Plantar fasciitis is a common orthopedic pathology that affects more than 3 million people in the US per year. It involves the plantar fascia which is a thick ligament that runs across the bottom of the foot, from the toes to the heel bone. The ligament serves as a support for the arch and is a shock absorber. Injury or repetitive stress to the plantar fascia can cause inflammation, resulting in pain and stiffness, most commonly along its insertion site onto the heel. Too much pressure can also cause damage resulting in small tears or even a complete tear of the ligament.
- Dull or sharp pain commonly along the heel, but can occur along the arch as well.
- Pain worse with the first few steps after awakening or when getting up after sitting that seems to get better after walking more.
- Pain after standing for long periods.
Factors Contributing to Plantar Fasciitis
- Age: Common between ages 40-60.
- Foot structure & mechanics: Low (pronated) arched feet, high (supinated) arched feet, abnormal gait resulting in excess pressure along the plantar fascia.
- Weight: Increase in weight can put excessive pressure along the ligament.
- Activities: Certain sports/activities (running, long periods of standing for work).
- Poor shoe gear with no arch support.
Testing and Diagnosis
A physical exam will show tenderness along the plantar fascia, most commonly along the bottom of the heel where the ligament inserts into the heel bone. X-rays will likely be taken to rule out other issues. Sometimes the x-rays will reveal a heel spur. Heel spurs have not been linked to heel pain, as some people with spurs have no pain. However, it is evidence that the ligament has been tight for some time, pulling on the insertion site resulting in the growth of a spur. Ultrasound and MRI can also be used to evaluate for plantar fasciitis.
Most cases are treated successfully with conservative treatments, especially if addressed early on. Few go on to require surgical treatment.
- Rest, ice, elevation.
- Medications: Ibuprofen, Naproxen, etc..
- Injections: Steroid (helps to reduce inflammation), injections to help with soft tissue healing (platelet-rich plasma, prolotherapy, amniotic membrane injection).
- Night splint: Device that helps stretch the plantar fascia and Achilles tendon to encourage stretching.
- Taping: Applying athletic tape to support the bottom of your foot.
- Supportive shoe gear: Athletic shoes with proper support and stability that can accommodate orthotics are advised. Avoid going barefoot.
- Orthotics: Proper arch support for your shoes (ideally custom-fitted) to help distribute pressure more evenly across your feet and reduce pressure along the heel.
- Physical Therapy: A physical therapist will help you learn and perform the appropriate exercises to help stretch the plantar fascia and reduce your pain. They will have other modalities at their facility to address the pain and inflammation as well.
- MLS laser therapy: Offered in our office. Helps reduce pain and inflammation.
- Radial shockwave therapy: Offered in our office. An apparatus is used to apply sound waves to the area of pain along the heel to stimulate healing. Used often for chronic heel pain resistant to other conservative treatments.
- Consists of releasing/detaching part of the plantar fascia from the heel bone. This can be done in an open procedure or through a small incision.
Addressing heel pain early on is key to getting patients back on their feet pain-free. If you are experiencing heel pain or have any questions about this common pathology, contact our office today!