Plantar fasciitis is a common cause of heel pain that is characterized by the inflammation of the plantar fascia, a thick band of connective tissue (ligament) that runs from the heel bone to the toes. Plantar fasciitis typically causes a stabbing pain in the bottom of the heel and/or middle of the foot, often presenting in the morning as the first steps are taken or after prolonged sitting or lying down. Because the plantar fascia ligaments experience daily wear and tear, they can easily become inflamed and cause the stiffness associated with plantar fasciitis. It is a common ankle and foot disorder.
Plantar fasciitis pain usually decreases as the patient moves and is typically not bothersome during exercise, however, it is not unusual for the pain to worsen after exercise. Most patients who experience plantar fasciitis are affected in only one foot, but it is possible for both feet to have plantar fascia pain.
What Causes Plantar Fasciitis?
The plantar fascia is shaped similarly to a bowstring and supports the arch of the foot, acting as a shock absorber as we walk. When excessive tension or stress is placed on the plantar fascia, small tears can occur. Over time, repeated tearing can cause the plantar fascia to become irritated and inflamed. In many cases, the exact cause of plantar fasciitis is unclear, however, certain risk factors can increase the likelihood of developing the condition.
Rick factors for plantar fasciitis include:
- Obesity: Carrying excess weight can overstress the plantar fascia.
- Age: Wear and tear over time can lead to tears in the plantar fascia. Plantar fasciitis presents most commonly in patients between the ages of 40-60.
- Certain activities: Repetitive impact activities, such as ballet or aerobic dance and long-distance running, can place stress on the heel and the attached tissue.
- Uneven weight distribution on the foot: Abnormal walking patterns, high arch, or flat feet can contribute to heel pain.
- Tight Achilles tendon: The tendon that attaches the heel to the calf muscles can become tight and cause stress on the plantar fascia.
- Poor arch support: Shoes with soft soles or those with little arch support can be factors in plantar fascia pain.
Diagnosing and Treating Plantar Fasciitis
Diagnosing plantar fasciitis often includes ruling out alternative causes of heel pain. Your podiatrist may utilize x-rays to determine if arthritis or fractures are contributing to the condition.
A thorough examination of the affected heel will likely involve looking for common signs of plantar fasciitis, such as:
- High arch
- Tenderness at the bottom of the foot in front of the heel bone
- Range of motion limitations while flexing the ankle upward
- Pain while flexing as doctor presses the plantar fascia
Your doctor will also evaluate your reflexes, balance, coordination, and muscle tone. Once diagnosed, plantar fasciitis can typically be successfully treated through the use of conservative non-surgical methods including:
- Rest: Limiting or stopping activities that worsen the condition is usually required to improve symptoms.
- Medication: Non-steroidal anti-inflammatory medicines, such as naproxen or ibuprofen, can be utilized to reduce pain and inflammation. Consult your doctor on extended use of these over-the-counter products.
- Ice: Icing 3-4 times daily can be an effective way of alleviating pain.
- Stretching exercises: Specific methods of stretching the calf and plantar fascia can help alleviate the muscle tightness that aggravates plantar fasciitis.
- Physical therapy: Additional specialized treatments with an experienced physical therapist can be beneficial to the healing process.
- Cortisone injections: A corticosteroid can be injected into the plantar fascia to treat inflammation and pain.
- Orthotics/supportive shoes: A cushioned insert or heel pad can elevate and cushion the heel as it strikes the ground, lessening the tension placed on the fascia.
- Splinting: Temporarily wearing a splint at night can stretch the plantar fascia and keep the foot from pointing down in the relaxed position while sleeping (which is the reason the heel incurs pain in the mornings).
Plantar Fasciitis Surgery
In severe cases and if non-surgical treatments are exhausted with no improvement, plantar fasciitis may be surgically treated. Two surgical options are available and are recommended based on the patient’s individual condition:
- Plantar fascia release: This surgery involves partially detaching the ligament from the heel bone to reduce tension. It can be performed endoscopically, but traditional, open surgery is usually preferred. Plantar fascia release is typically recommended for those patients with normal range of ankle motion.
- Gastrocnemius recession: This procedure is utilized when tight calf muscles are creating tension on the plantar fascia. The calf lengthening surgery (open or endoscopic) is recommended for those who are still unable to flex the foot after months of therapy.
If you are experiencing the painful symptoms of plantar fasciitis, please contact the podiatric team at OSMI for an evaluation.