Plantar Fasciitis

Cause

Plantar fasciitis is caused by straining the ligament (plantar fascia) that supports your arch. Repeated strain can cause tiny tears in the plantar fascia. These can lead to pain along the bottom of the foot and heel. This may be more likely to happen if:

• You have high arches.
• You have tight Achilles tendons or calf muscles.
• You walk, stand, or run for long periods of time, especially on hard surfaces.
• You are overweight.
• You wear shoes that don't fit well or are worn out.

Symptoms

The main symptom of plantar fasciitis is heel pain when you take your first steps after you get out of bed or after you sit for a long time. It gets better after a few steps but gets worse as the day goes on. You may also have:

• Pain that gets worse when you climb stairs or stand on your toes.
• Pain after you stand for long periods.
• Pain at the start of exercise. It gets better or goes away as exercise continues, but it comes back when exercise is done.

Plantar fasciitis may be mistaken for other conditions with similar symptoms, such as a stress fracture or a nerve problem such as tarsal tunnel syndrome.

What Happens

Plantar fasciitis most often occurs because of injuries that have happened over time. With treatment, you will have less pain within a few weeks. But it may take time for the pain to go away completely. It may take a few months to a year.

When to Call a Doctor

Call your doctor now if you have heel pain with fever, with redness or warmth in your heel, or with numbness or tingling in your heel.

Call your doctor if you have:

• Pain that continues when you aren't standing or bearing any weight on your heel.
• A heel injury that results in pain when you put weight on your heel.
• Heel pain that doesn't getter better after a week, even though you have tried rest, ice, over-the-counter pain medicine (such as ibuprofen or acetaminophen), and other home treatment.

Call your doctor if you've been diagnosed with plantar fasciitis and the home treatment you agreed on is not helping to control your heel pain.

Watchful waiting

If you have heel pain:

• First, try resting and icing your heel. If possible, stop or reduce activities that cause the pain, such as running, standing for long periods of time, or walking on hard surfaces.
• Try different shoes. Make sure they have good arch support and well-cushioned soles. Or if your current shoes are in good shape, try heel cups or shoe inserts (orthotics) to cushion your heel.
• Switch to other activities or exercises that don't put pressure on your heel. After your symptoms are completely gone, gradually resume the activity that was causing pain.
• If you are an athlete, do not ignore or attempt to "run through" the pain. This can lead to a chronic problem that is harder to treat.

Exams and Tests

To diagnose plantar fasciitis, your doctor will ask questions about:

• Your past health. This includes what illnesses or injuries you've had.
• Your symptoms. Examples are where the pain is and at what time of day your foot hurts most.
• How active you are.
• What types of physical activity you do.

If you are an athlete, your doctor may look for other problems. These may include issues with how your feet strike the ground, how your feet are shaped, or your training routine.

X-rays aren't helpful in diagnosing plantar fasciitis because they don't show ligaments clearly. But you might get X-rays if your doctor suspects a stress fracture, a bone spur, or some other foot or ankle bone problem.

Treatment Overview

No single treatment works best for everyone with plantar fasciitis. But there are many things you can try to help your foot get better.

• Give your feet a rest. Cut back on activities that make your foot hurt. Try not to walk or run on hard surfaces.
• To reduce pain, try putting ice on your heel. Or take an over-the-counter pain reliever.
• Do passive toe stretches, standing calf stretches, and seated calf stretches using a towel several times a day, especially when you first get up.
• Get a new pair of shoes. Pick shoes with good arch support and a cushioned sole. Or try heel cups or shoe inserts (orthotics). Use them in both shoes, even if only one foot hurts.

If these treatments don't help, your doctor may recommend splints that you wear at night, shots of medicine (such as a steroid) in your heel, surgery, or other treatments.

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Self-Care

There are many methods you can try to relieve the heel pain of plantar fasciitis. Different people find that one method or a combination of methods works best for them. Try the following methods.

• Rest your feet.

  Stop or reduce any activities that may be causing your heel pain.

• Wear supportive footwear.

  Wear shoes that have good arch support and heel cushioning.

• Buy shoe inserts (orthotics).

  Shoe inserts may be made of plastic, rubber, or felt. Orthotics can reduce stress and pulling on the plantar fascia ligament.

• Use ice on your heel.

  Ice can help reduce inflammation. If ice isn't helping after 2 or 3 days, try heat, such as a heating pad set on low.

• Take a nonsteroidal anti-inflammatory drug (NSAID).

  This medicine reduces pain and inflammation. Examples include ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve). NSAIDs come in pills and in a cream that you rub over the sore area. Be safe with medicines. Read and follow all instructions on the label.

• Wear night splints.

  Night splints gently stretch the plantar fascia ligament and Achilles tendon and keep them from getting tight during the night.

• Do stretching and strengthening exercises.

  Exercises for stretching the Achilles tendon and plantar fascia will increase their flexibility. Exercises to strengthen the muscles of the foot and ankle will help support the arch.

• Replace athletic shoes regularly.

  Often athletes develop foot problems because they train in shoes that are worn out or don't fit properly. Replace your shoes every few months, because the padding wears out. Also, replace shoes if the tread or heels are worn down.

The healing process takes time—from a few months to a year. But you should begin to have less pain within weeks of starting treatment. If you have not improved after trying these methods for 6 weeks, your doctor may suggest other treatments.

To be successful at treating plantar fasciitis, you will need to:

• Be patient and consistent. The majority of cases of plantar fasciitis go away in time if you regularly stretch, wear good shoes, and rest your feet so they can heal.
• Start treatment right away. Don't just ignore the pain and hope it will go away. The longer you wait to begin treatment, the longer it will take for your feet to stop hurting.

Stretching your plantar fascia before you get out of bed

Many people with plantar fasciitis have intense heel pain when they take their first steps after resting for a long time. This pain comes from the tightening of the plantar fascia that happens during sleep. Stretching or massaging your plantar fascia before you stand up can often reduce heel pain.

• Stretch your foot by flexing it up and down 10 times before you stand up.
• Do toe stretches to stretch the plantar fascia.
• Use a towel to stretch the bottom of your foot (calf stretch with a towel).

Stretching exercises should create a pulling feeling. But they shouldn't cause pain. Ask your physical therapist or doctor which exercises will work best for you.

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