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Plantar
fasciitis
Do your first few steps out of bed in
the morning cause severe pain in your heel? Or does your heel hurt after
jogging or playing tennis?
Most commonly, heel pain is caused by
inflammation of the plantar fascia — the tissue along the bottom of your
foot that connects your heel bone to your toes. The condition is called
plantar fasciitis (PLAN-tur fas-e-I-tis).
Plantar fasciitis causes stabbing or
burning pain that's usually worse in the morning because the fascia
tightens (contracts) overnight. Once your foot limbers up, the pain
normally decreases, but it may return after long periods of standing or
after getting up from a seated position.
In most cases, you can kick the pain
of plantar fasciitis without surgery or other invasive treatments. And you
can take steps to prevent plantar fasciitis from recurring.
Signs and symptoms
Plantar fasciitis usually develops
gradually, but it can come on suddenly and be severe. Plantar fasciitis
can affect both feet, but it usually occurs in only one foot at a time.
Watch for:
 | Sharp pain in the inside part of
the bottom of your heel, which may feel like a knife sticking in the
bottom of your foot
| | Heel pain that tends to be worse
with the first few steps after awakening, when climbing stairs or when
standing on tiptoe
| Heel pain after long periods of
standing or after getting up from a seated position
| Heel pain after, but not usually
during, exercise
| Mild swelling in your heel |
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Causes
Under normal circumstances, your
plantar fascia acts like a shock-absorbing bowstring, supporting the arch
in your foot. But, if tension on that bowstring becomes too great, it can
become irritated or inflamed. The causes of plantar fasciitis can be:
| Physical activity
overload. Plantar fasciitis is common in long-distance
runners. Jogging, walking or stair climbing also can place too much
stress on your heel bone and the soft tissue attached to it,
especially as part of an aggressive new training regimen. Even
household exertion, such as moving furniture or large appliances, can
trigger the pain.
| Arthritis. Some
types of arthritis can cause inflammation in the tendons in the bottom
of your foot, which may lead to plantar fasciitis.
| Diabetes.
Although doctors don't know why, plantar fasciitis occurs more often
in people with diabetes.
| Faulty foot mechanics.
Being flat-footed, having a high arch or even having an abnormal
pattern of walking can adversely affect the way weight is distributed
when you're on your feet, putting added stress on the plantar fascia.
| Improper shoes.
Shoes that are thin-soled, loose, or lack arch support or the ability
to absorb shock don't protect your feet. If you regularly wear shoes
with high heels, your Achilles tendon — which is attached to your
heel — can contract and shorten, causing strain on the tissue around
your heel. |
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Risk factors
Your risk of developing plantar
fasciitis increases if you are:
| Active in sports.
Activities that place a lot of stress on your heel bone and attached
tissue are most likely to cause plantar fasciitis. This includes
running, ballet dancing and aerobics.
| Flat-footed or have high
arches. People with flatfeet may have poor shock absorption,
which increases the stretch and strain on the plantar fascia. People
with highly arched feet have tighter plantar tissue, which also leads
to poor shock absorption.
| Middle-aged or older.
Heel pain tends to be more common with aging as the arch of your foot
begins to sag, putting stress on the plantar fascia.
| Overweight.
Carrying around extra pounds can break down the fatty tissue under the
heel bone and cause heel pain.
| Pregnant. The
weight gain and swelling that accompany pregnancy can cause ligaments
in your body — including your feet — to relax. This can lead to
mechanical problems and inflammatory conditions.
| Working on your feet.
People with occupations that require a lot of walking or standing on
hard surfaces, including factory workers, teachers and waitresses, can
damage their plantar fascia.
| Wearing shoes with poor
arch support or stiff soles. A closet of poorly designed
pumps, loafers and boots can mean plantar problems. |
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When to seek medical advice
If you have heel pain, try self-care
measures, such as stretching and changing your activities. If you don't
see much progress after a few weeks of home treatment, see your family
doctor or a foot doctor (podiatrist).
Seek help sooner if your pain
worsens, despite home treatment. If you have diabetes or another condition
that causes poor circulation, see your doctor for an early evaluation of
any changes in your feet.
Screening and diagnosis
Your doctor will ask you about your
symptoms and look for points of tenderness in your foot. This can help
rule out other causes of heel pain, such as tendinitis, arthritis, nerve
irritation or a cyst. Your doctor may also suggest an X-ray or MRI to make
sure you don't have a stress fracture.
Sometimes, an X-ray shows a spur of
the bone projecting forward from the heel bone. In the past, bone spurs
were often blamed for heel pain and removed surgically, but doctors have
found that they're typically not the cause of pain. Surgery to remove
spurs is rare.
