Plantar Fasciitis

1 What is Plantar Fasciitis?

Plantar fasciitis 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 the foot.

The plantar fascia connects the heel bone to the toes. Plantar fasciitis usually causes a stabbing pain that occurs with the very first step in the morning. So, at times in the morning or when you have been sitting in a chair for a while, getting up suddenly can sometimes cause shooting pain to radiate from the heel of your foot.

It is particularly common in runners. In addition, individuals who are overweight and those who wear shoes with inadequate support are at risk for plantar fasciitis. This is why you need to consult a doctor or a specialist at the earliest, as they can help you seek effective treatment and prevent your current condition from impacting your health or lifestyle.

Have a question aboutPlantar Fasciitis?Ask a doctor now

2 Symptoms

A stabbing pain in the bottom of the foot near the heel is the main symptom of plantar fasciitis.

The pain is at its worst during the first few steps after waking up. At times, it can even be excruciating, so much so that you are not able to take a single step forward. It can also be triggered by long periods of standing or getting up from a seated position. Make sure you consult a doctor soon and get it treated right away.

3 Causes

Plantar fasciitis is caused by strain due to an excessive amount of pressure.

Under normal circumstances, the plantar fascia acts as a shock-absorbing bowstring, supporting the arch in the foot.

If tension on this bowstring becomes too great, it can cause small tears in the fascia.

Repeated stretching and tearing can lead to an irritated or inflamed fascia. This can make it near impossible for you to walk even a few steps, so seek a medical consult at the earliest and have it examined right away.

Another cause of plantar fasciitis is being overweight, as the extra weight exerts greater pressure on the feet. Sometimes picking up a new form of exercise, and thus suddenly increasing the work rate, or standing for longer periods of time can also cause plantar fasciitis.

Some of the other reasons include conditions like arthritis, wearing high-heeled shoes, and uneven foot lengths.

4 Making a diagnosis

Diagnosis of plantar fasciitis is made based on a patient’s medical history and a physical examination.

Once you consult your family doctor, a specialist in foot disorders or sports medicine can then get involved.

Before making an appointment, it is important to write a list that includes the following details:

  • A detailed description of symptoms, from the radiating pain to how often the pain occurs since it can help your doctor make an accurate diagnosis.
  • Medical information on any problems that run in the family. A complete medical history should enable your doctor to understand your current condition and prescribe the right treatment.
  • All medications and dietary supplements being taken up to that point. Your doctor may need this information to help determine if your current condition could be a result of the medications or supplements you are taking.

The doctor is likely to ask a number of questions, including:

  • Do your symptoms tend to occur at a particular time of day?
  • What types of shoes do you usually wear?
  • Are you a runner, or do you participate in any sports that involve running?
  • Do you have a physically demanding job?
  • Have you experienced any injuries to your feet in the past?
  • Besides your foot, do you feel pain anywhere else?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

Being ready to answer these and others may reserve time to go over any points you want to discuss at greater length.

During the physical exam, the doctor checks for points of tenderness in the foot. Pain location can help determine its cause. To do so, the doctor gently palpates your foot until they can localize the area that’s causing you to experience excruciating pain every time you step forward.

Occasionally, doctors may suggest an X-ray or magnetic resonance imaging (MRI) to make sure the pain isn't being caused by another problem, such as a stress fracture or pinched nerve.
Getting an X-ray done should help to prove that your current condition is not on account of any fracture or pinched nerve, and further tests will help your doctor rule out other medical conditions which may be causing you to experience similar pain.

Sometimes, an X-ray shows a spur of bone projecting forward from the heel. In the past, these bone spurs were often blamed for heel pain and removed surgically, so make it a point to consult your doctor the moment you start experiencing sharp pain in your heel.

However, many people who have bone spurs on their heels have no heel pain.

5 Treatment

Most people with plantar fasciitis recover with conservative treatments in just a few months. It is completely treatable and, with adequate medication, you should be able to manage your pain better. Meanwhile, you will be required to take better care of your foot, and your doctor may even recommend some protective footwear, which places less stress on your heel while supporting it.

Pain relievers such as ibuprofen and naproxen may ease pain and inflammation associated with plantar fasciitis. Just remember to avoid purchasing pain killers over the counter while on prescription medication since some of them come with side effects and others, like codeine, can be quite addictive. Consult your doctor and ask them to prescribe some pain killers to help alleviate the sharp, excruciating pain you experience each time you walk.

