Plantar Fasciitis

Do your first few steps out of bed in the morning cause severe pain in your heel? Or does your heel hurt after jogging or playing tennis? Most commonly, heel pain is caused by inflammation of the plantar fascia, the tissue along the bottom of your foot that connects your heel bone to your toes. The condition is called plantar fasciitis (PLAN-tur fas-e-I-tis). Plantar fasciitis causes stabbing or burning pain that's usually worse in the morning because the fascia tightens (contracts) overnight. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.

In most cases, you can overcome the pain of plantar fasciitis without surgery or other invasive treatments.

Plantar fasciitis usually develops gradually, but it can come on suddenly and be severe. And although it can affect both feet, it more often occurs in only one foot at a time. Watch for:

  • Sharp pain in the inside part of the bottom of your heel, which may feel like a knife sticking in the bottom of your foot
  • Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe
  • Heel pain after long periods of standing or after getting up from a seated position
  • Heel pain after, but not usually during, exercise
  • Mild swelling in your heel

The plantar fascia is a thick structure (fascia) that covers the bottom (plantar) surface of your feet. Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. But, if tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed. The causes of plantar fasciitis can be:

  • Physical activity overload. Plantar fasciitis is common in long-distance runners. Jogging, walking or stair climbing also can place too much stress on your heel bone and the soft tissue attached to it, especially as part of an aggressive new training regimen. Even household exertion, such as moving furniture or large appliances, can trigger the pain.

  • Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot, which may lead to plantar fasciitis.

  • Diabetes. Although doctors don't know why, plantar fasciitis occurs more often in people with diabetes.

  • Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you're on your feet, putting added stress on the plantar fascia.

  • Improper shoes. Shoes that are thin-soled, loose, or lack arch support or the ability to absorb shock don't protect your feet. If you regularly wear shoes with high heels, your Achilles tendon — which is attached to your heel — can contract and shorten, causing strain on the tissue around your heel.

Your risk of developing plantar fasciitis increases if you are:

  • Active in sports. Activities that place a lot of stress on your heel bone and attached tissue are most likely to cause plantar fasciitis. This includes running, ballet dancing and aerobics.

  • Flat-footed or have high arches. People with flatfeet may have poor shock absorption, which increases the stretch and strain on the plantar fascia. People with highly arched feet have tighter plantar tissue, which also leads to poor shock absorption.

  • Overweight. Carrying around extra pounds can break down the fatty tissue under the heel bone and cause heel pain.

  • Pregnant. The weight gain and swelling that accompany pregnancy can cause ligaments in your body — including your feet — to relax. This can lead to mechanical problems and inflammatory conditions.

  • Being on your feet. People with occupations that require a lot of walking or standing on hard surfaces, including factory workers, teachers and waitresses, can damage their plantar fascia.

  • Wearing shoes with poor arch support or stiff soles. A closet of poorly designed pumps, loafers and boots can mean plantar problems.

If you have heel pain, try self-care measures, such as stretching and changing your activities. If you don't see much progress after a few weeks of home treatment, you should seek help. Seek help sooner if your pain worsens, despite home treatment. If you have diabetes or another condition that causes poor circulation, see your doctor for an early evaluation of any changes in your feet.

Your doctor can help rule out other causes of heel pain, such as tendinitis, arthritis, nerve irritation or a cyst. Your doctor may also suggest an X-ray or magnetic resonance imaging (MRI) to make sure you don't have a stress fracture. Sometimes, an X-ray shows a spur of the bone projecting forward from the heel bone. In the past, bone spurs were often blamed for heel pain and removed surgically, but doctors have found that bone spurs typically aren't the cause of pain. Surgery to remove spurs is rare.

Ignoring plantar fasciitis may result in a chronic condition that hinders your regular activities. You may also develop foot, knee, hip or back problems because of the way plantar fasciitis changes your walking motion.

For most people, the condition improves within a year of beginning conservative treatment. Non-surgical treatments that may promote healing include:

  • Night splints. Your doctor may recommend wearing a splint fitted to your calf and foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight so that they can be stretched more effectively.

  • Spinal and Extremity Adjusting: All of the bones in your feet need to be in proper alignment, as well as all joint of the body. A Certified Chiropractic Sports Physician is trained in these procedures.

  • Orthotics. Your doctor may prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.

  • Rehabilitation and physiotherapy: You can be instructed to perform exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. bottom of your foot.

  • Surgery. Only a small percentage of people need surgery to detach the plantar fascia from the heel bone (plantar fasciotomy). It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.

Prevention
You can take some simple steps now to prevent painful steps later:

  • Maintain a healthy weight. This minimizes the stress on your plantar fascia.
    Choose supportive shoes. Give stilettos the boot. Also avoid shoes with excessively low heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency.

  • Don't go barefoot, especially on hard surfaces.

  • Don't wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet. If you're a runner, buy new shoes after about 400 miles of use.

  • Start sports activities slowly. Warm up before starting any athletic activity or sport, and start a new exercise program slowly.

  • Wake up with a stretch. Before you get out of bed in the morning, stretch your calf muscles, arch and Achilles tendon by reaching for your toes and gently flexing your foot. This helps reverse the tightening of the plantar fascia that occurs overnight.

Self-care
By following these self-care tips, you may be able to eliminate heel pain without further treatment:

  • Apply ice. Hold a cloth-covered ice pack over the area of pain for 15 to 20 minutes three or four times a day or after activity. Or try ice massage. Freeze a water-filled paper cup and roll it over the site of discomfort for about five to seven minutes. Regular ice massage can help reduce pain and inflammation.

  • Put your feet up. Stay off your feet for several days when the pain is severe.

  • Decrease your miles. You probably won't have to permanently retire your running or walking shoes, but it's a good idea to cover shorter distances until pain subsides.

  • Take up a no- or low-impact exercise. Swap swimming or bicycling for walking or jogging. You'll likely be able to return to your regular activities as heel pain gradually improves or disappears. However, some people find that the only way to avoid a recurring problem is to permanently modify their aerobic activities.

  • Try acupressure techniques. Apply pressure to your heel by rolling a golf ball or tennis ball with the arch of your foot while you are standing and stabilized. This can help reduce pain and increase blood flow.

  • Stretch your arches. Simple exercises using household objects can stretch or strengthen your plantar fascia, Achilles tendon and calf muscles.