Dr. Pratik Shah

Plantar fasciitis is the most common cause of pain on the bottom of the heel.

Plantar fasciitis occurs when the strong band of tissue that supports the arch of your foot becomes irritated and inflamed. The plantar fascia is a long, thin ligament that lies directly beneath the skin on the bottom of your foot. It connects the heel to the front of your foot and supports the arch of your foot. The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body's natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis. In most cases, plantar fasciitis develops without a specific, identifiable reason.

There are, however, many factors that can make you more prone to the condition:

• Tighter calf muscles that make it difficult to flex your foot and bring your toes up toward your shin 
• Obesity 
• Very high arch 
• Repetitive impact activity (running/sports) 
• New or increased activity

Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.

The most common symptoms of plantar fasciitis include:

• Pain on the bottom of the foot near the heel 
• Pain with the first few steps after getting out of bed in the morning, or after a long period of rest, such as after a long car ride. The pain subsides after a few minutes of walking 
• Greater pain after (not during) exercise or activity

Tests

X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray.

Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.

Treatment

• More than 90% of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods.
• Rest. Decreasing or even stopping the activities that make the pain worse is the first step in reducing the pain. You may need to stop athletic activities where your feet pound on hard surfaces (for example, running or step aerobics).
• Ice. Rolling your foot over a cold water bottle or ice for 20 minutes is effective. This can be done 3 to 4 times a day.
• Nonsteroidal anti-inflammatory medication. Drugs such as ibuprofen or naproxen reduce pain and inflammation.
• Exercise. Plantar fasciitis is aggravated by tight muscles in your feet and calves. Stretching your calves and plantar fascia is the most effective way to relieve the pain that comes with this condition.
• Calf stretch
• Plantar fascia stretch
• Cortisone injections
• Supportive shoes and orthotics
• Night Splints
• Physical therapy
• Extracorporeal shockwave therapy (ESWT)
• Surgery is considered only after 12 months of aggressive nonsurgical treatment.