Plantar fasciitis

What is it?

Plantar fasciitis is a painful inflammation of the plantar fascia, a fibrous band of tissue on the bottom of the foot that helps to support the arch. Plantar fasciitis occurs when this band of tissue is overloaded or overstretched. This causes small tears in the fibers of the fascia, especially where the fascia meets the heel bone.

Plantar fasciitis is common in obese people and in pregnant women, perhaps because their extra body weight overloads the delicate plantar fascia. It is also more common in people with diabetes, although the exact reason for this is unknown.

Plantar fasciitis also can be triggered by physical activities that overstretch the fascia, including sports (volleyball, running, tennis), other exercises (step aerobics, stair climbing), or household exertion (pushing furniture or a large appliance). In athletes, plantar fasciitis may follow intense training, especially in runners who push themselves too quickly to run longer distances.

Worn or poorly constructed shoes can contribute to the problem if they do not provide enough arch support, heel cushion, or sole flexibility.

Despite what is known about risk factors and triggers of plantar fasciitis, many people who develop this condition have no identifiable risk factors or trigger.

Symptoms

Symptoms of plantar fasciitis can occur suddenly or gradually. When they occur suddenly, there is usually intense heel pain on taking the first morning steps, known as first-step pain. This heel pain will often subside as you begin to walk around, but it may return in the late afternoon or evening. When symptoms occur gradually, a more long-lasting form of heel pain will cause you to shorten your stride while running or walking. You also may shift your weight toward the front of the foot, away from the heel.

Diagnosis

A health care professional will ask you whether you have the classic symptoms of first-step pain and about your activities, including whether you recently have intensified your training or changed your exercise pattern.

Your doctor often can diagnose plantar fasciitis based on your history and symptoms, together with a physical examination. If the diagnosis is in doubt, your doctor may order a foot X-ray, bone scan, or nerve conduction studies to rule out another condition, such as a stress fracture or nerve problem.

Expected duration

Once an appropriate treatment program begins, it may take six to eight weeks before the pain begins to be relieved. Total pain relief may not happen for several months.

Prevention

You can help to prevent plantar fasciitis by maintaining a healthy weight, by warming up before participating in sports, and by wearing shoes that support the arch and cushion the heel. In people who are prone to episodes of plantar fasciitis, exercises that stretch the heel cord (known as the Achilles tendon) and the plantar fascia may help to prevent plantar fasciitis from returning. Ice massage also can be used on the bottom of the foot after stressful athletic activities. It is possible that strict control of blood sugar will prevent plantar fasciitis in people with diabetes, although this has not been proven.

Treatment

Most doctors recommend an initial six-to-eight-week program of conservative treatment, including:

• rest, balanced with stretching exercises to lengthen the heel cord and plantar fascia
• ice massage to the bottom of the foot after activities that trigger heel pain
• avoidance of walking barefoot or wearing slippers or sandals that provide little arch support
• a temporary switch to swimming and/or bicycling instead of sports that involve running and jumping
• shoes with soft heels and insoles
• taping the bottom of the injured foot
• nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, and other brand names) or acetaminophen (Tylenol) for pain
• physical therapy using ultrasound, electrical stimulation with corticosteroids, or massage techniques.

If this conservative treatment does not help, your doctor may recommend that you wear a night splint for six to eight weeks. While you sleep, the night splint will keep your foot in a neutral or slightly flexed (bent) position to help maintain the normal stretch of the plantar fascia and heel cord.

If the night splint doesn't work, your doctor may inject corticosteroid medication into the painful area, or place your foot in a short leg cast for one to three months.

A number of unproven therapies have sometimes been recommended to treat plantar fasciitis. These include shock wave therapy, radiation therapy, botulinum toxin injections, laser therapy, and whole blood or platelet-rich plasma injections. Their benefit is uncertain and they are not considered standard or routine treatment options.

If all else fails, your doctor may suggest surgery. But this is rare, and surgery is not always successful.

When to call a professional

Call your doctor whenever you have significant foot or heel pain, especially if this pain makes it difficult for you to walk normally.

Prognosis

The outlook is excellent for most people with plantar fasciitis. At least 90% of patients respond either to the first six to eight weeks of conservative therapy, or to conservative therapy followed by six to eight weeks of wearing night splints.

Additional info

National Institute of Arthritis and Musculoskeletal and Skin Diseases
https://www.niams.nih.gov/

American Podiatric Medical Association (APMA)
https://www.apma.org/