Plantar Fasciitis

Overview

The plantar fascia is a thick layer of connective tissue that covers the bones on the bottom of the foot. The tissue runs from the toes to the heel and provides support to the foot. As one walks and toes are extended, the plantar fascia is tightened and it can become inflamed and painful in some people, making walking difficult. Plantar fasciitis is the most common cause of heel pain in adults. It generally results from degenerative wear and tear in the section of fascia attached to the heel.

Symptoms

Plantar fasciitis occurs gradually. Symptoms frequently include pain at the heel (in front, toward the toes) that is usually worse in the morning when one first stands and steps after waking. Prolonged standing and walking can increase pain, as well. By the end of the day, the pain may be replaced by a dull aching that improves with rest.

Causes

Repeated overuse and overtraining over a period of time is the most likely cause of plantar fasciitis. The condition is not trauma-related.

Plantar fasciitis is commonly thought to be caused by a bone spur on the heel, but research does not support this. X-rays frequently show heel spurs in people who don’t have plantar fasciitis.

Risk Factors

Plantar fasciitis is generally more common in women and people who are obese. Risk factors include foot arch problems (both flat foot and high arches), sudden weight gain, running and a tight Achilles tendon (the tendon connecting the calf muscles to the heel).

Diagnosis

A thorough physical examination by a sports-medicine doctor, orthopaedist podiatrist or qualified physiatrist is needed to reveal a specific diagnosis of plantar fasciitis. Frequent findings include tenderness at the front of the heel. Some patients have mild swelling and visible redness.

Diagnostic tests may include X-rays of the affected foot, but may not be necessary if the patient’s history and physical exam clearly indicate the presence of plantar fasciitis. An X-ray with the patient bearing weight on the foot may be performed prior to a steroidal injection, for people needing such treatment.

Complications

If not treated, plantar fasciitis can cause chronic heel pain. Patients may have to make significant changes in activity. The condition may also cause the person to change his gait or limp to minimize discomfort. Unfortunately, such alterations may worsen symptoms of plantar fasciitis or trigger other alignment-related discomfort in the back, hip, knee or foot.

Recovery

Self-treatment for plantar fasciitis includes rest, ice, compression, elevation (the RICE regimen) to control inflammation and pain. Oral medications such as acetaminophen, ibuprofen or naproxen may relieve or reduce pain.

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