Feet > Plantar Fasciitis

What is the Plantar Fascia?

The plantar fascia is the fibrous tissue on the bottom of your foot that connects the heel bone (calcaneous) to the toes. When you bend your toes, you can feel the plantar fascia tighten along the bottom of your foot. It maintains the shape of your foot's arch and helps ensure you have a normal gait when walking or running. When standing, the plantar fascia is tightened and helps form the arch of your foot. At the beginning of each step, the heel lifts up and the plantar fascia tightens in the shape of your arch, allowing you to push off with your toes.
Tears in the plantar fascia tissue result in the condition called plantar fasciitis. It can cause chronic pain in the arch, usually close to the heel, and is sometimes called heel pain syndrome. Plantar fascia tears most often occur where the tissue inserts in the heel bone, but they may occur anywhere along the bottom of your foot. The heel pain caused by plantar fasciitis is a common sports injury that can be be irritating and hinder your ability to perform.

Plantar fasciitis is commonly caused by overuse or increasing the intensity of your activities or sports. You may be at particular risk for developing plantar fasciitis if you begin a new activity after a period of inactivity. Simply spending too much time on your feet can increase your chances of suffering plantar fasciitis, especially if your job requires many hours of walking on a hard surface. Sports that require running or jumping on hard surfaces, like sprinting, ballet dancing, and basketball, commonly cause plantar fasciitis. Jogging and walking can also put added strain on the plantar fascia. The normal aging process decreases some of the plantar fascia's elasticity or resilience, which may put older people at greater risk for developing heel pain during less stressful activities. Unpadded or worn-out footwear may increase the strain to your plantar fascia. Biomechanical faults in the shape of your foot or the strength of your leg muscles often put too much stress on the plantar fascia. Feet with either flat or high arches are more likely to suffer plantar fasciitis. Having weak muscles in the calf, toes, or ball of your foot can hinder your ability to absorb shock when walking or running, which can place extra tension on the plantar fascia. Excess body weight also increases the strain on the plantar fascia.

Though plantar fasciitis is a common cause of heel pain, your physician may need to rule out less common causes like nerve compression, stress fractures in the heel bone, or loss of the fatty tissue that pads the bottom of your heel. Plantar fasciitis often causes small bony growths called heel spurs. Because the plantar fascia is connected to many tendons in the foot, many people also suffer from plantar fasciitis and tendinitis at the same time. The treatment for plantar fasciitis, heel spurs, and tendinitis is often the same. If left untreated, your heel pain may continue to worsen. In general, the longer you wait to seek treatment for your heel pain, the longer it takes to cure. You should visit your physician as soon as you notice heel pain to receive the most effective treatment. Conservative, non-surgical treatment helps cure about 90 percent of patients with plantar fasciitis. Mild to moderate cases are often treated with ice, stretching, and shoe modification. Severe plantar fasciitis may require splints to immobilize the foot and possibly cortisone injections to reduce inflammation in the tissue. Successful treatment often takes months to cure plantar fasciitis, especially in athletes that overuse their feet, like cross-country and marathon runners.

Orthopedic Evaluation

There are usually three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your doctor may order.

Your physician likely will ask about your activities, which may be causing the pain in your heel. He will probably ask when the soreness or pain began. If you have had any prior foot injuries, your physician will ask about the treatments you have tried in the past. Physicians also typically ask about other conditions, such as diabetes and allergies, and medications currently being taken. You may also be asked about your physical and athletic goals ­ information that will help your physician decide what treatment might be best for you in achieving those goals.

Physicians can often diagnose plantar fasciitis by putting direct pressure on the bottom of your heel. The heel is usually tender when pressure is applied and pain tends to increase when your toes and foot are bent upward. Your physician usually individualizes your treatment by evaluating the shape of your foot and the biomechanics of your stride.

X-rays are sometimes used if your physician suspects you have bone spurs.  MRI (magnetic resonance imaging) is infrequently used to check for abnormally large amounts of fluid, called edema, in the plantar fascia.

   Imaging techniques