If your first few steps out of bed in the morning cause severe pain in the heel under your foot, you may have plantar fasciitis, an overuse injury that affects the sole of the foot. A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes. It is a common condition that affects 10% of the population.
You're more likely to develop the condition if you're female, overweight, or have a job that requires a lot of walking or standing on hard surfaces. You're also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles upwards. People with very flat feet or very high arches also are more prone to plantar fasciitis.
Plantar fasciitis typically starts gradually with mild pain at the bottom of the heel bone, often referred to as a stone bruise. You're more likely to feel it after (not during) exercise. The pain classically occurs right after getting up in the morning and after a period of sitting. Plantar fasciitis may become a chronic condition. You may not be able to keep up your level of activity, and you may develop other symptoms of the foot, knee, hip, and back because plantar fasciitis can change the way you walk.
Stretching is the best treatment
for plantar fasciitis. It may help to try to keep weight off your foot until the initial inflammation goes away. You can also apply ice to the sore area for 20 minutes 3-4 times a day to relieve your symptoms. Rolling a frozen water bottle on the bottom of your foot can be beneficial.
Your foot and ankle orthopaedic surgeon may prescribe a nonsteroidal anti-inflammatory medication such as ibuprofen or naproxen. Anti-inflammatory medications can help decrease the inflammation in the arch and heel of your foot. Use the medication as directed on the package. If you tolerate it well, take it daily for two weeks then discontinue for one week. If symptoms worsen or return, resume for two weeks, then stop. You should take these medications with food, as they can be hard on your stomach.
Physical therapy can be considered to aid in calf and plantar fascia stretching. However, home exercises to stretch your Achilles tendon and plantar fascia are the mainstay of treatment and reduce the chance of recurrence.
In one exercise, you lean forward against a wall with one knee straight and heel on the ground. Your other knee is bent. Your heel cord and foot arch will stretch in the leg that is straight as you lean forward. Hold for 10 seconds, relax, and straighten up. Repeat 20 times for each sore heel. It is important to keep the knee fully extended with your toes pointed straight or slightly inwards on the side being stretched.
In another exercise, you lean forward onto a countertop, spreading your feet apart with one foot in front of the other. Flex your knees and squat down, keeping your heels on the ground as long as possible. Your heel cords and foot arches will stretch as the heels come up in the stretch. Hold for 10 seconds, relax and straighten up. Repeat 20 times.
About 90% of people with plantar fasciitis improve significantly after two months of initial treatment. You may be advised to use shoes with shock-absorbing soles or fitted with an off-the-shelf shoe insert like a rubber heel pad. Over-the-counter inserts can provide added arch support and soft cushion. Some patients will require custom inserts. Your foot may also be taped into a specific position.
If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medication. If you still have symptoms, you may need to wear a walking cast for 2-3 weeks or a positional splint (night splint) when you sleep. You may also be advised to consider treatments including platelet-rich plasma injections or extracorporeal shock wave therapy. While some patients do obtain relief with these treatments, they may not be covered by your insurance plan.
In a few cases, surgery involving release of the plantar fascia or lengthening of the calf muscle is needed for chronically contracted tissue, but this is usually only considered after a prolonged period of non-surgical treatment.
Perform at least three sets of stretches per day. You cannot perform the stretch too often. The most important times to stretch are before taking the first step in the morning and before standing after a period of prolonged sitting.
All treatments can have certain risks. For plantar fascial steroid injections, risks can include rupture of the plantar fascia and gradual loss of the fat pad at the heel, as well as infection or injury to nerves and blood vessels. Your foot and ankle orthopedic surgeon can discuss these risks with you if you are considering an injection.
Original article by Arash Aminian, MD
Contributors/Reviewers: Michael Greaser, MD; Sudheer Reddy, MD; Jeremy Chan, MD
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