Plantar Fasciitis

Written by Christine Case-Lo
Medically Reviewed by George Krucik, MD

What Is Plantar Fasciitis?

Plantar fasciitis causes pain in the bottom of the heel. The plantar fascia is a thin ligament that connects your heel to the front of your foot. It supports the arch in your foot and is important in helping 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 Causes Plantar Fasciitis?

You are at a greater risk for developing plantar fasciitis if you are 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 are a long distance runner, you may be more likely to develop plantar fascia problems. You are 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 is 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 (the tendons attaching the calf muscles to the 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 is not caused by heel spurs. A heel spur is a hook of bone that can form on the heel bone (calcaneus) of the foot. One out of every 10 people has a heel spur, but only one out of 20 people with heel spurs experience pain, according to OrthoInfo.

What Are the Symptoms of Plantar Fasciitis?

The major complaint of those with plantar fasciitis is pain and stiffness in the bottom of the heel. This develops gradually over time. It usually affects just one foot, but 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 the heel stiffness.

After prolonged activity, the pain can flare-up due to increased inflammation. Pain is not usually felt during the activity, but rather just after stopping.

How Is Plantar Fasciitis Diagnosed?

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 caused by a different foot problem. The doctor may ask you to flex your foot while he or she pushes on the plantar fascia to see if the pain gets worse as you flex and better as you point your toe. Mild redness or swelling will also be noted.

Your doctor will evaluate the strength of your muscles and the health of your nerves by checking your reflexes, your muscle tone, your sense of touch and sight, your coordination, and your balance.

X-rays or a magnetic resonance imaging (MRI) scan may be ordered to check that nothing else is causing your heel pain, such as a bone fracture.

What Treatments Are Available for Plantar Fasciitis?

Reducing inflammation in the plantar fascia ligament is an important part of treatment, though this does not 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 a 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 (i.e. Motrin or Advil) and naproxen (i.e. Aleve), are often used to 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 be given. Your doctor can do this in his or her office. Your doctor may use an ultrasound device to help determine the best place for the injection. Corticosteroids can also be administered on the skin of your heel or the arch of your foot, and then a painless electrical current is applied to let the steroid pass through your skin and into the muscle.

Physical therapy is an important part of treatment for planter 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. Sound waves are bombarded against your heel to stimulate healing within the ligament. This treatment can result in bruises, swelling, pain, and numbness, and has not been proven to be consistently effective in relieving symptoms.

The most dramatic therapy, used only in cases where pain is very severe, is surgery. The plantar fascia can be partially detached from the heel bone, but the arch of the foot is weakened and full function may be lost. Another surgery involves lengthening the calf muscle, a process 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 can prevent further damage to the plantar fascia. A boot cast may be used to immobilize your foot and reduce strain while the plantar fascia heals. A boot cast looks like a ski boot and can be removed for bathing.

What Can I Expect in the Long-Term?

Most people do not need surgery to relieve pain. However, treatment can last from several months to two years before symptoms improve.

What Are the Potential Complications of Plantar Fasciitis?

If you ignore the condition, you can develop chronic heel pain. This can change the way you walk and cause injury to your legs, knees, hips and 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.

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