Plantar Fasciitis

Plantar fasciitis usually initially presents when the first few steps in the morning cause severe pain in the heel of the foot. An overuse injury, it affects the sole or flexor surface (plantar) of the foot. A diagnosis of plantar fasciitis means the patient has inflamed the tough, fibrous band of tissue (fascia) connecting the heel bone to the base of the toes.

Those more likely to be afflicted are women and overweight people. Others at risk are those who walk or run for exercise, especially if tight calf muscles limit how far the ankles can flex. People with very flat feet or very high arches are also more prone to plantar fasciitis.

If plantar fasciitis remains untreated, it may become a chronic condition. Chronic plantar fasciitis imposes limits on a person’s level of activity and may also cause problems with the foot, knee, hip and back, because it affects gait.

Rest is the first treatment for plantar fasciitis, keeping weight off the foot until the inflammation is reduced. Ice should be applied to the sore area for 20 minutes, three or four times daily, and medication might include non-steroidal anti-inflammatories, such as Naprosyn or ibuprofen. A program of home exercises to stretch the Achilles tendon and plantar fascia are the mainstay of treating the condition and lessening the chance of recurrence. About 90 percent of people with plantar fasciitis improve significantly after two months of treatment. Patients may be advised to use shoes with shock-absorbing soles or fitted with a standard orthotic device like a rubber heel pad.

If plantar fasciitis continues after a few months of conservative treatment, an injection into the heel with steroidal anti-inflammatory medications (corticosteroid) may become necessary. If symptoms still remain, a walking cast worn for 2-3 weeks and/or a positional splint at night might be indicated. In some cases, a platlet rich plasma injection for the heel may be beneficial. Surgery is rarely necessary to release the plantar fascia ligament.

Not all heel pain is plantar fasciitis. In fact, many patients that do not improve may have been misdiagnosed and are suffering from another condition causing pain in the heel. These include tarsal tunnel syndrome (a nerve entrapment in the foot), atrophy of the tissue (loss of the normal heel pad), pinched nerves in the foot, or a stress fracture of the calcaneus (heel bone), among other conditions. Although the majority of these disorders require only conservative treatment, the options are slightly different and should be particularly rendered to address the specific condition.

Modified from the AAOS