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Plantar fasciitis

Definition

The plantar fascia is the thick tissue on the bottom of the foot. It connects the heel bone to the toes and creates the arch of the foot. When this tissue becomes swollen or inflamed, it is called plantar fasciitis.

Causes

Plantar fasciitis occurs when the thick band of tissue on the bottom of the foot is overstretched or overused. This can be painful and make walking more difficult.

You are more likely to get plantar fasciitis if you:

  • Have foot arch problems (both flat feet and high arches)
  • Run long distances, downhill or on uneven surfaces
  • Are obese or gain weight suddenly
  • Have a tight Achilles tendon (the tendon connecting the calf muscles to the heel)
  • Wear shoes with poor arch support or soft soles
  • Change your activities

Plantar fasciitis is seen in both men and women. However, it most often affects active men ages 40 - 70. It is one of the most common orthopedic foot complaints.

Plantar fasciitis was commonly thought to be caused by a heel spur. However, 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 symptom is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn.

The pain is often worse:

  • In the morning when you take your first steps
  • After standing or sitting for awhile
  • When climbing stairs
  • After intense activity

The pain may develop slowly over time, or come on suddenly after intense activity.

Exams and Tests

The health care provider will perform a physical exam. This may show:

  • Tenderness on the bottom of your foot
  • Flat feet or high arches
  • Mild foot swelling or redness
  • Stiffness or tightness of the arch in the bottom of your foot.

X-rays may be taken to rule out other problems.

Treatment

Your health care provider will often recommend these steps first:

  • Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation
  • Heel and foot stretching exercises
  • Night splints to wear while sleeping to stretch the foot
  • Resting as much as possible for at least a week
  • Wearing shoes with good support and cushions

Other steps to relieve pain include:

  • 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.
  • Try wearing a heel cup, felt pads in the heel area, or shoe inserts.
  • Use night splints to stretch the injured fascia and allow it to heal.

If these treatments do not work, your health care provider may recommend:

  • Wearing a boot cast, which looks like a ski boot, for 3 - 6 weeks. It can be removed for bathing.
  • Custom-made shoe inserts (orthotics)
  • Steroid shots or injections into the heel

Sometimes, foot surgery is needed.

Outlook (Prognosis)

Nonsurgical treatments almost always improve the pain. Treatment can last from several months to 2 years before symptoms get better. Most patients feel better in 9 months. Some people need surgery to relieve the pain.

When to Contact a Medical Professional

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

Prevention

Making sure your ankle, Achilles tendon, and calf muscles are flexible can help prevent plantar fasciitis. Stretch your plantar fascia in the morning before you get out of bed. Doing activities in moderation can also help.

References

Murphy GA. Disorders of tendons and fascia and adolescent and adult pes planus. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 12th ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 82.

Abu-Laban RV,Rose GW. Ankle and foot. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa: Mosby Elsevier; 2013:chap 58.

Wapner KL, Parekh SG. Heel pain. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:section F.

Silverstein JA, Moeller JL, Hutchinson MR.Common issues in orthopedics. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 30.


Review Date: 3/8/2014
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, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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