This is Patient Education Article – Plantar Fasciitis. It explains the basics of the pathology including signs, symptoms and basic treatment options.
Heel pain is most often caused by plantar fasciitis — a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, or nerve irritation. Because there are several potential causes, it is important to have heel pain properly diagnosed.
What is Plantar Fasciitis?
Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed-resulting in heel pain.
The symptoms of plantar fasciitis are:
- Pain on the bottom of the heel
- Pain that is usually worse upon arising
- Pain that increases over a period of months
People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia.
For some people the pain subsides but returns after spending long periods of time on their feet.
What Causes Plantar Fasciitis?
The most common cause of plantar fasciitis relates to faulty mechanics of the foot. For example, people who have
problems with their arches—either overly flat feet or high-arched feet—are more prone to developing plantar fasciitis. People with tight Achilles tendons, also are more prone to develop plantar fasciitis.
Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when a person’s job requires long hours on their feet. Obesity also contributes to plantar fasciitis.
To arrive at a diagnosis, Dr. DeMill will obtain your medical history and examine your foot. Throughout this process, Dr. DeMill will rule out all the possible causes for your heel pain other than plantar fasciitis. Some of these include tarsal tunnel syndrome, heel pad syndrome or stress fractures of the calcaneus.
In addition, diagnostic imaging studies such as x-rays, a bone scan, or magnetic resonance imaging (MRI) may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:
- Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery.
- Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
- Ice. Putting an ice pack on your heel for 10 minutes several times a day helps reduce inflammation. Limit activities. Cut down on extended physical activities to give your heel a rest.
- Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia. Your shoes should provide a comfortable environment for the foot.
- Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help reduce pain and inflammation.
- Lose weight. Extra pounds put extra stress on your plantar fascia.
If you still have pain after several weeks of doing the above treatments, Dr. DeMill may add one or more of these approaches:
- Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
- Injection therapy. In some cases, injections are used to help reduce the inflammation and relieve pain. There are various types of injections that are used for plantar fasciitis and include steroids, PRP or amniotic cells.
- Removable walking boot. A removable walking boot may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
- Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping or resting. This may help reduce the morning pain or start up pain experienced by some patients.
- Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery may be considered.
When non-surgical treatments fail to relieve the symptoms of plantar fasciitis, Dr. DeMill may suggest surgical treatment. They goal of surgery to treat plantar fasciitis is to improve the flexibility of the tightened fascia and to increase the blood flow to the often-times diseased and thickened fibrotic tissue that generates the pain. These surgeries can be done as an open, more traditional way or in a minimally invasive technique. Whenever possible a minimally invasive technique is usually preferred as it can lead to a quicker recovery.
No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, using custom orthotic devices and continuing stretching are the mainstay of long-term treatment for plantar fasciitis.
Download Article as PDF
Foot exercises are a great way to maintain healthy and happy feet! Click on the image above to download some simple exercises to help maintain flexibility, range of motion and strength in the feet.
Custom Orthotics can help balance your foot and correct foot pain and problems without surgery.