancy.
• 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 abnormal pattern of walking can affect the way weight is distributed when you’re standing and can put added stress on the plantar fascia. Tight Achilles tendons, which are the tendons attaching your calf muscles to your heels, may also result in plantar fascia pain. Simply wearing shoes with soft soles and poor arch support can also result in plantar fasciitis.
• Obesity. Excess pounds put extra stress on your plantar fascia, especially if you have sudden weight gain.
• 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 damage the plantar fascia.

Note: Plantar fasciitis isn’t typically the result of heel spurs. Doctors used to believe that heel spurs caused pain in people with plantar fasciitis, but this isn’t the case.

Complications

Ignoring plantar fasciitis may result in chronic heel pain that hinders your regular activities. Changing the way you walk as a way to relieve plantar fasciitis pain might lead to foot, knee, hip or back problems.

How is it diagnosed?

Medical history and physical examination

Plantar fasciitis is diagnosed based on your medical history and physical examination. During the exam, your doctor will check for areas of tenderness in your foot. The location of your pain can help determine its cause. Also, they may ask you to flex your foot while they push on the plantar fascia to see if the pain gets worse as you flex and better as you point your toe. They’ll also note if you have mild redness or swelling.

Your doctor will evaluate the strength of your muscles and the health of your nerves by checking your:

• reflexes
• muscle tone
• sense of touch and sight
• coordination
• balance

Imaging tests

Usually, no tests are necessary. Your doctor might suggest an X-ray or magnetic resonance imaging (MRI) to make sure another problem, such as a stress fracture, is not causing you pain.

Sometimes an X-ray shows a piece of bone sticking out (spur) from the heel bone. 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.

What are the treatment options available?

Most people who have plantar fasciitis recover in several months with conservative treatment, including resting, icing the painful area and stretching.

Medications

Pain relievers such as ibuprofen and naproxen may ease the pain and inflammation caused by plantar fasciitis.

Therapies

Stretching and strengthening exercises or using special devices may relieve symptoms. They include:

• Physical therapy. A physical therapist can show you a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles. A therapist might also teach you to apply athletic taping to support the bottom of your foot.
• Night splints. Your physical therapist or doctor might recommend that you wear a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight to promote stretching.
• Orthotics. Your doctor might prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.

Surgical or other procedures

If more-conservative measures aren’t working after several months, your doctor might recommend:

• Injections. Injecting steroid medication 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. Using ultrasound imaging, platelet-rich plasma obtained from the patient’s own blood can be injected to promote tissue healing.
• Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It’s usually used for chronic plantar fasciitis that hasn’t responded to more-conservative treatments. Some studies show promising results, but it 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. Using ultrasound energy, the probe tip vibrates rapidly to break up the damaged tissue, which is then 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 severe or lasts more than 6-12 months and other treatments have failed.
  • It can be done as an open procedure or through a small incision with local anesthesia.
  • In a plantar fascia release, your surgeon partially detaches the plantar fascia from the heel bone.
  • This reduces tension, but weakens the arch of the foot, and full function may be lost.
  • Surgery can result in chronic pain and nerve damage, so it should be considered only after trying other treatment options.

Are there any home remedies?

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

• Maintain a healthy weight. Carrying 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 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. Icing can help reduce pain and inflammation.
• Stretch your arches. Simple home exercises can stretch your plantar fascia, Achilles tendon and calf muscles.
  • Gentle stretches can help relieve and even prevent plantar fasciitis. Stretching your calves and the plantar fascia itself helps loosen your muscles and reduce heel pain.
  • It’s important to take time off from certain exercises, like running, to give the plantar fascia time to heal. Swimming and other low-impact activities can let you exercise without worsening your heel pain. When you start running again, be sure to begin slowly.
  • Stop and stretch while exercising to keep the pain from returning. Remember to stretch before beginning your workouts, too.

Is there any difference between plantar fasciitis and heel spur?

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A heel spur is a hook of bone that can form on the heel bone, or calcaneus, of the foot. Like plantar fasciitis, it can develop from long-term stress on your feet. An orthopedic surgeon or a podiatrist can diagnose a heel spur with an X-ray.

People often assume that foot pain is caused by a heel spur, but this usually isn’t true. Heel spurs often cause no symptoms.

According to the American Association of Orthopaedic Surgeons (AAOS), 1 in 10 people has a heel spur, but only 1 in 20 people with heel spurs experiences pain. Conversely, the Cleveland Clinic reports that 50 percent of people who have heel spurs feel pain because of the heel spur.

Heel spurs share similar causes with plantar fasciitis. Some of these include:

• unsupportive or worn-out shoes
• being overweight
• arthritis
• walking with an incorrect or unnatural gait

Having plantar fasciitis also increases your likelihood of forming heel spurs. Although heel spurs won’t heal without surgery, they typically don’t cause any pain or other symptoms. As a result, surgery usually isn’t needed.

You can treat heel spurs close to the same way you would treat plantar fasciitis. Rest and use ice, pain medications, and shoe inserts to reduce any symptoms.

Outlook

Most people don’t need surgery to relieve pain from plantar fasciitis. Instead, their condition improves through physical therapy, home treatments, and medical treatments. However, treatment can take several months to 2 years to improve your symptoms.

Courtesy. Mayo Clinic and Healthline