Plantar Fasciitis

Plantar fasciitis is one of the most common causes of pain in the bottom of the heel, the arch or both areas. The plantar fascia is a thick, fibrous, ligament-like band on the bottom of the foot. It is attached to the heel, runs forward along the foot to attach again at the ball of the foot.

When the plantar fascia becomes irritated and swollen, the condition is called plantar fasciitis.

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Symptoms

When you have plantar fasciitis, you usually feel pain in the bottom of the heel or the arch of the foot. Some people describe the pain as feeling like a bruise or an ache. The pain tends to gradually go away once you begin walking around. With continued walking the pain may return, but usually goes away after rest. If the swollen plantar fascia irritated a nerve in the foot, pain may radiate into the ankle.

In the early stages of plantar fasciitis, the pain may go away quickly once you take weight off the foot. Over time, however, it may take longer and longer for the pain to go away. Without treatment, the plantar fascia will eventually tear partially away from the heel. The body fills the torn area in with calcium. This eventually becomes a bone and is called a heel spur.

Causes of and Risk Factors

With every step forward we take, all of our body weight comes to rest first on the heel of one foot and then gradually over the length of the foot. As the foot begins to bear weight, it flattens. This puts pressure on the plantar fascia, which has very little stretch. As we walk, the plantar fascia pulls on its attachment at the heel.

If the foot is properly aligned this pull causes no problems. If the foot is pronated - rolls outward at the ankle, the arch falls too much and there is an abnormally amount of pull on the fairly rigid plantar fascia. This causes an abnormally strong pull on the heel where the plantar fascia attach.

Something similar happens when the foot has supination (rolls inward). These type of feet are relatively inflexible, usually have a high arch and a short or unusually tight plantar fascia.

Plantar fasciitis can be caused by:

  • A lack of arch support
  • A sudden injury
  • A tendency to pronate or supinate your feet
  • An increase in activities such as running, basketball, tennis, soccer or gymnastics that involve repetitive pounding of foot
  • Being overweight
  • Doing a lot of walking barefooted
  • Having one leg that is shorter than the other. This causes the foot on the longer leg to carry the body's entire weight longer than normal, stressing the fascia on that foot.
  • Additionally, the foot of the shorter leg falls to the ground harder, putting more force and pressure on that foot.
  • Poor flexibility in the calf muscle
  • Poor training for physical activities
  • Standing too long
  • Wearing shoes that don't bend easily under the ball of the foot
  • Wearing shoes without enough cushioning on hard surfaces

It's not always possible to identify the cause. Plantar fasciitis tends to develop as we get older and the fascia become less elastic. Women tend to get this condition more than men.

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Diagnosis

This condition is usually diagnosed on the basis of your description of your symptoms. Your doctor may examine your foot and its structure or look at your shoes to see how they are wearing when you walk. (Feet that pronate, tend to break down the inner side of the shoe; feet that supinate, tend to break down the outer side of the shoe.)

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Treatments

Different treatments may be more effective for you personally than others in addressing the pain and discomfort of plantar fasciitis. Some approaches include:

  • Rest. Doing less weight-bearing exercise involving running and jumping can help. Sitting or lying down and raising your feet can also help reduce swelling.
  • Applying ice. Putting ice packs to cool (not freeze) your foot helps reduce pain and swelling. The ice should be used on heels and arches (not toes) for about 20 minutes three times a day. If you have diabetes or poor circulation you should discuss this with your doctor first.
  • Orthotics
  • Heel cushions. These are off-the-shelf devices that are put inside your shoes to cushion the heel.
  • Splinting your foot at night
  • Avoid going barefoot
  • Stretching your foot