Plantar Fasciitis

Plantar fasciitis (PLAN-tur fas-e-I-tis) involves pain and inflammation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot and connects your heel bone to your toes. Plantar fasciitis is one of the most common causes of heel pain.The pain is usually caused by collagen degeneration (which is sometimes misnamed “chronic inflammation”) at the origin of the plantar fascia at the medial tubercle of the calcaneus.   

Plantar fasciitis commonly causes stabbing pain that usually occurs with your very first steps in the morning. 

In most cases, the pain associated with plantar fasciitis:

• Develops gradually
• Affects just one foot, although it can occur in both feet at the same time
• Is triggered by — and is worst with — the first few steps after awakening, although it can also be triggered by long periods of standing or getting up from a seated position Patients often notice pain at the beginning of activity that lessens or resolves as they warm up. The pain may also occur with prolonged standing and is sometimes accompanied by stiffness. In more severe cases, the pain will also worsen toward the end of the day.
• Feels like a stab in the heel of your foot 

Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.

Heel Spurs 

Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.

Heel spurs do not cause plantar fasciitis pain.

The plantar fascia is a thickened fibrous aponeurosis that originates from the medial tubercle of the calcaneus and runs forward to form the longitudinal foot arch. The function of the plantar fascia is to provide static support of the longitudinal arch and dynamic shock absorption. Individuals with pes planus (low arches or flat feet) or pes cavus (high arches) are at increased risk for developing plantar fasciitis.

Risk factors

By Mayo Clinic staff

Factors that may increase your risk of developing plantar fasciitis include:

• Age. Plantar fasciitis is most common between the ages of 40 and 60.
• Sex. Women are more likely than are men to develop plantar fasciitis.
• Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing and dance aerobics — can contribute to an earlier onset of plantar fasciitis.
• Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you're standing and put added stress on the plantar fascia.
• Obesity. Excess pounds put extra stress on your plantar fascia.
• Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.
• Improper shoes. Avoid loose, thin-soled shoes, as well as shoes without enough arch support or flexible padding to absorb shock. If you regularly wear high heels, your Achilles tendon — which is attached to your heel — can contract and shorten, causing strain on the tissue around your heel.

About 90 percent of the people who have plantar fasciitis recover with conservative treatments in just a few months.

Therapies 

Stretching and strengthening exercises or use of specialized devices may provide symptom relief. These include:

• Physical therapy. A physical therapist can instruct you in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist may also teach you to apply athletic taping to support the bottom of your foot.
• Night splints. Your physical therapist or doctor may recommend wearing a splint that stretches your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and facilitates stretching.
• Orthotics. Your doctor may prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.
• Follow these self-care tips to ease pain and discomfort in your foot:
• Put your feet up. Stay off your feet for several days when the pain is severe.
• Apply ice. 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. Or try ice massage. Freeze a water-filled paper cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massage can help reduce pain and inflammation.
• Decrease your miles. You probably won't have to permanently retire your running or     walking shoes, but it's a good idea to cover shorter distances until pain subsides.
• Take up a no- or low-impact exercise. Swap swimming or bicycling in for walking or jogging. You'll likely be able to return to your regular activities as heel pain gradually improves. However, some people find that the only way to avoid a recurring problem is to give up high-impact activities, such as running and some forms of dance.
• Add arch supports to your shoes. Inexpensive over-the-counter arch supports take the tension off the plantar fascia and help absorb shock.
• Stretch your arches. Simple exercises using household objects can stretch your plantar fascia, Achilles tendon and calf muscles.

In one study,3 83 percent of patients involved in stretching programs were successfully treated, and 29 percent of patients in the study cited stretching as the treatment that had helped the most compared with use of orthotics, nonsteroidal anti-inflammatory drugs (NSAIDs), ice, steroid injection, heat, heel cups, night splints, walking, plantar strapping and shoe changes.3

Strengthening programs should focus on intrinsic muscles of the foot. Exercises used include towel curls and toe taps. Exercises such as picking up marbles and coins with the toes are also useful.

• To do a towel curl, the patient sits with the foot flat on the end of a towel placed on a smooth surface. Keeping the heel on the floor, the towel is pulled toward the body by curling the towel with the toes.

• To do toe taps, all the toes are lifted off the floor and, keeping the heel on the floor and the outside four toes in the air, the big toe is tapped to the floor repetitively. Next, the process is reversed, and the outside four toes are repetitively tapped to the floor while keeping the big toe in the air.

In another study,6 strengthening programs were cited as the most helpful treatment by 34.9 percent of the subjects, compared with exercise, night splints, orthotics, heel cups, NSAIDs, steroid injection or surgery.

This stretch not only helps with Plantar Fasciitis but also helps your calves and knees.

TYPICAL TREATMENT PLAN

In general, start by correcting training errors. This usually requires relative rest, the use of ice after activities, and an evaluation of the patient's shoes and activities. Next, we try correction of biomechanical factors with a stretching and strengthening program. If the patient still has no improvement, we consider night splints and orthotics. Finally, all other treatment options are considered. Non-steroidal anti-inflammatory medications are considered throughout the treatment course, although we explain to the patient that this medicine is being used primarily for pain control and not to treat the underlying problem.

Prevention

By Mayo Clinic staff

You can take some simple steps now to prevent painful steps later:

• Maintain a healthy weight. This minimizes the stress on your plantar fascia.
• Choose supportive shoes. Avoid high heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency. Don't go barefoot, especially on hard surfaces.
• Don't wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet. If you're a runner, buy new shoes after about 500 miles of use.
• Don't wear high heels