Foot Conditions A-Z
Plantar fasciitis is inflammation of the plantar fascia, a dense band of fibrous tissue that extends from the bottom of the heel bone (calcaneus) to the base of the toes (ball of the foot). The plantar fascia is the main support mechanism for the arch of the foot. It attaches to the middle of the heel bone and divides into five sections as it progresses toward the forefoot, each section extending into a toe and straddling the flexor tendons. Plantar fasciitis is often associated with heel spurs, which are protrusions (bumps) that develop along the edge of the heel bone.
The terms “heel spur” and plantar fasciitis are often used interchangeably; but, although they’re closely related, they are not identical. Heel spurs occur as part of the body’s response to inflammation of the plantar fascia. They are not always painful, but if they protrude into the plantar fascia, they can cause irritation and contribute to heel pain.
Pain from plantar fasciitis can best be described as a stabbing or burning pain, akin to a hot nail being driven into the inside area of the heel. It is often most noticeable in the morning when you get out of bed and take your first few steps. That’s because the plantar fascia relaxed and contracted during the night, while the foot is plantar flexed (toes pointed downward); pointing the toes upward (called “dorsiflexion”) causes the fascia to stretch and become irritated again. The pain often diminishes once you have been walking or exercising for a while.
Plantar fasciitis is thought to develop as the result of repeated small tears in the plantar fascia that occur when your foot strikes the ground. Common causes include the following:
- Overuse or a sudden rapid increase in physical activity. Plantar fasciitis is especially common in long-distance runners. Other types of sudden exertion, such as lifting heavy weights, can trigger the pain.
- Faulty biomechanics. Overpronation (flat-footedness), a high arch or an altered gait can affect the way weight is distributed when you're on your feet, thereby stressing the plantar fascia.
- Being overweight, especially if weight gain takes place rapidly.
- Poorly designed shoes. Shoes that are thin-soled, too loose, too stiff, or that lack arch support and impact absorption don't protect the feet well. If you regularly wear shoes with high heels, the Achilles tendon can contract and shorten, causing strain on the plantar fascia.
- Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of the foot, which can lead to plantar fasciitis.
- Diabetes. For reasons that are not yet clear, plantar fasciitis occurs more often in people with diabetes than in those who don’t have diabetes.
- Being on the feet for extended periods. People in occupations that require a lot of walking or standing on hard surfaces often develop plantar fasciitis.
Prevention and Treatment
Inserts that provide arch support and a slight heel lift help lessen the stress on the plantar fascia to reduce the possibility of inflammation. If your feet overpronate, inserts can help support them and prevent them from turning in excessively. They also help support the arch area and promote proper biomechanics.
To ensure that your feet are optimally protected, IPFH suggests you wear only properly selected and fitted, as part of an integrated approach, padded socks with shoes with non-slip outsoles and any inserts or orthotics prescribed or recommended by a doctor or foot health professional. Peer-reviewed, published studies have shown that wearing clinically-tested padded socks can help protect against injuries to the skin/soft tissue of the foot.
If you feel a burning sensation in the heel area that signifies the possible onset of plantar fasciitis, see a foot health professional before the pain becomes more severe or chronic. Plantar fasciitis generally is treated conservatively. The first step is to cut back on the amount of time you spend on your feet and the intensity and duration of your physical activity. Inserts that elevate the heels can also help and may be incorporated with other non-invasive techniques such as icing and stretching. Special exercises and anti-inflammatory drugs, if tolerated, may also be prescribed. Arch support is critical in preventing plantar fasciitis. Most foot specialists recommend that patients not go barefooted.
Recovery from plantar fasciitis may take up to six to nine months; in some cases, anti-inflammatory injections may calm symptoms. A relatively recent and potentially successful treatment method for particularly difficult cases is extracorporeal shock wave therapy. If all else fails, your doctor may suggest surgery.
While plantar fasciitis is often a painful and even debilitating condition, it is usually curable and won’t do any long-term damage; however, severe pain may interfere with your ability to do certain types of work or engage in specific sports or other recreational activities.
Always talk with your doctor if you have soreness, pain, redness, swelling or other indications of problems in any area of your feet that persist for more than a few days.