Plantar fasciitis is the most common cause of heel pain. The plantar fascia is the flat band of tissue (ligament) that connects your heel bone to your toes. It supports the arch of your foot. If you strain your plantar fascia, it gets weak, swollen, and irritated (inflamed). Then your heel or the bottom of your foot hurts when you stand or walk. Plantar fasciitis is common in middle-aged people. It also occurs in younger people who are on their feet a lot, like athletes or soldiers. It can happen in one foot or both feet.
The plantar fascia can also become aggravated by repetitive activity. If you increase the number of times the heel hits the ground, that can cause plantar fasciitis, a number of people develop problems when their feet are unaccustomed to hard tile or wood floors. Other risk factors for plantar fasciitis include obesity, an extra high or low foot arch, and activities like running.
Plantar fasciitis sufferers feel a sharp stab or deep ache in the middle of the heel or along the arch. Another sign is the morning hobble from the foot trying to heal itself in a contracted position overnight. Taking that first step causes sudden strain on the bottom of the foot. The pain can recur after long spells of sitting, but it tends to fade during a run, once the area is warmed up.
A health care professional will ask you whether you have the classic symptoms of first-step pain and about your activities, including whether you recently have intensified your training or changed your exercise pattern. Your doctor often can diagnose plantar fasciitis based on your history and symptoms, together with a physical examination. If the diagnosis is in doubt, your doctor may order a foot X-ray, bone scan or nerve conduction studies to rule out another condition, such as a stress fracture or nerve problem.
Non Surgical Treatment
Most doctors recommend an initial six- to eight-week program of conservative treatment, including Rest, balanced with stretching exercises to lengthen the heel cord and plantar fascia. Ice massage to the bottom of the foot after activities that trigger heel pain. Avoidance of walking barefoot or wearing slippers or sandals that provide little arch support. A temporary switch to swimming and/or bicycling instead of sports that involve running and jumping. Shoes with soft heels and insoles. Taping the bottom of the injured foot. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin and other brand names), or acetaminophen (Tylenol) for pain. Physical therapy using ultrasound, electrical stimulation with corticosteroids or massage techniques. If this conservative treatment does not help, your doctor may recommend that you wear a night splint for six to eight weeks. While you sleep, the night splint will keep your foot in a neutral or slightly flexed (bent) position to help maintain the normal stretch of the plantar fascia and heel cord. If the night splint doesn't work, your doctor may inject corticosteroid medication into the painful area or place your foot in a short leg cast for one to three months. Shock wave therapy, in which focused sound energy is applied to the sore heel, may be recommended for plantar fasciitis. The shock waves are intended to irritate or injure the plantar fascia to promote healing. The overall benefit of this approach is uncertain. Other therapies that have been tried include radiation therapy and botulinum toxin injections. But their effectiveness is unclear. If all else fails, your doctor may suggest surgery. But this is rare, and surgery is not always successful.
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you. No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.
The following exercises are commonly prescribed to patients with this condition. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 2 - 3 times daily and only provided they do not cause or increase symptoms. Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place provided there is no increase in symptoms. Calf Stretch with Towel. Begin this stretch in long sitting with your leg to be stretched in front of you. Your knee and back should be straight and a towel or rigid band placed around your foot as demonstrated. Using your foot, ankle and the towel, bring your toes towards your head until you feel a stretch in the back of your calf, Achilles tendon, plantar fascia or leg. Hold for 5 seconds and repeat 10 times at a mild to moderate stretch provided the exercise is pain free. Resistance Band Calf Strengthening. Begin this exercise with a resistance band around your foot as demonstrated and your foot and ankle held up towards your head. Slowly move your foot and ankle down against the resistance band as far as possible and comfortable without pain, tightening your calf muscle. Very slowly return back to the starting position. Repeat 10 - 20 times provided the exercise is pain free.