Plantar fasciitis is a painful condition involving the thick band of tissue (fascia) on the bottom of the foot. The fascia connects the heel bone to the toes and creates the arch of the foot, working like a rubber band between the heel and the bones in the ball of the foot. A fascia that is short forms a high arch; if it is long, it creates a low arch or flat foot. A pad of fat in your heel covers the fascia to absorb the shock of walking.
When the fascia is overstretched or overused, the tissue becomes irritated and inflamed, causing excruciating pain and difficulty walking. It was commonly thought heel spurs caused plantar fasciitis, but researchers found this is not the case. Heel spurs occur in people with or without plantar fasciitis.
One of the most common orthopedic foot complaints, plantar fasciitis occurs in men and women, but most often affects active men ages 40–70. You are more likely to experience it if you already have arch problems or flat feet, or if you are obese or gain weight suddenly. Other causes include a tight Achilles tendon or wearing shoes with poor arch support or soft soles. Performing aerobic sports such as ballet, long-distance running or dance aerobics places you at risk. Those in occupations that require walking or standing on hard surfaces all day are at risk.
As we age, the plantar fascia becomes less elastic and the fat pad on the heel becomes thinner and unable to absorb as much shock. The extra shock damages the fascia and causes it to swell, tear or bruise.
The most common symptoms are sharp or dull pain and stiffness in the bottom of the heel. The bottom of the foot may also ache or burn. Pain is usually worse when you take your first steps in the morning, after standing or sitting for a while, when climbing stairs and after intense activity. The pain may develop over time or occur suddenly after intense activity.
Left untreated, plantar fasciitis may cause chronic heel pain, hindering regular activities. If you change the way you walk to minimize the pain, you may develop foot, knee, hip or back problems. Your health care provider may refer you to a podiatrist or an orthopedist who specializes in sports injuries.
Your specialist will perform a physical exam to assess your foot for tenderness on the bottom and the heel, flat feet or high arches, mild swelling or redness, or stiffness or tightness of the arch. X-rays can rule out problems such as a stress fracture or pinched nerve.
Initial treatment includes using acetaminophen (Tylenol), ibuprofen (Advil, Motrin) or naproxen (Aleve) to reduce pain and inflammation, along with resting as much as possible for a least a week. Physical therapy may be recommended, with exercises to stretch the plantar fascia and Achilles tendon and strengthen lower leg muscles to stabilize your ankle and heel. Your provider may show you how to apply athletic taping to support the bottom of your foot or may recommend wearing a splint that stretches your calf and arch while you sleep; off-the-shelf heel cups, cushions or custom-fitted arch supports can help distribute pressure to your feet more evenly.
Most people who have plantar fasciitis recover with conservative treatments in just a few months. When conservative measures don’t work, you may need steroid injections, shock wave therapy or surgery. Injecting a steroid into the tender area of the heel can provide temporary pain relief. Multiple injections are not recommended because they can weaken your plantar fascia and cause it to rupture, as well as shrink the fat pad on your heel. Extracorporeal shock wave therapy directs sound waves at the area of pain to stimulate healing. It may cause bruises, swelling, pain, numbness or tingling and has not been shown to be consistently effective. Few people need surgery to detach the plantar fascia from the heel bone. It is generally an option only when the pain is severe and all else fails, as it can weaken the arch.
Plantar fasciitis self-care tips:
- Maintain a healthy weight to minimize stress on your feet.
- Wear supportive shoes. Avoid high heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency. Don’t go barefoot, especially on hard surfaces.
- Replace athletic shoes before they stop supporting and cushioning your feet. If you’re a runner, buy new shoes after 500 miles of use.
- Try a low-impact sport such as swimming or bicycling instead of walking or jogging.
- Apply a cloth-covered ice pack over the painful area for 15 to 20 minutes three or four times a day or after activity.
- Regular ice massage reduces pain and inflammation. Freeze a water-filled paper cup or full bottle of water and roll it over the site for five to seven minutes.
- Stretch your plantar fascia, Achilles tendon and calf muscles with simple exercises. (See the American Orthopaedic Foot & Ankle Society website.)
The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition.
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