Plantar Fasciitis

What is plantar fasciitis?

Plantar fasciitis is a painful inflammation of the bottom of the foot between the ball of the foot and the heel. The tough tissue that supports the arch of your foot is called the fascia.

How does it occur?

There are many possible causes of plantar fasciitis, including:

• wearing high heels
• gaining weight
• increased running, jumping, walking, or stair-climbing

Wearing high-heeled shoes for long periods of time is one possible cause. If you wear high-heeled shoes, including western-style boots, the fascia can become shorter. Pain then occurs when you stretch fascia that has shortened. This painful stretching might happen, for example, when you walk barefoot after getting out of bed in the morning.

If you gain weight, you might be more likely to have plantar fasciitis, especially if you walk a lot or stand in shoes with poor heel cushioning. Normally there is a pad of fatty tissue under your heel bone. Weight gain might break down this fat pad and cause heel pain.

Runners may get plantar fasciitis when they change their workout and increase their mileage or frequency of workouts. It can also happen with a change in exercise surface or terrain, or if your shoes are worn out and don't provide enough cushion for your heels.

If the arches of your foot are unusually high or low, you are more likely to develop plantar fasciitis than if your arches are normal.

What are the symptoms?

The main symptom of plantar fasciitis is heel pain when you walk. You may also feel pain when you stand and possibly even when you are resting. This pain typically occurs first thing in the morning after you get out of bed, when your foot is placed flat on the floor. The pain occurs because you are stretching the plantar fascia. The pain usually lessens with more walking, but you may have it again after periods of rest.

You may feel no pain when you are sleeping because the position of your feet during rest allows the fascia to shorten and relax.

How is it diagnosed?

Your healthcare provider will ask about your symptoms. He or she will ask if the bottom of your heel is tender and if you have pain when you stretch the bottom of your foot. You may have an X-ray of your heel.

How is it treated?

To treat this condition:

• Give your painful heel lots of rest. You may need to stay completely off your foot for several days when the pain is severe.
• Raise your heel on a pillow when you sit or lie down.
• Take an anti-inflammatory such as ibuprofen, or other medicine as directed by your provider. Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.
• Rest your heel on an ice pack wrapped in a cloth for up to 20 minutes at a time several times a day can also help.
• A night splint may help keep the plantar fascia stretched while you are sleeping.
• Try to cushion your foot. You can do this by wearing athletic shoes, even at work, for a while. Heel cushions can also be used. The cushions should be worn in both shoes. They are most helpful if you are overweight or an older adult.
• Your healthcare provider may recommend shoe inserts, called orthotics. You can buy orthotics at a pharmacy or athletic shoe store or they can be custom-made. These supports can be particularly helpful if you have flat feet or high arches.
• Lose weight if needed.
• Your provider may give you an injection of a corticosteroid medicine.
• Physical therapy may be needed to stretch, strengthen, and stabilize muscles and fascia.
• Surgery is rarely needed.

How long will the effects last?

You may find that the pain is sometimes worse and sometimes better over time. If you get treatment soon after you notice the pain, the symptoms should stop after several weeks. If, however, you have had plantar fasciitis for a long time, it may take many weeks to months for the pain to go away.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. Return to your activities depends on how soon your foot recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal is to return to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may safely return to your activities when, starting from the top of the list and progressing to the end, each of the following is true:

• You have full range of motion in the injured foot compared with the uninjured foot.
• You have full strength of the injured foot compared with the uninjured foot.
• You can walk straight ahead without significant pain or limping.

How can I prevent plantar fasciitis?

The best way to prevent plantar fasciitis is to wear shoes that are well made and fit your feet. This is especially important when you exercise or walk a lot or stand for a long time on hard surfaces. Get new athletic shoes before your old shoes stop supporting and cushioning your feet.

You should also:

• Avoid repeated jarring to the heel.
• Keep a healthy weight.
• Do your leg and foot stretching exercises regularly.