Plantar Fasciitis

What causes heel pain? 

— One of the most common causes of heel pain is a problem called “plantar fasciitis.”

Plantar fasciitis is the term doctors use when a part of the foot called the plantar fascia gets irritated or swollen. The plantar fascia is a tough band of tissue that connects the heel bone to the toes.

Heel pain caused by plantar fasciitis is very common. It often affects people who run, jump, or stand for long periods. Most people who get this type of heel pain get better within a year even if they do not get treated.

What are the symptoms of plantar fasciitis? 

— The most common symptom is pain under the heel and sole (bottom) of the foot. It commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move more, the pain normally decreases, but it might return after long periods of standing or after rising from sitting.

Plantar fasciitis pain can also be bad when you get up after being seated for some time.

What causes Plantar Fasciitis?

Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension and stress on that bowstring become too great, small tears can arise in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed, though in many cases of plantar fasciitis, the cause isn’t clear.

What are the risk factors for the development of plantar fasciitis?

Though plantar fasciitis can arise without an obvious cause, factors that can increase your risk of developing plantar fasciitis include:

  • Age. Plantar fasciitis is most common between the ages of 40 and 60.
  • Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballistic jumping activities, ballet dancing and aerobic dance — can contribute to an earlier onset of plantar fasciitis.
  • Foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can affect the way weight is distributed when you’re standing and put added stress on the plantar fascia.
  • Obesity. Excess pounds put extra stress on your plantar fascia.
  • 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 their plantar fascia.

Is there anything I can do on my own to feel better?

 — Yes, you can:

If you are overweight, loosing weight will help.

Rest – Give your foot a chance to heal by resting. But don’t completely stop being active. Doing that can lead to more pain and stiffness in the long run.

Ice your foot – Putting ice on your heel for 20 minutes up to 4 times a day might relieve pain. Icing and massaging your foot before exercise might also help.

Do special foot exercises – Certain exercises can help with heel pain. Do these exercises every day.

Take pain medicines – If your pain is severe, you can try taking pain medicines that you can get without a prescription. Examples include ibuprofen and naproxen . But if you have other medical conditions or already take other medicines, ask your doctor or nurse before taking new pain medicines.

Wear sturdy shoes – Sneakers with a lot of cushion and good arch and heel support are best. Shoes with rigid soles can also help. Adding padded or gel heel inserts to your shoes might help, too.

Wear splints at night – Some people feel better if they wear a splint while they sleep that keeps their foot straight. These splints are sold in drugstores and medical supply stores.

Is there a test for plantar fasciitis? 

— No, there is no test. But your doctor or nurse should be able to tell if you have it by learning about your symptoms and doing an exam. He or she might suggest an X-ray, or other tests to check whether your symptoms might be caused by something else.

Sometimes an X-ray shows a spur of bone projecting forward 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.

How is plantar fasciitis treated?

— The first step is to try the things you can do on your own. But if you do not get better, or your symptoms are severe, your doctor or nurse might suggest:

Athletic Tape – taping your foot in a special way that helps the support the foot

●Special shoe inserts, made to fit your foot

Shots (that go into your foot) of a medicine called a steroid, which can help with the pain. Multiple injections aren’t recommended because they can weaken your plantar fascia and possibly cause it to rupture. More recently, platelet-rich plasma has been used, under ultrasound guidance, to provide pain relief with less risk of tissue rupture.

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. This procedure might cause bruising, swelling, pain, numbness or tingling. Some studies show promising results, but it hasn’t been shown to be consistently effective.

Tenex procedure. This minimally invasive procedure removes the scar tissue of plantar fasciitis without surgery. This procedure allows you to get back to your regular routine in as little as 10 days.

●Putting a splint over your foot and ankle in a way 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 and facilitates stretching.

●Surgery (this is an option only in some cases that do not get better with other treatments)

Some doctors also suggest a treatment called “shock wave therapy.” This treatment is painful and has not been proven to work.

Is there anything I can do to keep from getting heel pain again? 

— Yes. To reduce the chances that your pain will come back:

●Wear shoes that fit well, have a lot of cushion, and support the heel and ankle

●Avoid wearing slippers, flip-flops, slip-ons, or poorly fitted shoes

●Avoid going barefoot

●Do not wear worn-out shoes

This content was written by

Dr. Carlo Oller

Board Certified Emergency Physician

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