Plantar Fasciitis

Plantar fasciitis is the most common cause of heel pain. The plantar fascia is the ligament that connects your heel bone to your toes. If you strain your plantar fascia, it gets irritated or inflamed. Then, your heel or the bottom of your foot hurts when you stand or walk.

Plantar fasciitis is caused by straining the plantar fascia, the ligament that supports the arch. Repeated strain can cause tiny tears in the ligament, leading to inflammation along the bottom of the heel. This problem is more likely to happen if you walk, stand or run for long periods, especially on hard surfaces.

Plantar fasciitis is more likely to develop if:

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

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 a few months to a year for the pain to go away completely.

Catching plantar fasciitis early may shorten the time you suffer from the painful symptoms. Call your doctor now if:

• You have heel pain with fever, redness, warmth, numbness and tingling in your heel
• You experience pain that continues when you aren’t standing or bearing any weight on your heel
• You suffer a heel injury that results in pain when you put weight on your heel
• Your heel pain doesn’t get better after a week, even though you have tried rest, ice, over-the-counter pain medicine (such as ibuprofen or acetaminophen), and other home treatments

The main symptom of plantar fasciitis is heel pain when you take your first steps after getting out of bed or sitting for a long time. Most people with plantar fasciitis have pain along the bottom of their foot and heel. Your foot may hurt more as the day goes on and may hurt the most when you climb stairs.

Other symptoms may include:

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

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

To diagnose plantar fasciitis, your doctor will examine your feet and watch you stand and walk. They will also ask questions about your symptoms, past health, where the pain is and what time of day your foot hurts most.

Your doctor will ask questions about:

• Your past health, including illnesses or injuries you’ve had
• Your symptoms, such as where you feel pain and at what time of day your foot hurts most
• How active you are
• Common types of physical activity for you

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 don’t help diagnose 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 another foot or ankle bone problem.

No single treatment works best for everyone with plantar fasciitis, and different people find that one method or a combination of methods works best for them. But there are things you can try to help your foot get better, including the following:

• Rest your feet and cut back on activities that hurt your foot.
• Try not to walk or run on hard surfaces.
• Try putting ice on your heel to reduce pain, or take an over-the-counter pain reliever.
• Use a towel several times daily, especially when you first get up, for passive toe stretches, standing calf stretches and seated calf stretches.
• Get a new pair of shoes with good arch support and a cushioned sole. You can also try heel cups, shoe inserts or orthotics. Use them with both shoes, even if only one foot hurts.

You can try many methods to relieve the heel pain of plantar fasciitis. Many people with plantar fasciitis experience 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 during sleep. Stretching or massaging your plantar fascia before you stand up can often reduce heel pain.

Stretching exercises should create a pulling feeling. But they shouldn’t cause pain. Ask your physical therapist or doctor which exercises or adjustments will work best for you. They may suggest you try the following methods:

• Rest your feet. Stop or reduce any activities that may be causing your heel pain.
• Wear supportive footwear and shoes that have good arch support and heel cushioning.
• Buy shoe inserts, such as orthotics. Shoe inserts may be made of plastic, rubber or felt. Orthotics can reduce stress and pulling on the plantar fascia ligament.
• Ice your heel to reduce inflammation. If ice doesn’t help after two or three days, try heat, such as a heating pad set on low.
• To reduce pain and inflammation, take a nonsteroidal anti-inflammatory drug (NSAID). Examples include ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve). NSAIDs come in pills and creams that you rub over the sore area.
• Wear night splints that gently stretch the plantar fascia ligament and Achilles tendon and keep them from getting tight during the night.
• Exercises for stretching the Achilles tendon and plantar fascia will increase their flexibility and strengthen the foot and ankle muscles, which will help support the arch.
• Replace athletic shoes regularly. Athletes often 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.

Remember that healing 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 six weeks, your doctor may suggest other treatments.

To help yourself heal, remember to:

• Be patient and consistent. Most cases of plantar fasciitis will 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.