Plantar Fasciitis. Plantar Fascia

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1 Plantar Fasciitis Introduction Plantar fasciitis is an inflammation of the thick band of tissue that connects your heel bone to your toes. This thick band of tissue is called the plantar fascia. Plantar fasciitis is a very common cause of heel pain. Most people who seek medical care for heel pain are diagnosed with plantar fasciitis. If left untreated, it can seriously limit a person s regular activities, such as walking and exercising. This reference summary will help you understand plantar fasciitis. It explains the symptoms, causes and treatment options. Plantar Fascia Anatomy Healthy feet are strong and flexible. They allow us to walk and run as they support the weight of the whole body. A ligament connects two bones or holds together a joint. The plantar fascia is a ligament. The plantar fascia is the thick band of tissue that connects your heel bone to your toes across the bottom of the foot. The plantar fascia fans out as it gets closer to the toes. The arch of your foot is supported by the plantar fascia, absorbing the pressure from the body s weight. With each step, the plantar fascia contracts and loosens. It acts like a rubber band. Also connecting to the heel bone is the Achilles tendon, or heel cord. The Achilles tendon connects the calf muscles to the heel bone. The calf muscles are the muscles on the back of the lower leg. 1

2 Plantar Fasciitis Plantar fasciitis happens when the plantar fascia is overused. The plantar fascia becomes inflamed and you feel pain. Normally the plantar fascia ligament stretches to adjust to the weight of the body when a person is standing, walking, or running. When the plantar fascia is overused, it causes small tears. The body can usually repair one or few such tears. But repeated tearing of the ligament can cause inflammation and swelling of the plantar fascia, causing pain. Repeated overuse and tears can sometimes cause a bone spur. A bone spur is a pointy growth of a bone. A bone spur on the heel is sometimes called a heel spur. The pain associated with plantar fasciitis is not caused by heel spurs. Plantar Fascia Tear Symptoms Pain associated with plantar fasciitis usually develops slowly over time. The first steps that a person takes after waking up may be the most painful. The pain will likely be centralized around the heel. Most people with plantar fasciitis describe it as stabbing pain. Pain may lessen throughout the day as the plantar fascia relaxes. The pain can return after long periods of standing or sitting. Usually only one foot is affected. However, plantar fasciitis can happen in both feet at the same time. Heel pain caused by plantar fasciitis may be severe enough to affect regular activities. It can cause a person to limp or avoid walking and exercising. Risk Factors Plantar fasciitis is more likely to happen if you repeatedly strain the plantar fascia ligament. You are more likely to repeatedly strain the plantar fascia if you roll your feet inwards as you walk. This stresses the plantar fascia. 2

3 Women are more likely than men to develop plantar fasciitis. Also, it is most common between the ages of 40 and 60. If you have high arches or flat feet the plantar fascia is more likely to become stressed. This is because weight is distributed unevenly across your feet. Walking, standing, or running for long periods of time all strain the plantar fascia. Doing so on hard surfaces increases your chance of developing plantar fasciitis. Any type of exercise or activity that places strain on your foot, such as ballet, may increase your risk for developing plantar fasciitis. Being overweight strains the plantar fascia as it has more weight to support and absorb. Shoes that don t fit well or are worn out should be replaced. The plantar fascia will not be given the correct support from shoes that don t fit well or are worn out. Tight Achilles tendons and calf muscles, which may be caused by wearing high heels, cause strain on the tissue around your heel and on the plantar fascia. Diagnosis Your doctor will review your medical history and symptoms. An examination of your foot is also needed to diagnose plantar fasciitis. During a physical exam, your doctor will check which points on your foot are tender. The location of pain helps your doctor determine whether or not you have plantar fasciitis. Your doctor may also check the general health of your foot and ankle, such as your muscle strength and coordination. Sometimes imaging tests may be ordered to make sure your pain is not caused by something else. Usually an x-ray or MRI is suggested. An x-ray is a type of high-energy radiation that can go through the body and onto film, making a picture. An MRI is also used to make detailed pictures of areas inside your body. It uses strong magnets to create images of the inside of the body. 3

