Plantar Fasciitis: Causes, Symptoms & Diagnosis
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Plantar Fasciitis

What Is Plantar Fasciitis?

Plantar fasciitis causes pain in the bottom of the heel. The plantar fascia is a thin, web-like ligament that connects your heel to the front of your foot. It supports the arch of your foot and helps you walk.

Plantar fasciitis is one of the most common orthopedic complaints. Your plantar fascia ligaments experience a lot of wear and tear in your daily life. Normally, these ligaments act as shock absorbers, supporting the arch of the foot. Too much pressure on your feet can damage or tear the ligaments. The plantar fascia becomes inflamed, and the inflammation causes heel pain and stiffness.

What Are the Symptoms of Plantar Fasciitis?

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The major complaint of those with plantar fasciitis is pain and stiffness in the bottom of the heel, although some experience pain at the bottom mid-foot area. This develops gradually over time. It usually affects just one foot, but it can affect both feet. Some people describe the pain as dull, while others experience a sharp pain, and some feel a burning or ache on the bottom of the foot extending outward from the heel.

The pain is usually worse in the morning when you take your first steps out of bed, or if you’ve been sitting or lying down for a while. Climbing stairs can be very difficult due to heel stiffness.

After prolonged activity, the pain can flare up due to increased inflammation. Pain isn’t usually felt during the activity but rather just after stopping.

What Causes Plantar Fasciitis?

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You’re at a greater risk of developing plantar fasciitis if you’re overweight or obese. This is due to the increased pressure on your plantar fascia ligaments, especially if you have sudden weight gain. Women who are pregnant often experience bouts of plantar fasciitis, particularly during late pregnancy.

If you’re a long-distance runner, you may be more likely to develop plantar fascia problems. You’re also at risk if you have a very active job that involves being on your feet often, such as a factory worker or a restaurant server. Active men and women between the ages of 40 and 70 are at the highest risk for developing plantar fasciitis. It’s also slightly more common in women than men.

If you have foot problems, such as very high arches or very flat feet, you may develop plantar fasciitis. Tight Achilles tendons, which are the tendons attaching your calf muscles to your heels, may also result in plantar fascia pain. Simply wearing shoes with soft soles and poor arch support can also result in plantar fasciitis.

Plantar fasciitis isn’t typically the result of heel spurs. A heel spur is a hook of bone that can form on the heel bone, or calcaneus, of the foot. According to the American Association of Orthopaedic Surgeons (AAOS), one out of every 10 people has a heel spur, but only one out of 20 people with heel spurs experience pain.

How Is Plantar Fasciitis Diagnosed?

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Your doctor will perform a physical exam to check for tenderness in your foot and the exact location of the pain to make sure that it’s not the result of a different foot problem. Your doctor may ask you to flex your foot while they push on the plantar fascia to see if the pain gets worse as you flex and better as you point your toe. They’ll also note if you have mild redness or swelling.

Your doctor will evaluate the strength of your muscles and the health of your nerves by checking your:

  • reflexes
  • muscle tone
  • sense of touch and sight
  • coordination
  • balance

An X-ray or an MRI scan may be necessary to check that nothing else is causing your heel pain, such as a bone fracture.

What Are the Treatment Options for Plantar Fasciitis?

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Reducing inflammation in the plantar fascia ligament is an important part of treatment, but this doesn’t address the underlying damage to the ligament.

Home Treatments

Initial home treatment includes staying off your feet and applying ice for 15 to 20 minutes, three or four times per day to reduce swelling. You can also try reducing or changing your exercise activities. Using arch supports in your shoes and doing stretching exercises may also help to relieve pain.

Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Motrin or Advil) and naproxen (Aleve), often reduce inflammation in the ligament.

Medical Treatments

If home treatments and over-the-counter, anti-inflammatory drugs don’t ease the pain, an injection of a corticosteroid directly into the damaged section of the ligament can help. Your doctor can do this in their office. Your doctor may use an ultrasound device to help determine the best place for the injection. Your doctor can also apply corticosteroids to the skin of your heel or the arch of your foot, and then apply a painless electrical current to let the steroid pass through your skin and into the muscle.

Physical therapy is an important part of treatment for plantar fasciitis. It can help stretch your plantar fascia and Achilles tendons. A physical therapist can also show you exercises to strengthen your lower leg muscles, helping to stabilize your walk and lessen the workload on your plantar fascia.

If pain continues and other methods aren’t working, your doctor may recommend extracorporeal shock wave therapy. In this therapy, sound waves bombard your heel to stimulate healing within the ligament. This treatment can result in:

  • bruises
  • swelling
  • pain
  • numbness

It hasn’t been proven to be consistently effective in relieving symptoms.

The most dramatic therapy, used only in cases in which pain is very severe, is surgery. Your surgeon can partially detach the plantar fascia from the heel bone, but this weakens the arch of the foot and full function may be lost. Another surgery involves lengthening the calf muscle. This process is called gastrocnemius recession.

Braces and Supports

Night splints are another treatment that can help stretch your calf and the arch of your foot. Night splints are a type of brace that holds your foot in a flexed position and lengthens the plantar fascia and Achilles tendon overnight. This can prevent morning pain and stiffness.

Special orthotics, or arch supports, for your shoes may help alleviate some of the pain by distributing pressure, and they can prevent further damage to the plantar fascia. A boot cast may immobilize your foot and reduce strain while the plantar fascia heals. You can remove the boot cast, which looks like a ski boot, for bathing.

What Are the Complications Associated with Plantar Fasciitis?

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You can develop chronic heel pain if you ignore the condition. This can change the way you walk and cause injury to your:

  • legs
  • knees
  • hips
  • back

Steroid injections and some other treatments can weaken the plantar fascia ligament and cause potential rupture of the ligament.

Surgery carries the risks of bleeding, infection, and reactions to anesthesia. Plantar fascia detachment can also cause changes in your foot and nerve damage. Gastrocnemius resection can also cause nerve damage.

What Is the Long-Term Outlook for People with Plantar Fasciitis?

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Most people don’t need surgery to relieve pain from plantar fasciitis. Instead, their condition improves through physical therapy, home treatments, and medical treatments. However, treatment can take several months to two years to improve your symptoms.

You Asked, We Answered

  • What are some ways an overweight or obese person with plantar fasciitis can exercise to alleviate their symptoms, without experiencing more pain?
  • While it's typical to experience pain in just one foot, massage and stretch both feet. Do it first thing in the morning and three times during the day. Here are great exercises that you can do:

    Achilles Tendon Stretch: Stand with your affected foot behind your healthy one. Point the toes of the back foot toward the heel of the front foot and lean into a wall. Bend the front knee and keep the back knee straight with your heel firmly planted on the floor. Hold for a count of 10.

    • Plantar Fascia Stretch: Sit down, and place the affected foot across your knee. Using the hand on your affected side, pull your toes back toward your shin until you feel a stretch in your arch. Run your thumb along your foot. You should feel tension. Hold for a count of 10.

    • Swimming or Other Water Sports: These exercises place no direct impact on your heels, and water therapy can help reduce the inflammation caused by plantar fasciitis.
    - Steve Kim M.D.

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