Plantar fasciitis is irritation and swelling of the thick tissue on the bottom of the foot.
The plantar fascia is a very thick band of tissue that connects the heel bone to the toes. This band of tissue is what creates the arch of the foot. When the fascia is overstretched or overused, it can become inflamed. When the fascia is inflamed, it can be painful and make walking more difficult.
Risk factors for plantar fasciitis include:
Plantar fasciitis typically affects active men ages 40-70.
This condition is one of the most common orthopedic complaints relating to the foot.
Plantar fasciitis is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On x-ray, heel spurs are seen in people with and without plantar fasciitis.
The most common complaint is pain in the bottom of the heel, which is usually worse in the morning and may improve throughout the day. By the end of the day the pain may be replaced by a dull ache that improves with rest.
Typical physical exam findings include:
X-rays may be taken to rule out other problems, but having a heel spur is not significant.
Conservative treatment is almost always successful, given enough time. Treatment can last from several months to 2 years before symptoms get better. Most patients will be better in 9 months.
Initial treatment usually consists of:
To relieve plantar fasciitis:
If these fail, putting the affected foot in a short leg cast (a cast up to but not above the knee) for 3-6 weeks is often successful in reducing pain and inflammation. Alternatively, a cast boot (which looks like a ski boot) may be used. It is still worn full time, but can be removed for bathing.
Some physicians will offer steroid injections, which can provide lasting relief in many people. However, this injection is very painful and not for everyone.
In a few patients, non-surgical treatment fails and surgery to release the tight, inflamed fascia becomes necessary.
Nearly all patients will improve within 1 year of beginning non-surgical therapy, with no long-term problems. Most of the few patients who need surgery get relief from their heel pain.
Complications with surgery include:
With other treatments, a complication is continued pain.
Contact your health care provider if you have symptoms of plantar fasciitis.
Maintaining good flexibility around the ankle, particularly the Achilles tendon and calf muscles, is probably the best way to prevent plantar fasciitis.