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Plantar fasciitis

Definition

Plantar fasciitis is irritation and swelling of the thick tissue on the bottom of the foot.

Causes, incidence, and risk factors

The plantar fascia is a very thick band of tissue that connects the heel bone to the toes. This band of tissue is what creates the arch of the foot. When the fascia is overstretched or overused, it can become inflamed. When the fascia is inflamed, it can be painful and make walking more difficult.

Risk factors for plantar fasciitis include:

• Foot arch problems (both flat feet and high arches)
• Obesity
• Repetitive loading on the feet from long-distance running, especially running downhill or on uneven surfaces
• Sudden weight gain
• Tight Achilles tendon (the tendon connecting the calf muscles to the heel)
• Shoes with poor arch support or soft soles

Plantar fasciitis typically affects active men ages 40 - 70.

This condition is one of the most common orthopedic complaints relating to the foot.

Plantar fasciitis is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On x-ray, heel spurs are seen in people with and without plantar fasciitis.

Symptoms

The most common complaint is pain in the bottom of the heel, which is usually worse in the morning and may improve throughout the day. By the end of the day the pain may be replaced by a dull ache that improves with rest.

Signs and tests

Typical physical exam findings include:

• Mild swelling
• Redness
• Tenderness on the bottom of the heel

X-rays may be taken to rule out other problems, but having a heel spur is not significant.

Treatment

Conservative treatment is almost always successful, given enough time. Treatment can last from several months to 2 years before symptoms get better. Most patients will be better in 9 months.

Initial treatment usually consists of:

• Anti-inflammatory medications
• Heel stretching exercises

To relieve plantar fasciitis:

• Apply ice to the painful area. Do this at least twice a day for 10 - 15 minutes, more often in the first couple of days.
• Rest as much as possible for at least a week.
• Take acetamin for pain or ibuprofen for pain and inflammation.
• Try wearing a heel cup, felt pads in the heel area, or an orthotic device.
• Use night splints to stretch the injured fascia and allow it to heal.
• Wear properly fitting shoes.

If these fail, putting the affected foot in a short leg cast (a cast up to but not above the knee) for 3 - 6 weeks is often successful in reducing pain and inflammation. Alternatively, a cast boot (which looks like a ski boot) may be used. It is still worn full time, but can be removed for bathing.

Some physicians will offer steroid injections, which can provide lasting relief in many people. However, this injection is very painful and not for everyone.

In a few patients, nonsurgical treatment fails and surgery to release the tight, inflamed fascia becomes necessary.

Support Groups

Expectations (prognosis)

Nearly all patients will improve within 1 year of beginning nonsurgical therapy, with no long-term problems. Most of the few patients who need surgery get relief from their heel pain.

Complications

Complications with surgery include:

• Infection
• Nerve injury
• No improvement in pain
• Rupture of the plantar fascia

With other treatments, a complication is continued pain.

Calling your health care provider

Contact your health care provider if you have symptoms of plantar fasciitis.

Prevention

Maintaining good flexibility around the ankle, particularly the Achilles tendon and calf muscles, is probably the best way to prevent plantar fasciitis.

References

Lee SY, McKeon P, Hertel J. Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis. Phys Ther Sport. 2009;10:12-18.

Hawke F, Burns J, Radford JA, du Toit V. Custom-made foot orthoses for the treatment of foot pain. Cochrane Database Syst Rev. 2008;16:(3):CD006801.

Donley BG, Moore T, Sferra J, Gozdanovic J, Smith R. The efficacy of oral nonsteroidal anti-inflammatory medication (NSAID) in the treatment of plantar fasciitis: a randomized, prospective, placebo-controlled study. Foot Ankle Int. 2007;28:20-23.

Review Date: Jun 13, 2010
Reviewed By: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.