Plantar Fasciitis
Plantar fasciitis is one of the most common causes of heel pain. It involves inflammation or degeneration of the plantar fascia, a thick band of tissue that runs along the bottom of the foot and connects the heel bone to the toes.
Understanding the Condition
The plantar fascia is a strong, fibrous band of tissue that supports the arch of the foot and acts as a shock absorber during walking and running. When this tissue is subjected to excessive stress or tension, small tears can develop, leading to inflammation and pain.
While the term "fasciitis" implies inflammation, research suggests that in many cases, especially chronic ones, the condition may involve degenerative changes rather than true inflammation. Some clinicians use the term "plantar fasciosis" to describe this degenerative process.
The condition can affect one or both feet and is particularly common in runners, people who are overweight, and those who wear shoes with inadequate support.
Common Symptoms
The hallmark symptom of plantar fasciitis is stabbing pain in the bottom of the foot near the heel. This pain is often most intense with the first steps after waking up in the morning or after periods of sitting or rest.
After initial movement, the pain may decrease but can return after prolonged standing or when rising after sitting. The pain may also worsen after exercise, though it is typically not felt during activity itself.
Some people experience a dull, constant ache in the heel rather than sharp pain. The affected area may be tender to the touch, and stiffness in the foot, particularly in the morning, is also common.
Potential Causes and Risk Factors
Plantar fasciitis can develop without an obvious cause, but certain factors may increase the risk. Foot mechanics play a role; flat feet, high arches, or an abnormal walking pattern can affect weight distribution and add stress to the plantar fascia.
Age is a factor, with the condition being most common in people between 40 and 60 years old. Activities that place significant stress on the heel, such as long-distance running, ballet, and aerobic dance, may contribute to the onset of plantar fasciitis.
Occupations that require prolonged standing or walking on hard surfaces may also increase risk. Excess body weight can contribute by placing additional stress on the plantar fascia.
Tight calf muscles and Achilles tendons can limit ankle flexibility and increase strain on the plantar fascia. Wearing shoes with poor arch support or thin soles may also be a contributing factor.
Diagnosis
Diagnosis of plantar fasciitis is typically based on medical history and physical examination. A healthcare provider may ask about the location and nature of the pain, when it occurs, and what activities make it better or worse.
During the physical examination, the foot is examined for areas of tenderness. The location of pain can help determine the cause. Foot flexibility, range of motion, and nerve function may also be assessed.
Imaging studies are not typically necessary for diagnosis but may be ordered to rule out other causes of heel pain, such as stress fractures or arthritis. X-rays may sometimes show a heel spur, a bony projection from the heel bone, though many people with heel spurs do not have pain.
Treatment Approaches
Most people with plantar fasciitis improve with conservative treatment over several months. Initial approaches typically focus on reducing pain and inflammation while addressing factors that may have contributed to the condition.
Rest and activity modification may help reduce stress on the plantar fascia. Stretching exercises targeting the plantar fascia and calf muscles are commonly recommended. Ice application to the heel for 15-20 minutes several times daily may help reduce pain and inflammation.
Supportive footwear and over-the-counter arch supports or heel cups may provide relief. Custom orthotic devices may be considered for some individuals. Night splints that stretch the calf and arch during sleep can be helpful for some people.
Physical therapy may be recommended to provide instruction on stretching and strengthening exercises. When conservative measures are insufficient, options such as corticosteroid injections, extracorporeal shock wave therapy, or surgical release of the plantar fascia may be considered in some cases.