Plantar fasciitis is a very common injury accounting for more than 3 million cases in the United States each year.

It is caused by inflammation of a band of tissue that runs across the bottom of your foot and connects your heel bone to your toes. If you experience a significant pain with your first steps out of bed in the morning, you may be suffering from this condition. Walking after long periods of standing or sitting may worsen the problem.

Patients who run competitively or for exercise/leisure are more prone to experience plantar fasciitis. It is one of the most common ailments that sidelines distance runners. Females, overweight individuals and patients who stand on hard surfaces for long periods of time may also be more susceptible.

While plantar fasciitis is typically an acute condition that responds well to rest and proper stretching, if left untreated, it can become a chronic, long-term problem. As is the case with many other foot maladies, those with flat feet may also be at a greater risk of developing plantar fasciitis. Pain after (not during) exercise is a classic symptom, in addition to pain early in the morning or after sitting.

A foot and ankle doctor may prescribe anti-inflammatory medication, arch supports and a home stretching program to help the affected foot.

It is important to not return to sport or strenuous activity prior to recovering from plantar fasciitis to avoid it evolving into a long-term, chronic problem.

Do you have or feel any of these symptoms?

• Pain on the bottom of the foot near the heel
• Pain with the first few steps after getting out of bed in the morning, or after a long period of rest, such as after a long car ride. The pain subsides after a few minutes of walking
• Greater pain after (not during) exercise or activity

What is Plantar Fasciitis?

Plantar fasciitis (fashee-EYE-tiss) is the most common cause of pain on the bottom of the heel. Approximately 2 million patients are treated for this condition every year.

Plantar fasciitis occurs when the strong band of tissue that supports the arch of your foot becomes irritated and inflamed.

The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body’s natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.

Risk factors include

• Tighter calf muscles that make it difficult to flex your foot and bring your toes up toward your shin
• Obesity
• Very high arch
• Repetitive impact activity (running/sports)
• New or increased activity

Before you see a physician  

More than 90% of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods.

Potential at home nonsurgical treatments

• Rest –Decreasing or even stopping the activities that make the pain worse is the first step in reducing the pain. You may need to stop athletic activities where your feet pound on hard surfaces (for example, running or step aerobics).
• Ice –Rolling your foot over a cold-water bottle or ice for 20 minutes is effective. This can be done 3 to 4 times a day.
• Nonsteroidal anti-inflammatory medication-Drugs such as ibuprofen or naproxen reduce pain and inflammation. Using the medication for more than 1 month should be reviewed with your primary care doctor.
• Exercise –Plantar fasciitis is aggravated by tight muscles in your feet and calves. Stretching your calves and plantar fascia is the most effective way to relieve the pain that comes with this condition.

Examples of at home exercises include:

• Calf stretch
  Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch.

• Plantar fascia stretches
  This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you in a controlled fashion. If it is difficult to reach your foot, wrap a towel around your big toe to help pull your toes toward you. Place your other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or walking.

Reasons to see a physician and treatment options

Pain in the heel persist and limits or disrupts normal walking or exercising

Non-surgical treatments

Cortisone injections. Cortisone, a type of steroid, is a powerful anti-inflammatory medication. It can be injected into the plantar fascia to reduce inflammation and pain. Your doctor may limit your injections. Multiple steroid injections can cause the plantar fascia to rupture (tear), which can lead to a flat foot and chronic pain.

Supportive shoes and orthotics. Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you step and your heel strikes the ground, a significant amount of tension is placed on the fascia, which causes microtrauma (tiny tears in the tissue). A cushioned shoe or insert reduces this tension and the microtrauma that occurs with every step. Soft silicone heel pads are inexpensive and work by elevating and cushioning your heel. Pre-made or custom orthotics (shoe inserts) are also helpful.

Soft heel pads can provide extra support.

Night splints. Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you sleep. Although it can be difficult to sleep with, a night splint is very effective and does not have to be used once the pain is gone.

Physical therapy. Your doctor may suggest that you work with a physical therapist on an exercise program that focuses on stretching your calf muscles and plantar fascia. In addition to exercises like the ones mentioned above, a physical therapy program may involve specialized ice treatments, massage, and medication to decrease inflammation around the plantar fascia.

Surgical treatments

Surgery is considered only after 12 months of aggressive nonsurgical treatment.

Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches.

In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope, an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs.

Complication rates for gastrocnemius recession are low, but can include nerve damage.

Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is partially cut to relieve tension in the tissue. If you have a large bone spur, it will be removed, as well. Although the surgery can be performed endoscopically, it is more difficult than with an open incision. In addition, endoscopy has a higher risk of nerve damage.

Prevention methods and other tips

To reduce your risk of having plantar fasciitis some helpful tips are to

• Tape your arches.
• Stretch your feet, calves and Achilles tendon.
• Ice your foot.
• Get plenty of rest.
• Do a low-impact exercise, like swimming, that doesn’t put pressure on your feet.
• Change your shoes regularly if you’re a walker or a runner.

Anatomy

The plantar fascia is a long, thin ligament that lies directly beneath the skin on the bottom of your foot. It connects the heel to the front of your foot, and supports the arch of your foot.

The word “fasciitis” means “inflammation of the fascia of a muscle or organ” while “plantar” relates to the sole of the foot. The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body’s natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.