Complications
Ignoring plantar fasciitis may result
in a chronic condition that hinders your regular activities. You may also
develop foot, knee, hip or back problems because of the way plantar
fasciitis changes your walking motion.
Treatment
If self-care techniques don't help,
your doctor might suggest other treatments to heal your heel.
Conservative treatment
Nonsurgical treatments that may promote healing include:
| Night splints.
Your doctor may recommend wearing a splint fitted to your calf and
foot while you sleep. This holds the plantar fascia and Achilles
tendon in a lengthened position overnight so that they can be
stretched more effectively.
| Orthotics. Your
doctor may prescribe custom-fitted shoe inserts (orthotics), which are
specially molded to your feet, to help distribute pressure to your
feet more evenly. These are generally recommended if over-the-counter
shoe inserts don't work.
| Physical therapy.
A physical therapist can devise a series of exercises to stretch the
plantar fascia and Achilles tendon and to strengthen lower leg
muscles, which stabilize your ankle and heel. A therapist may also
teach you to apply athletic taping to support the bottom of your foot. |
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Surgical or other procedures
If conservative treatment doesn't provide relief, you might consider:
| Corticosteroids.
When other treatments don't work, your doctor may suggest one or two
injections of corticosteroid medication into your foot for temporary
relief. Multiple injections aren't recommended because they can weaken
your plantar fascia and possibly cause it to rupture, as well as
shrink the fat pad covering your heel bone. Another method for
delivering corticosteroid medication is a technique known as
iontophoresis (i-on-toe-fuh-RE-sis), which uses gentle electric
current to draw the medicine into the area of discomfort.
| 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. Early studies on this procedure reported positive results,
but some recent studies have had limited success in treating plantar
fasciitis. More research may determine if extracorporeal shock wave
therapy is an effective treatment for heel pain, and if so, what kind
of machine and treatment regimen seems to work best.
Complications of this procedure
may include bruising of your skin, swelling, pain, numbness or
tingling, and rupture of the plantar fascia. This therapy isn't used
for children, pregnant women or patients with a history of bleeding
problems.
| Surgery. Only a
small percentage of people need surgery to detach the plantar fascia
from the heel bone (plantar fasciotomy). It's generally an option only
when the pain is severe and all else fails. Side effects include a
weakening of the arch in your foot. |
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Prevention
You can take some simple steps now to
prevent painful steps later.
| Maintain a healthy weight.
This minimizes the stress on your plantar fascia.
| Choose supportive shoes.
Give stilettos the boot. Also avoid shoes with excessively low heels.
Buy shoes with a low to moderate heel, good arch support and shock
absorbency. Don't go barefoot, especially on hard surfaces.
| Don't wear worn-out
athletic shoes. Replace your old athletic shoes before
they stop supporting and cushioning your feet. If you're a runner, buy
new shoes after about 400 miles.
| Start sports activities
slowly. Warm up before starting any athletic activity or
sport, and start a new exercise program slowly.
| Wake up with a stretch.
Before you get out of bed in the morning, stretch your calf muscles,
arch and Achilles tendon by reaching for your toes and gently flexing
your foot. This helps reverse the tightening of the plantar fascia
that occurs overnight. |
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Self-care
By following these self-care tips,
you may be able to eliminate heel pain without further treatment.
| Apply ice. Hold a
cloth-covered ice pack over the area of pain for 15 to 20 minutes
three or four times a day or after activity. Or try ice massage.
Freeze a water-filled paper cup and roll it over the site of
discomfort for about five to seven minutes. Regular ice massage can
help reduce pain and inflammation.
| Put your feet up.
Stay off your feet for several days when the pain is severe.
| Decrease your miles.
You probably won't have to permanently retire your running or walking
shoes, but it's a good idea to cover shorter distances until pain
subsides.
| Take up a no- or
low-impact exercise. Swap swimming or bicycling for walking
or jogging. You'll likely be able to return to your regular activities
as heel pain gradually improves or disappears. However, some people
find that the only way to avoid a recurring problem is to permanently
modify their aerobic activities.
| Add arch supports or heel
cups to your shoes. Inexpensive over-the-counter arch
supports and heel cups take the tension off the plantar fascia and
help absorb shock.
| Try acupressure
techniques. Apply pressure to your heel by rolling a golf
ball or tennis ball with the arch of your foot, while you are standing
and stabilized. This can help reduce pain and increase blood flow.
| Use over-the-counter pain
medications. Acetaminophen (Tylenol, others), ibuprofen
(Advil, Motrin IB, others), naproxen (Aleve) and others may ease pain
and inflammation, although they won't treat the underlying problem.
Use as directed, tapering off as your pain decreases.
| Stretch your arches.
Simple exercises using household objects can stretch or strengthen
your plantar fascia, Achilles tendon and calf muscles. |
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