Stretching and strengthening exercises or the use of specialized devices may also provide symptom relief. It’s a good idea to research your current condition to learn more about it and what you can do to help alleviate some of the symptoms.

These include:

  • Physical therapy: A physical therapist can instruct you on a series of exercises to stretch the plantar fascia and Achilles tendon as well as strengthen lower leg muscles, which stabilize the ankle and heel. Remember that some physical therapy sessions can be a tad painful in the beginning, but with frequent exercises, you should be able to get some relief from the pain of plantar fasciitis.
  • Taping: A therapist may also teach you to apply athletic taping to support the bottom of your foot. This is to prevent additional stress being placed on your heel as well as provide you with additional support.
  • Night splints: The physical therapist or doctor may also recommend wearing a splint that stretches the calf and the arch of the foot during sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and facilitates stretching, which should help in treating your current condition.

Doctors may also prescribe off-the-shelf heel cups, cushions, or custom-fitted arch supports (orthotics). While orthopedic shoes may seem clunky, they will help to support you and distribute your weight more evenly so that you do not suffer any more excruciating pain from your plantar fascia.

When more conservative measures don't work, doctors might recommend:

  • Steroid shots: Injecting a type of steroid medication into the tender area can provide temporary pain relief. Multiple injections aren't recommended since they can weaken the plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone. So, if the other methods of treatment are not working, consult with your doctor about steroid shots. Although these shots are not a cure for plantar fasciitis, they can at least provide some immediate relief from the pain.
  • Extracorporeal shockwave 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 bruising, swelling, pain, numbness, or tingling and has not been shown to be consistently effective. However, it is something you may want to look into if other treatment methods are not working. But, as mentioned earlier, shockwave therapy comes with its own side effects, so it should not be undertaken without due consideration.
  • Surgery: Few 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 the foot. Your doctor should be able to advise you regarding your various options, and if you are still experiencing severe chronic pain, you may have to have the surgery. The surgical process is quite simple and should not take long, but post-operative care is important and your condition would need to be monitored for a while afterwards. 
Heel Spur

6 Lifestyle and coping

The following lifestyle tips can be useful in the prevention of plantar fascilitis:

  • Maintain a healthy weight, which minimizes stress on the plantar fascia: It is important that you maintain a healthy BMI value, since being overweight will cause you to place more stress on your heel, leading to plantar fasciitis. Make sure that you are eating right, and try consuming superfoods, like chia seeds, to reduce your weight within a short while. Moreover, chia seeds are known to lessen your appetite while providing you with all the nutrients your body requires.
  • Choose supportive shoes: Avoid high heels as they cause enormous pressure and stress to be placed on your heels, especially on the plantar fascia. Instead, seek out more comfortable shoes that help cushion your legs. Do not go barefoot, especially on hard surfaces, since this can put stress on your heel and sole. Do not wear worn-out athletic shoes either; for a runner, buying new shoes after about 500 miles of use is advised. Or, try a low-impact sport, such as swimming or bicycling, instead of walking or jogging.
  • 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. The ice pack should help to alleviate some of the pain and swelling. Or try an ice massage: freeze a water-filled paper cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massages can help reduce pain and inflammation. In most cases, the condition should disappear by itself, but if it does not, you need to consult your doctor right away.
  • Stretching the arches can also be a helpful measure to combat plantar fasciitis.

7 Risks and complications

The following are risk factors for developing plantar fasciitis:

  • Plantar fasciitis is most common in people between the ages of 40 and 60. Certain types of exercise, such as long-distance running, ballet, and dance aerobics, can contribute to an earlier onset of plantar fasciitis. Try to exercise more, but of the sort that does not put undue stress on your legs, like ballet dancing does. Ballet includes balancing on your toes while stressing your heel. So, make it a point to avoid placing more stress on your plantar fascia and take better care of your foot to prevent the problem from recurring.
  • Being flat-footed, having a high arch, or even having an abnormal pattern of walking can adversely affect the way weight is distributed when standing and put added stress on the plantar fascia. So, try to change your posture and walk upright and in a way that places less stress on your heel.
  • Excess pounds put extra stress on the plantar fascia. Factory workers, teachers, and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.
  • If one changes the way they walk to minimize plantar fasciitis pain, problems with the foot, knee, hip, or back may develop.

Ignoring plantar fasciitis may result in chronic heel pain that hinders regular activity.

8 Related Clinical Trials