What is plantar fasciitis?
It is an inflammation (irritation and swelling with presence of extra immune cells) of the thick tissue on the bottom of the foot that causes heel pain and disability.
What is the plantar fascia?
The plantar fascia is a band of tissue, much like a tendon, on the bottom of the foot. It starts at the heels and goes along the bottom of the foot. It attaches to each one of the bones that form the ball of the foot. The plantar fascia works like a rubber band between the heel and the ball of the foot to form the arch of the foot. If the band is short, one will have a high arch, and if it is long, one will have a low arch or flatfeet. A pad of fat in the heel covers the plantar fascia to help absorb the shock of walking. Damage to the plantar fascia can be a cause of heel pain.
What are the causes?
The plantar fascia can become inflamed and painful in some people, making walking more difficult. Some risk factors for development of this problem include foot arch problems (both flat foot and high arches), obesity, sudden weight gain, running and a tight Achilles tendon (the tendon connecting the calf muscles to the heel). A typical patient is an active male between the ages of 40 and 70 years old.
One is more likely to get the condition if one is overweight, or if one has a job that requires a lot of walking or standing on hard surfaces. One is also at risk if one walks or run for exercise, especially if one has tight calf muscles that limit how far one can flex the ankles. This condition is one of the most common orthopaedic complaints relating to the foot. Plantar fasciitis is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On X-ray, heel spurs are seen commonly both in people with and without plantar fasciitis.
What are the symptoms?
The condition starts gradually with mild pain at the heel bone often referred to as a stone bruise. One is more likely to feel it after not during exercise. The most common complaint is pain in the bottom of the heel, usually worse in the morning and improving throughout the day. By the end of the day the pain may be replaced by a dull aching that improves with rest.
How is the diagnosis made?
Typical physical examination findings include tenderness on the bottom of the heel, closer to the midline, and mild swelling and redness. X-rays may be taken to rule out other problems, but the presence or absence of a heel spur is not significant.
The doctor asks about the kind of pain one is having, when it occurs and how long one has had it. If one has pain in the heels when one stand up for the first time in the morning, one may have plantar fasciitis. Most people with plantar fasciitis say the pain is like a knife or a pin sticking into the bottom of the foot. After one has been standing for a while, the pain becomes more like a dull ache. If one sits down for any length of time, the sharp pain comes back when one stands up again.
What is the treatment?
Rest is the first treatment for plantar fasciitis. One should try to keep weight off the foot until the inflammation goes away.
Conservative treatment is almost always successful, given enough time. Duration of treatment can be anywhere from several months to two years before symptoms resolve, although about 90% of patients will be better in 9 months. Initial treatment usually consists of heel stretching exercises, shoe inserts, night splints, and anti-inflammatory medications. Aspirin, acetaminophen, naproxen or ibuprofen can ease the heel pain, but one should consult a doctor before taking them.
One may be advised to use shoes with shock-absorbing soles or fitted with a standard device like a rubber heel pad. The foot may be taped into a specific position. If these fail, casting the affected foot in a short leg cast (a cast up to but not above the knee) for 3 to 6 weeks is very often successful in reducing pain and inflammation. One can also apply ice to the sore area for 20 minutes three or four times a day to relieve the symptoms.
Some physicians offer steroid injections, which provide lasting relief in about 50% of people. However, this injection is very painful and is not recommended for everyone. In few patients, non-surgical treatment fails and surgery to release the tight, inflamed fascia becomes necessary.
What is the prognosis?
Nearly all patients improve within one year of the initiation of non-operative therapy with no long-term problems. In the few patients requiring surgery, over 95% have relief of their heel pain.
What are the complications?
A complication of non-operative therapy is continued pain. In surgical therapy, there is a risk of nerve injury, infection and failure of the pain to improve. Doing too much running or jumping can inflame the tissue band (fascia) connecting the heel bone to the base of the toes.
What is the prevention?
Maintaining good flexibility around the ankle is probably the best way to prevent plantar fasciitis.