4 Imaging tests can show if a bone spur has formed on your heel. They also can show if a stress fracture or pinched nerve is causing your pain instead of plantar fasciitis. A stress fracture is a tiny crack in the bone. This may be caused by repeated stress on the bone. Treatment Options Medication and therapy are the most common treatments for plantar fasciitis. Surgery is an option when medication and therapy are not working and pain is interfering with regular activities. X-Ray Machine Doctors will try conservative therapies first to treat plantar fasciitis. The first recommendation is to rest your foot from the activity causing the pain. For instance, if you are standing too long, you are asked to rest your foot for a while. This allows your foot to heal the inflammation in the ligament. Other conservative therapies used to treat plantar fasciitis include physical therapy, shoe inserts, and night splints. Physical therapy teaches you how to stretch and strengthen the lower leg muscles. Strong lower leg muscles stabilize your ankle and heel. Shoe inserts, or orthotics, may be used as arch supports that help distribute pressure to your foot more evenly. This prevents straining the plantar fascia. Shoe inserts are a key element of the conservative therapies for treating plantar fasciitis. Night splints may be recommended to wear while you sleep. They stretch your Achilles tendon and the plantar fascia. This strengthens your calf and the arch of your foot. Your doctor may also recommend medications to relieve pain and fight inflammations. These medications are known as NSAIDs (Non Steroidal Anti Inflammatory Drugs) because they do not contain steroids. 4

5 Some examples of NSAIDs include ibuprofen and naproxen. The vast majority of people with plantar fasciitis improve within the first few months of treatment with NSAIDs medications and conservative therapy. However, these conservative treatments may require a long period of time to work, ranging from 3 to 12 months depending on the patient. If the pain is not treated, the doctor may recommend medications containing steroids. Corticosteroids are strong medicine used to fight inflammation. They can be given by mouth, injection or applied to the skin. Corticosteroids decrease inflammation. Corticosteroids do come with side effects that your doctor will explain. If conservative treatments fail, your doctor may recommend a new procedure called extracorporeal shock wave therapy. In this treatment sound waves are used to stimulate healing from the skin of your foot. This treatment may cause bruises, swelling, pain, and numbness or tingling. This therapy may not work for everyone. In some cases, surgery may be used to treat plantar fasciitis if all non-surgical treatments did not work. During surgery, the plantar fascia is detached from the heel bone. Prevention The following are ten tips to prevent the occurrence or recurrence of plantar fascitis: 1. Do not suddenly strain the plantar fascia ligament. For instance, if you do not walk or run regularly, do not suddenly run a marathon without training. Instead, gradually increase your walking or running distance first. 2. Do not stand for a long time on a hard surface without resting your feet. 3. Lose weight if you are overweight. 4. Use shoe inserts if you have flat feet. 5

6 5. Avoid wearing high-heel shoes for a long time and on a regular basis. 6. Invest in shoes that provide good support to the arch of the foot. 7. Do not wear shoes that do not fit well. 8. Strengthen the muscles of your calves and hamstrings with specific exercises for the legs. 9. Always stretch your lower leg muscles before you exercise them. 10. Do not over-exercise calves and hamstring muscles. Do not suddenly increase the weight significantly in resistance training of these muscles. Summary Plantar fasciitis is inflammation of the thick band of tissue called the plantar fascia that connects your heel bone to your toes at the bottom of the foot. Heel pain caused by plantar fasciitis may be severe enough to affect your regular activities. Resting the foot, medication and non-surgical therapies are the most common treatments for plantar fasciitis. Surgery may be recommended in few cases when medication and non-surgical therapies are not working and pain is interfering with regular activities. The majority of people with plantar fasciitis improve within the first few months of treatment with medication and non-surgical therapies. However, they need to give these conservative treatments a few months before they can see an improvement. 6

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