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Definition
Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves pain and inflammation of a thick band of tissue, called the plantar fascia, which runs across the bottom of your foot — connecting your heel bone to your toes.
Plantar fasciitis causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.
Plantar fasciitis is particularly common in runners. People who are overweight, women who are pregnant and those who wear shoes with inadequate support are at a higher risk of plantar fasciitis.
Symptoms
In most cases, the pain associated with plantar fasciitis:
- Develops gradually
- Affects just one foot, although it can occur in both feet simultaneously
- Is worst with the first few steps after awakening, although it also can be triggered by long periods of standing or getting up from a seated position
- Feels like a sharp pain in the heel of your foot
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 create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.
Risk factors
Factors that may increase your risk of developing plantar fasciitis include:
- Age. Plantar fasciitis is most common between the ages of 40 and 60.
- Sex. Women are more likely than men to develop plantar fasciitis.
- Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing and dance aerobics — can contribute to an earlier onset of plantar fasciitis.
- 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 standing, putting added stress on the plantar fascia.
- Obesity. Excess pounds put extra stress on your plantar fascia.
- Occupations that keep you on your feet. People with occupations that require a lot of walking or standing on hard surfaces — such as factory workers, teachers and waitresses — can damage their 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.
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.
Preparing for your appointment
While you may initially consult your family physician, he or she may refer you to a doctor who specializes in foot disorders or sports medicine.
What you can do
You may want to write a list that includes:
- Detailed descriptions of your symptoms
- Information about medical problems you've had
- Information about the medical problems of your parents or siblings
- All the medications and dietary supplements you take
- Questions you want to ask the doctor
What to expect from your doctor
During the physical exam, your doctor will check for points of tenderness in your foot. The location of your pain can help determine if it's caused by other problems.
Your doctor may also check the musculoskeletal and neurological health of your ankle joint and foot by testing your:
- Reflexes
- Muscle strength
- Muscle tone
- Senses of touch and sight
- Coordination
- Balance
Tests and diagnosis
Your doctor may suggest an X-ray or magnetic resonance imaging (MRI) to make sure your pain isn't being caused by another problem, such as a stress fracture or pinched nerve.
Sometimes, an X-ray shows a spur of bone projecting forward from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain.
Treatments and drugs
About 90 percent of the people who have plantar fasciitis recover with conservative treatments in just a few months.
Medications
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve), may ease pain and inflammation, although they won't treat the underlying problem.
- Corticosteroids. This type of medication may be delivered through a process called iontophoresis, in which a corticosteroid solution is applied to the skin over the painful area and the medication is absorbed with the aid of a nonpainful electric current. Another delivery method is injection. 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. Ultrasound guidance is sometimes used for more accurate placement of the corticosteroid injection.
Therapies
- Physical therapy. A physical therapist can instruct you in 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.
- 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 off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.
Surgical or other procedures
- 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. This procedure may cause bruises, swelling, pain, numbness or tingling, and has not been shown to be consistently effective.
- Surgery. Only a small percentage of people need surgery to detach the plantar fascia from the heel bone. 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.
Alternative medicine
Although some over-the-counter arch supports contain magnets, no reliable evidence indicates that arch supports with magnets relieve heel pain any better than arch supports without magnets.
Lifestyle and home remedies
- Put your feet up. Stay off your feet for several days when the pain is severe.
- 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.
- 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 in place of 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 to your shoes. Inexpensive over-the-counter arch supports take the tension off the plantar fascia and help absorb shock.
- Stretch your arches. Simple exercises using household objects can stretch your plantar fascia, Achilles tendon and calf muscles.
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. Avoid high 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 500 miles of use.
Last Updated: 2009-03-24
