What causes plantar fasciitis?
Heel pain is one of the most popular reasons for a visit to a podiatrist, and more often than not it is due to a condition called plantar fasciitis. It is estimated that 10% of the population will develop plantar fasciitis over their lifetime, and 2 million Americans experience symptoms at any one time (1). Plantar fasciitis is inflammation of the thick ligament on the bottom of the foot; this ligament supports your arch. A common symptoms is pain with the first steps after periods of rest. People with plantar fasciitis report that pain often presents on the bottom of the heel and is alleviated with rest, but may worsen and become more consistent over time.
How to diagnose plantar fasciitis?
Diagnosing plantar fasciitis begins with a physical exam and retaining history from the patient on new activity, new shoes, and increase in activity. An x-ray helps evaluate for problematic foot type, rule out a break in the bone and assess for heel spurs. A diagnostic ultrasound can also be used to measure the fascia, as it thickens with this condition (2). An MRI may be obtained if the doctor feels a more thorough evaluation is necessary.
What is the cause of plantar fasciitis?
There are two populations at high risk of developing plantar fasciitis; running athletes and sedentary individuals (1). Risk factors for developing plantar fasciitis include tight calf and foot muscles, flat feet, high arches, obesity, limb length difference, running sports and prolonged walking or standing (2). Tight calf muscles that extend into the foot can cause pain along the plantar fascia ligaments. The heel bone can develop bone spurs that grow into the tight fascia, but do not cause pain. New shoes or new activities can often cause plantar fasciitis, in fact shoes that are worn out can result in foot pain. Walking barefoot or with flat shoes/ sandals can lead to heel pain and plantar fasciitis as well.
What is best treatment for plantar fasciitis?
For many people, plantar fasciitis is a self-limiting condition and can resolve within a year without treatment (2). Treating heel pain involves a combination of stretching, arch support and anti-inflammatories. Most people start treatment with rest and activity modification to reduce pain, but supportive shoes or arch supports are necessary as well. Shoe inserts or orthotics provide support under the arch which lessens the collapse, this decreases stress on the plantar fascia.
Medical advice from physicians and physical therapists includes stretching for twenty minutes two or more times a day, even after the pain subsides. In fact, physical therapy can be ordered for a more formal stretching protocol. Night splints may also be worn to stretch your calf while you sleep so those first few steps are not as painful.
According to the American College of Foot & Ankle Surgeons, anti-inflammatories such as ice, non-steroidal anti-inflammatory pills or topical gel and prednisone are often used to decrease pain. These work in combination with arch support and stretching to heal plantar fasciitis quickly. If the initial treatments are not providing complete relief, steroid injections are given to reduce inflammation. Shockwave therapy is another tool used to promote healing via a handheld device in the doctor’s office. A more recent option is platelet-rich plasma injections that deliver your own body’s growth factors to the area of injury in order to accelerate recovery.
For the small number of patients who continue experiencing pain using these methods, there is a minimally-invasive surgical procedure called endoscopic fasciotomy to release the tight fascia (3). Recovery is from two weeks to three months and most people are able to return to their previous activities.
How long does it take for plantar fasciitis to heal?
The average course of treatment involving arch support, stretching and anti-inflammatory medications relieves pain in approximately two weeks. Decreasing activities that aggravate the heel pain will also allow for faster pain relief. The treatment options recommended will decrease the heel pain but overall lifestyle modifications in activities, shoes and adding a stretching regimen will prevent further pain and decrease the chance of recurrence.
• Schneider HP, Baca J, Carpenter B, Dayton P, Fleischer AE, Sachs BD. American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain. J Foot Ankle Surg: Mar-Apr 2018;57(2):370-381.
• Luffy L, Grosel J, Thomas R, So E. Plantar fasciitis: A review of treatments. JAAPA. 2018;31(1):20-24.
• Trojian T, Tucker AK. Plantar Fasciitis. Am Fam Physician. 2019;99(12):744-750.