Achilles tendonitis is inflammation of the Achilles tendon, which connects the calf muscle to the heel bone. It can cause swelling and pain at the back of the heel and make walking difficult.…
What is plantar fasciitis?
Plantar fasciitis is a common condition that causes pain in the underside of the heel. It is also known as 'jogger's heel', as it is often aggravated by exercise, such as jogging.
The plantar fascia is a band of connective tissue that runs between the heel and the ball of the foot. In plantar fasciitis, this band of tissue becomes irritated, particularly at the point where it attaches to the heel.
There is recent evidence that suggests plantar fasciitis is caused by degeneration of the fascia. Small tears weaken the band of tissue and cause the pain of plantar fasciitis. This is often age-related, but can also occur in younger people as a result of repetitive strain and/or excessive stretching.
Triggers for plantar fasciitis include:
- Flat feet;
- High arching feet;
- Excessive running;
- Prolonged standing or walking occupations;
- Obesity, and;
- Tightness in the calf or foot muscles.
Risk factors for plantar fasciitis include:
- Age - being over 40 years of age;
- Gender - it is more common in women, and;
- Prolonged standing.
Signs and symptoms
Symptoms of plantar fasciitis include the following:
- Pain under the heel of the foot, which can radiate towards the sole;
- Pain that is usually worse first thing in the morning or after a period of rest;
- Usually one side of the foot hurts more than the other;
- Pain when wearing different types of footwear, and;
- Tenderness often felt underneath the heel, often made worse by pressing on the fascia.
Methods for diagnosis
A diagnosis can often be made based upon the symptoms and by performing a physical examination of the heel. Imaging tests, such as a X-ray or ultrasound, are rarely used for diagnosis, but can be used to exclude other causes of heel pain.
Types of treatment
Resting the heel is important, so limiting activities that aggravate the symptoms is advised. This may include running or walking shortened distances, or even stopping those activities completely in the short-term. An icepack applied to the heel can also be useful in reducing acute pain.
The use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also help reduce pain in the short-term, especially when combined with other treatments.
Stretching of the plantar fascia and muscles of the foot and calf are useful when pain does not settle with rest and pain-relief medications. There are several ways of stretching the areas involved and these can be taught by a doctor or physiotherapist. Deep tissue massage can also be helpful in reducing acute pain in some people.
Foot orthotics are often used to help ease the pain of plantar fasciitis. Orthotics are devices that are inserted into the shoe, which take the pressure of the plantar fascia, usually by raising the heel and enabling the calf to relax. The simplest type of orthotic is called a heel raiser, which is a rubber pad inserted into the heel of the shoe. More complex orthotics involve the whole foot and have to fit completely within the shoe. A person may need to see a podiatrist to have these assessed properly. Further options include night splints, which are specially designed devices worn at night to help prevent the foot from abnormal postures overnight. These can be uncomfortable and as such their use is limited to those suffering from chronic pain. Sometimes a person can be taught ways to tape their foot in order to better support it, but this method is only designed for short-term use as it provides minimal help to resolve the issue.
For severe swelling and pain, an injection of local anesthetic and corticosteroid may be given into the tender area. In most cases, this works quickly to reduce symptoms. These injections are generally limited to only a few times a year, to avoid side effects such as muscle wasting or localized skin discoloration.
Treatment options for persistent pain
If the above measures have not helped resolve the symptoms of plantar fasciitis after six months, then ultrasound therapy or surgery may be tried. Ultrasound therapy, or extracorporeal shock wave therapy, uses sound waves to improve blood flow and aid in healing the degenerated plantar fascia. The beneficial results for this treatment are varied. Surgery, known as plantar fasciotomy, is a procedure whereby a small part of the fascia is removed, which helps relieve tension on the fascia and reduces the pain.
The outlook for plantar fasciitis is generally good, as it tends to heal within a year, without treatment. The above treatment options can resolve the condition much sooner.
A person can help to prevent plantar fasciitis by:
- Allowing enough time to rest the heel, especially if there is pain;
- Avoiding long periods on their feet, not walking barefoot, or exercising on hard surfaces, and;
- Always stretching, especially first thing in the morning.
- Custom?made foot orthoses for the treatment of foot pain - Hawke - 2008 - Cochrane Database of Systematic Reviews - Wiley Online Library. Accessed 15 August 2014 from http://onlinelibrary.wiley.com/enhanced/doi/10.1002/14651858.CD006801.pub2
- Custom-made foot orthoses for the treatment of foot pain - The Cochrane Library - Hawke - Wiley Online Library. Accessed 15 August 2014 from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006801.pub2/abstract
- Eccentric loading compared with shock w... [J Bone Joint Surg Am. 2008] - PubMed - NCBI. (-a). Accessed 15 August 2014 from http://www.ncbi.nlm.nih.gov/pubmed/18171957
- Eccentric loading compared with shock w... [J Bone Joint Surg Am. 2008] - PubMed - NCBI. (-b). Accessed 15 August 2014 from http://www.ncbi.nlm.nih.gov/pubmed/18171957
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FAQ Frequently asked questions
What is plantar fasciitis?
Plantar fasciitis is a common condition which causes pain in the underside of your heel. It is also known as 'jogger's heel', as it is often made worse by exercise, such as jogging.
What are the symptoms of plantar fasciitis?
The primary symptom of plantar fasciitis is pain under the heel of your foot, especially first thing in the morning. The pain may radiate forward towards the sole of the foot. It may be worse after you have been resting.
What causes plantar fasciitis?
Plantar fasciitis can be caused by standing on your feet all day, being overweight, activities such as running, and having flat feet or having high arching feet. The plantar fascia runs from your heel to the ball of your foot and can degenerate, putting it at …
Who gets plantar fasciitis?
Plantar fasciitis is most common in middle age and occurs more frequently in women. It is also more common in athletes, especially runners.
How is plantar fasciitis diagnosed?
Your doctor can usually diagnose plantar fasciitis by taking your full medical history and examining your foot.
How is plantar fasciitis treated?
Useful first-line treatments for plantar fasciitis are: resting from the activities that may be causing it, applying ice to the heel and taking pain-relief medications, such as acetaminophen and ibuprofen. For more severe pain, the use of foot orthotics, …
Will plantar fasciitis clear on its own?
Most cases of plantar fasciitis go away within a year without treatment, and faster if treated.
What can be done at home to treat plantar fasciitis?
Stretching your foot as often as possible throughout out the day and when you wake each morning will help with plantar fasciitis. An easy exercise to try out when you are seated is rolling a can or ball around in all directions with your …
What is the outcome for plantar fasciitis?
Plantar fasciitis tends to resolve within a year. Foot orthotics and gentle stretching exercises may reduce the chance of it returning.