Plantar fasciitis: Symptoms, diagnosis and treatment
What is plantar fasciitis?
Plantar fasciitis is thickening of the plantar fascia, a band of tissue running underneath the sole of the foot.
The thickening can be due to recent damage or injury, or can be because of an accumulation of smaller injuries over the years.
Plantar fasciitis can be painful.
- What causes plantar fasciitis?
A number of factors can contribute to plantar fasciitis. While men can get plantar fasciitis, it is more common in women. You’re also more likely to have this condition as you age. Common causes of plantar fasciitis include:
Taking up a new form of exercise or suddenly increasing the intensity of your exercise
Standing on your feet for several hours each day
Medical conditions such as rheumatoid arthritis or lupus (systemic lupus erythematosus SLE)
Wearing high-heeled shoes, and switching abruptly to flat shoes
Wearing shoes that are worn out with weak arch supports and thin soles
Having flat feet or an unusually high arch
Having legs of uneven lengths or an abnormal walk or foot position
Having tight Achilles tendons, or ‘heel cords’
What are the symptoms of plantar fasciitis?
The symptoms of plantar fasciitis include:
Pain in the bottom of your foot, especially at the front or centre of the heel bone
Pain that is worse when first rising in the morning (called “first-step pain”), when first standing up after any long period of sitting, or after increased levels of activity especially in non-supportive shoes
Seek medical advice about plantar fasciitis if:
You have heel pain or pain in the bottom of your foot, especially when you get up in the morning, that does not respond to treatment or if there is redness or bruising in the heel.
How do I know if I have plantar fasciitis?
Most cases of plantar fasciitis are diagnosed by a health care provider who listens carefully to your description of symptoms. During an examination of your feet, your health care provider will have to press on the bottom of your feet – the area most likely to be painful in plantar fasciitis.
Because the pain of plantar fasciitis has unique characteristics – pain upon rising, improvement after walking for several minutes, pain produced by pressure applied in a specific location on your foot but not with pressure in other areas – your health care provider will probably feel comfortable making the diagnosis based on your symptoms and a physical examination. Your health care provider may suggest that you have an X-ray of your foot to verify that there is no stress fracture causing your pain.
What are the treatments for plantar fasciitis?
Most health care providers agree that initial treatment for plantar fasciitis should be quite conservative. You’ll probably be advised to avoid any exercise that is making your pain worse. Your doctor may also advise one or more of these treatment options.
A heel pad – In plantar fasciitis, a heel pad is sometimes used to cushion the painful heel if you spend a great deal of time on your feet on hard surfaces.
Also, over-the-counter or custom-made orthotics, which fit inside your shoes, may be constructed to address specific imbalances you may have with foot placement or gait.
Stretching: Stretching exercises performed three to five times a day can help elongate the heel cord.
Ice: You may be advised to apply ice packs to your heel or to use an ice block to massage the plantar fascia before going to bed each night.
Pain relievers: Over-the-counter nonsteroidal anti-inflammatory drugs ( NSAIDs), such as ibuprofen, are often helpful in decreasing inflammation and pain. If you have stomach trouble from such drugs, your health care provider may recommend an alternative.
A night splint: A night splint is sometimes used to hold your foot at a specific angle, which prevents the plantar fascia from shortening during sleep.
Ultrasound: Ultrasound therapy can be performed to decrease inflammation and aid healing.
Steroid injections: Anti-inflammatory steroid injections directly into the tissue around your heel may be temporarily helpful. However, if these injections are used too many times, you may suffer other complications, such as shrinking of the fat pad of your heel, which you need for insulation. Loss of the fat pad could actually increase your pain – or could even rupture the plantar fascia in rare cases.
Walking cast: In cases of long-term plantar fasciitis unresponsive to usual treatments, your doctor may recommend that you wear a short walking cast for about three weeks. This ensures that your foot is held in a position that allows the plantar fascia to heal in a stretched, rather than shortened, position.
Shock wave therapy: Extracorporeal shock wave therapy which may be prescribed prior to considering surgery if your symptoms have persisted for more than six months. This treatment does not involve any actual incisions being made rather it uses a high intensity shock wave to stimulate healing of the plantar fascia.
Surgery for plantar fasciitis
Most practitioners agree that treatment for plantar fasciitis is a slow process. Most cases resolve within a year. If these more conservative measures don’t provide relief after this time, your doctor may suggest other treatment.
In such cases, or if your heel pain is truly debilitating and interfering with normal activity, your doctor may discuss surgical options with you.
The most common surgery for plantar fasciitis is called a plantar fascia release and involves releasing a portion of the plantar fascia from the heel bone. A plantar fascia release can be performed through a regular incision or as endoscopic surgery, where a tiny incision allows a miniature scope to be inserted and surgery to be performed.
About one in 20 patients with plantar fasciitis will need surgery. As with any surgery, there is still some chance that you will continue to have pain afterwards.
How can I prevent plantar fasciitis?
While there are no sure ways to prevent plantar fasciitis, these prevention tips may be helpful:
- Keep your weight under reasonable control
Wear comfortable, supportive shoes
Use care when starting or intensifying exercise programmes