Plantar Fasciitis: A Cause of Heel Pain

Plantar fasciitis (say: fashee-eye-tis) is an inflammation of the plantar fascia – the band of tissue that starts at the heel and runs along the bottom of the foot to connect to the bones that form the ball of the foot. Plantar fasciitis is one of the most common causes of foot pain in adults and only rarely occurs in children. The peak ages for developing plantar fasciitis are between 40 and 60, although younger people, particularly runners, can be affected. Most of the time, symptoms occur in only one foot but in one-third of cases it can affect both feet at the same time.

The primary symptom of plantar fasciitis is pain on the sole of the foot, especially near the heel. Most people with plantar fasciitis complain of heel pain after taking the first few steps of the morning or getting out of bed. Similarly, pain can occur when taking steps after sitting still for a long time. This is because the plantar fascia tightens up or contracts after an extended period of inactivity. The pain is often described as a knife pointing into the bottom of the foot. The pain may also be associated with mild swelling in the heel.

The plantar fascia supports the foot’s arch and absorbs the shocks generated by a heel or foot when walking or exercising. When stressed, the fascia can tear and lead to inflammation. Some risk factors for developing plantar fasciitis include running long distances or other exercises that stress the heel; having a high-arched or low-arched (that is, flat-footed) foot; wearing shoes with inadequate arch supports; being obese; dancing (especially ballet or aerobic dance); being pregnant; using a trampoline; or standing for long periods of time. Some medical problems – including diabetes, rheumatoid arthritis or gout – also increase the chances of developing plantar fasciitis.

In order to make the diagnosis of plantar fasciitis, a healthcare provider will examine the feet to identify painful areas. He or she may also recommend X-rays to rule out other problems, such as a stress fractures. An X-ray may reveal a heel spur – a spur of bone projecting out from the heel bone. In the past, these were thought to cause plantar fasciitis but now doctors believe that they are not the source of pain.

Plantar fasciitis is usually treated conservatively – that is, without invasive procedures or surgery. If you are overweight, you will likely receive a recommendation to lose weight. Other treatments include rest and limiting athletic activities for up to two weeks. Complete rest and inactivity can lead to stiffening and is not advised, so some moderate activity is suggested. Applying ice to the painful area for 20 minutes up to four times a day may relieve pain. Taking NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve) for two or three weeks may reduce swelling and decrease pain.

You may be provided with a program of home exercises and stretches. Some people are advised to wear calf and foot splints while sleeping. Shoes providing extra heel or arch supports or even special silicone gel pad heel inserts may also be recommended. You should not wear slippers or walk barefoot.

Usually, these noninvasive steps will improve the pain within two to three weeks. However, sometimes more invasive approaches must be taken. An injection of steroids and numbing medicine directly into the affected area can temporarily relieve pain. On rare occasions, this injection can cause infection or weaken the plantar fascia and cause it to rupture. Occasionally, a cast may be worn. In a very small percentage of cases, if all other treatments fail, surgery may be performed.

Dr. McMahon, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny and Pennsylvania Medical Societies. She is in solo practice in the North Hills.