Sports Medicine

Plantar Fasciitis

Plantar fasciitis is a common problem that causes pain under the heel bone often with lengthy walking and prolonged standing. It is most often seen in middle-aged men and women. The plantar fascia is a thick band of tissue that lies at the bottom of the foot. It runs from the heel bone to the toes and forms the arch of the foot. The plantar fascia functions as a shock absorber and also supports the arch of the foot.

Causes

Too much pressure over the foot may damage or tear away the plantar fascia tissue and can be a cause of heel pain. It is also possible that when the plantar fascia is overstretched or overused repeatedly, there can be irritation or inflammation of the fascia. Inflammation of the plantar fascia causes plantar fasciitis.

Risk Factors

The risk factors that can make you more prone to develop plantar fasciitis include obesity, foot arch problems such as flat feet (pes planus) or high arch (pes cavus), activities such as long-distance running, ballet dancing, and dance aerobics, occupations that necessitate walking or standing on hard surfaces for long periods of time, and wearing shoes with poor arch support or thin soles.

Symptoms

The most common symptom of plantar fasciitis is stabbing pain on the bottom of the foot near the heel. The pain develops gradually and may involve either one or both feet at the same time. Pain is usually worse in the morning and may be aggravated after standing for a long time.

Diagnosis

Your doctor will examine your foot and will check for signs of flat feet or high arches, tenderness, swelling, and redness of the foot, and stiffness or tightness of the arch in the bottom of your foot. Your doctor may suggest X-rays or an MRI scan to rule out other causes of heel pain such as a stress fracture or pinched nerve.

Treatment

Most patients with plantar fasciitis are effectively treated with the following measures:

  • Medications: Your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) as they can reduce your pain and inflammation. Corticosteroids can be injected directly into the plantar fascia which may offer pain relief and reduce inflammation.
  • Rest: Decrease or avoid activities that worsen the pain.
  • Ice: Apply ice packs over the painful area for 15-20 minutes at least 3-4 times per day for the first few days.
  • Night Splints: Use of a night splint is beneficial as it stretches the plantar fascia and allows it to heal.
  • Supportive Shoes and Orthotics: Your doctor may recommend you wear shoes with good support and cushioning. Custom orthotics (shoe inserts) may also be helpful.
  • Physical Therapy: Your doctor may recommend physical therapy that focuses on stretching your plantar fascia and your Achilles tendon and exercises to help strengthen the muscles of the lower leg. In addition to exercises, application of athletic taping to support the bottom of your foot is also performed.
  • Extracorporeal Shock Wave Therapy: During this procedure, sound waves are targeted to the painful area to stimulate the healing process in the damaged plantar fascia tissue.
  • Surgery: Rarely, surgery to release the tight plantar fascia may be needed. However, it is recommended only after all non-surgical measures have failed.
  • Preventive measures such as stretching, exercise programs, and footwear modification can help prevent plantar fasciitis. But if it occurs, proper treatment is essential or plantar fasciitis can become a long-term problem.

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