What's New 

Author: David C. Thorson, M.D.
Clinic: Banning Avenue Clinic

View more Articles by this Physician

     The long flat ligament that runs along the bottom of the foot is called the plantar fascia. It helps maintain the arch of your foot. It starts at the heel and attaches at the area near the ball of the foot. When this gets irritated or inflamed it is called plantar fasciitis. It is the most common cause of heel pain in adults. Many local professional athletes have lost all or part of their competitive season because of this common ailment. The ligament develops small tears (usually near the heel) when it is stretched too far, either from a single overstretch or repetitive injury. These tears cause inflammation and pain. Typical pain for plantar fasciitis involves pain in the heel during the first several, steps after awakening from sleep or after prolonged sitting. People describe it as feeling like their heel is bruised. It will cause you to limp and will be worse after any exercise that increases the load across the bottom of the foot.

 

     There are some people who are at increased risk to develop this problem.  People who have high arches or whose feet roll or collapse to the inside (over pronation) apply more forces across the plantar fascia. Repetitive bounding (ballistic) activities, being overweight, wearing bad shoes (even high heels), or having tight heel cords (Achilles tendon) all place an individual at increased risk to develop these small tears and resulting pain.

 

     The diagnosis of plantar fasciitis does not usually require x-rays and is made by a careful history and physical exam. There is almost always point tenderness where the ligament originates at the heel (calcaneous). Sometimes, there will pain along the instep as well as slight swelling. Initial treatment will usually involve heel cord stretching and pain medicine (analgesics) with anti-inflammatory effects (NSAIDS), such as ibuprofen or naprosyn, as well as icing. Icing at the end of the day can be accomplished by rolling the foot over a large frozen juice as off-the-shelf types or custom orthotics from podiatry labs. Because people sleep encouraged to stretch their Achilles tendon before they get out of bed. Using a bath towel and hooking it under your toes then using your arms to gently stretch your heel cords easily accomplish this. Physical therapy is often beneficial if simple home care has failed. For stubborn cases, a night splint is used which holds the foot in a flexed position and sometimes even a cast is applied. If all these conservative measures fail cortisone injections are sometimes recommended. These injections may weaken the plantar fascia or damage the heel pad and therefore should be used only after conservative options have failed. There is a relatively new treatment that utilizes extra corporeal shock waves (one brand is Sonocur™) to treat refractory cases. Studies have shown that of people who have had more than 6 months of pain and failed conservative care and injections will have 85% improvement rate after three treatments and 90% after five treatments. Surgery is seldom utilized for this problem.                                                                        

 

     Plantar fasciitis left untreated can cause chronic heel pain and gait changes.  

These gait changes often lead to knee hip and low back pain. If you think you have plantar fasciitis and have not been able to get better with home treatment, please contact your MinnHealth family physician. They can identify any biomechanical causes as well as arrange for any further treatment that is needed.