Plantar Fasciitis Overview

plantar fasciitisThe most common cause of heel pain is plantar fasciitis. The plantar fascia is a flat ligament that connects the heel bone to the toes. This structure supports the foot’s arch. When the plantar fascia is strained, it becomes inflamed, weak, and swollen, causing pain at the bottom of the foot.

Plantar fasciitis is common among middle-aged people, but it also can affect anyone who stands for a prolonged time, such as soldiers and athletes.

Approximately 10% of American adults experience bouts of heel pain, resulting in 1 million visits to the doctor each year. Plantar fasciitis accounts for 10% of runner-related injuries, and around 13% of all foot symptoms seen by doctors. Adults ages 40 to 60 years are more likely to suffer from plantar fasciitis, with it occurring in women twice as often as men.

Risk Factors for Plantar Fasciitis

Plantar fasciitis is the result of strain on the ligament that supports the arch. Repetitive stress and strain causes tiny tears in the plantar fascia, which leads to pain and swelling. This occurs when:

  • The feet roll inward during walking (excessive pronation)
  • A person has high arches or flat feet
  • There is too much weight (overweight or obesity)
  • A person walks or stands on hard surfaces for a prolonged period of time
  • Shoes do not fit properly

Symptoms of Plantar Fasciitisheel pain plantar fasciitis

The hallmark symptom of plantar fasciitis is stabbing pain in the heel area, which is worse upon rising of the morning. While the pain and stiffness often eases up after walking for a bit, the foot/feet may continue to hurt throughout the day. The pain is often worse when stair climbing or standing.

Treatment for Plantar Fasciitis

  • Homecare measures – To reduce pain and swelling, cut back on activities for a few days and give the feet a rest. Also, try ice and over-the-counter pain relievers, such as Aleve or Motrin.

 

  • Orthopedic shoes – Some patients benefit from shoes with good arch supports and cushioned soles. Orthotic heel cups and shoe inserts are also helpful.

 

  • Corticosteroid injections – The doctor can inject steroid and anesthetic medication directly into the plantar fascia on the heel, or on the side near the arch.

 

  • Peripheral nerve block – The doctor injects a local anesthetic and steroid to block one or more nerves that supply the foot. This can be performed in a series of up five injections.

 

  • Physical therapy – The therapist instructs the patient on a series of exercises to stretch the plantar fascia and Achilles tendon, as well as strengthen the lower leg muscles.

 

  • Night splints – The splints are worn at night to stretch the calf and arch of the foot during sleep. A Plantar Fasciitissplint holds the Achilles tendon and plantar fascia in a lengthened position to facilitate stretching.

 

  • Extracorporeal shock wave therapy – With this procedure, sound waves are directed at the heel to stimulate healing. This treatment is used for chronic plantar fasciitis that does not respond to other measures.

 

  • Surgery – This is done to detach the plantar fascia from the heel bone. Surgery is only an option when all other measures fail to relieve the pain associated with plantar fasciitis.

 

Resources

Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. May 2004;25(5):303-10.

Werner RA, Gell N, Hartigan A, Wiggerman N, Keyserling WM. Risk factors for plantar fasciitis among assembly plant workers. PM R. Feb 2010;2(2):110-6; quiz 1 p following 167.