Plantar Fasciitis

The onset of plantar fasciitis may have little to no symptoms at all. It may just feel like a slight bruise to the heel and slight pain. Many people ignore the pain when it is mild and do not seek treatment. This can lead to severe inflammation of the area with stabbing pain to the heel. The pain is most severe when you take your first step in the morning, after exercise, and after sitting or standing for long periods. Other symptoms of plantar fasciitis are:

• Pain in the arch of the foot
• Pain that continues for months
• A swollen heel
• A tight Achilles tendon
• Increased pain after exercise

Plantar fasciitis (inflammation of the fascia of the sole) can happen without a tear or obvious injury. The plantar fascia is a thick web-like ligament that is found beneath the skin on the bottom of your foot. It is designed to absorb stress and strain that occurs in the foot, especially when standing, ambulating, or exercising. If there is too much pressure placed on the plantar fascia, damage or a tear can occur causing inflammation, stiffness, and heel pain. Degeneration of the plantar fascia can also be a cause of this type of heel pain.

Plantar fasciitis can happen for no obvious reason, but certain behaviors and anatomical features can increase your risk for inflammation and heel pain. These include:

• Age between 40 and 60 years old
• Exercise that stresses the heel for example ballet, dance & aerobics
• Excessive running
• Flat feet
• High arches
• Excessive foot pronation
• Different leg lengths
• Occupations that involve prolonged walking or standing
• Sedentary lifestyle
• Tight foot muscles and Achilles tendon
• Being overweight
• Working or exercising on a hard surface
• Wearing shoes with poor support
• Exercising without stretching your calves

If you have sharp and stabbing pain in the heel area, see your doctor or ask for a referral to a podiatrist. The doctor will ask you about your physical activities and examine your foot. They may press on the heel to check for pain. The following tests may be helpful, but usually not necessary:

X-ray. An x-ray can rule out bone spurs on the heel that may be causing the pain.

Magnetic resonance imaging (MRI). An MRI may be done to make sure there is no small fracture, pinched nerves, or other issues that may be painful.

If all other foot issues are ruled out, the doctor can easily diagnose you with plantar fasciitis and work with you on a treatment plan.

Often, the doctor will suggest proper fitting shoes with good support. Then it is usually recommended to do stretching exercises until the inflammation clears up. Your doctor may recommend rest, ice massage, and NSAIDs (nonsteroidal anti-inflammatory drugs) to help with healing and recovery. Ice can help relieve any pain and swelling, Use an ice pack 3 to 4 times a day for 20 minutes each.

Anti-inflammatories. You may need to take anti-inflammatory medications to relieve pain and inflammation. It is usually used for the first two weeksthen stopped for one week. If the pain is not yet gone, the doctor may have you use it for another two weeks then off for one week. It is important to eat with anti-inflammatories to prevent stomach upset.

Arch supports. The doctor may have you see a specialist that can make inserts for your shoes to give your arches support. You can also buy arch supports over the counter. These help relieve the pressure from the plantar fascia.

Stretching exercises. You need to stretch your Achilles tendon to help limber up your foot before any type of exercise and standing. Follow these steps: (1) Stand facing a wall about an arm’s length away from you. (2) Place the unaffected foot forward and the affected foot behind with the toes pointed forward. (3) Place your hands on the wall and lean into the wall. (4) Bend the unaffected knee and keep the affected leg straight placing the heel of the affected side flat on the ground. (5) Hold the position for 10 seconds and release. Do this 10 times at least 3 times daily.

Splints. You may need to wear a splint on your foot at night to help stretch the fascia.

Boot cast. For more severe cases, the doctor may have to place you in a boot cast to allow the inflammation to subside and the foot to heal.

You can get relief from the painful symptoms of plantar fasciitis with some self-care techniques and relaxation exercises. Massage with essential oils can relieve tension and provide pain relief without invasive treatments.

Lavender oil. Massaging lavender oil that is diluted in a carrier oil like olive or coconut oil can help relax your mind while providing anti-inflammatory activity in your affected feet.

Massage. This can help relieve pain and relax the muscles of the foot that may be causing a tight Achilles tendon and plantar fascia contraction. Massage your arches and heels with your thumbs in a circular motion from the ball of your foot to the heel. You can use a ball under your arches, but make sure it is not too hard so you do not injure your foot.

Botulinum toxin. This alternative treatment must be administered by your physician. A Botox injection causes skeletal muscle paralysis which can help reduce tension in the plantar fascia and provide some pain relief due to its analgesic effect.

Shock-wave therapy. Extracorporeal shock wave therapy (ESWT) delivers low-frequency sound waves to the plantar fascia causing increased blood flow and tissue regeneration. This form of therapy can be an alternative to surgery and may help decrease the pain that occurs after activity and when you awaken in the morning. Like Botox injections, this therapy requires a referral by your physician and is performed by licensed therapists.

If you are standing for prolonged periods, remember to take breaks and relax to give your feet a period of rest. Choose to wear supportive shoes with proper arch support and with a low heel. Replace old athletic shoes and purchase a new pair regularly. Signs of an old shoe include a breakdown of the shoe interior, new blisters that form on your feet and wear on the outsoles.

• Do your stretches every day
• Use an ice pack for up to 20 minutes 3 to 4 times daily
• Do not wear high heels and use a good shoe with arch support
• Do not go barefoot
• Lose extra weight to relieve the stress on your feet
• If you run, get new running shoes every 500 miles of running

If you do not get treatment for plantar fasciitis you may begin to have problems with muscles farther up the leg including in the knees, hips back. You may develop heel pain that does not go away and you may not be able to do your usual daily activities. If the pain persists for six months or longer you may need physical therapy and surgery. In the most severe cases, a plantar fasciotomy can be performed which involves cutting a portion of the fascia to release tension in the contracted ligament. It is a minimally invasive surgery that takes 15-20 minutes with a recovery period of non-weightbearing with the aid of crutches for two weeks.

American Academy of Orthopedic Surgeons. (2015, September 5). Plantar Fasciitis. Retrieved from American Orthopedic Foot and Ankle Society: https://www.aofas.org/footcaremd/conditions/ailments-of-the-heel/Pages/Plantar-Fasciitis.aspx/

Goff, J. D. & Crawford, R. (2011, September 15). Diagnosis and treatment of plantar fasciitis. American Family Physician, 84(6). Retrieved from https://www.aafp.org/afp/2011/0915/afp20110915p676.pdf

Hake, D. H. (2000, July). Endoscopic plantar fasciotomy: A minimally traumatic procedure for chronic plantar fasciitis. Oschner Journal, 2(3), 175-178. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117526/

Landorf, K. A. (2008, February 5). Plantar Heel Pain and Fasciitis. Retrieved from National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907928/

Latt, D. L., Jaffe, D. E. & Tang, Y.  (2020, February 13). Evaluation and treatment of chronic plantar fasciitis. Foot and Ankle Orthopaedics, 5(1), 1-11. Retrieved from https://journals.sagepub.com/doi/pdf/10.1177/2473011419896763

Mayo Clinic. (2014, February 27). Plantar Fasciitis: Definition. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/basics/definition/con-20025664