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Plantar Fasciitis

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Updated May 16, 2014

X-ray of the heelbone with plantar fasciitis.
Lucien Monfils/Wikimedia Commons
What is the Plantar Fascia?

The plantar fascia is a thick fibrous band on the bottom of your foot. It is attached to the heel bone (calcaneus) and fans forward toward the toes. It acts like a bowstring and supports the arch and several muscles inside the foot.

What is Plantar Fasciitis?

When there is increased stress on the arch, microscopic tears can occur within the plantar fascia, usually at its attachment on the heel. This results in inflammation and pain with standing and walking and sometimes at rest. It usually causes pain and stiffness on the bottom of your heel.

Causes
  • Improper and / or non-supportive shoes
  • Over-training in sports (repetitive microtrauma)
  • Lack of flexibility (decreased ankle dorsiflexion)
  • Weight gain (pregnancy)
  • Obesity
  • Fat-pad atrophy (decreased cushion on bottom of heel)
  • Prolonged standing
  • Prolonged bed rest
  • Walking / running on hard surfaces
  • Biomechanical problems (flat feet, high arch feet)

Some people also have heel spurs on the bottom of their heels. It is not the spur that is causing the pain. Many people have heel spurs and no pain. Likewise, there are people who have plantar fasciitis who do not have heel spurs. The pain is due to the microtears in the plantar fascia, not the heel spur.

Symptoms
  • “first step” pain after getting out of bed or sitting
  • pain after driving
  • pain on the bottom inside of your heel
  • deep aching pain
  • pain is worse when barefoot

First step pain occurs because the plantar fascia is permitted to relax when you are not walking on it, but when you step down on it; the fascia is put on immediate stretch. A certain amount of activity is needed to get the area to warm up and the pain may go away for awhile, but by the end of the day the pain may come back.

Treatment

Icing and massage can be accomplished at the same time by taking a bottle filled with water, freezing the bottle and then rolling the bottom of your foot on it. Roll on top of the frozen water bottle for 5-10 minutes at least 2 times per day.

Plantar fasciitis is supposed to be a self-limiting condition, which means it should go away in 3-4 months. That is not always the case. 90% of patients get rid of plantar fasciitis after 1 year, but that means 10% of patients deal with it long term and need to learn to manage the symptoms.

Surgery is usually not needed, but when indicated it can be done endoscopically. Patients with a BMI (body mass index) of 27 or higher do not seem to benefit as much from surgery. No matter what treatment you undergo, the underlying causes of plantar fasciitis may remain, therefore you may need to continue with certain treatments for a long period of time.

Other Causes of Heel Pain
    • Plantar fascia rupture

Sometimes the plantar fascia does rupture. If you continue to exercise despite the symptoms, you may experience a sudden sharp pain on the bottom of your heel. You may not be able to stand on your toes and you may notice bruising in the arch. It is treated by immobilization in a cast boot for 2-6 weeks, a period of rest and physical therapy.

Another problem with prolonged and neglected plantar fasciitis is the development of a stress fracture from the constant traction of the fascia on the heel bone. This appears more commonly in osteoporotic women and is also treated with cast boot immobilization.

The nerves that course along the heel occasionally get inflamed by the thickening and inflammation of the nearby plantar fascia. These symptoms often feel like numbness and burning and usually resolve with physical therapy and injections. You should also be aware that heel numbness can be the first sign of a back problem.

Sources:

DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA, Murray JC, Wilding GE, Baumhauer JF. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am. 2003 Jul;85-A(7):1270-7.

May TJ, Judy TA, Conti M, Cowan JE. Current treatment of plantar fasciitis. Curr Sports Med Rep. 2002 Oct;1(5):278-84.

Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003 May;85-A(5):872-7.

Roxas M. Plantar fasciitis: diagnosis and therapeutic considerations. Altern Med Rev. 2005 Jun;10(2):83-93.

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