Plantar Fasciitis

By Ronald Hull, D.P.M.

The plantar fascia is a ligament like structure that runs along the arch of the foot from the heel to the base of the toes. It functions both as a support and to absorb shock. When the plantar fascia is overworked or injured, it becomes inflamed resulting in a condition known as plantar fasciitis. About 10% of the population can expect to suffer from plantar fasciitis during their lifetime.

Plantar fasciitis is more common in runners, people who are overweight and pregnant women. Having a job that requires standing for long periods on hard surfaces can also result in plantar fasciitis. Other risk factors include middle age, having an either excessively flat or high arched foot, tight calf muscles and wearing flat, loose and/or thin soled shoes. There is also some current research that suggests that plantar fasciitis may be more of a degenerative process rather than an inflammatory one.

The onset of symptoms is usually gradual and can involve either one or both feet. Symptoms often include sharp pain in the heel and arch, upon initial weight bearing after periods of rest. The pain usually subsides in a few minutes. Symptoms might also occur with excessive standing and the painful area sometimes swells. Not all heel and arch pain is plantar fasciitis. There are other conditions such as tendonitis, bursitis, stress fractures and nerve entrapments that can have similar symptoms. Heel spurs are often associated with plantar fasciitis, but these are usually a result of the condition and not a cause of the pain. If your self-administered treatment (see below) fails to relieve the pain, it is important to see a podiatrist or physician to confirm that you made an accurate self diagnosis.

Illustration A.

Treatment includes anti-inflammatory medications like naproxen and ibuprofen (if you are able to take these medications). Calf and arch-stretching exercises as well as ice massage to the painful area are also important (See Illustration A). Wearing a supportive, shock absorbing shoe with a thick sole is probably the most important part of the treatment plan in order to reduce the inflammation and reduce the risk of recurrence. A firm arch support placed inside the shoe will often help by distributing pressure more evenly on the foot. But, such supports should not be used in place of a supportive shoe. Recent studies conclude that a good, over-the-counter support is as effective as the costly, custom-made devices.

If you are a runner and suffer from foot pain, you may want to run shorter distances or switch to a lower-impact exercise like swimming or cycling. Either a night splint or doing the stretching exercises prior to getting out of bed can help reduce pain that occurs with initial weight bearing. Should these measures fail, your doctor may want to try a prescription anti-inflammatory, a steroid injection or immobilization in a cast or splint. In the rare cases that conservative therapy fails, there are surgical options. These include shockwave therapy and radiofrequency ablation, both of which stimulate healing in the area but can be painful with inconsistent benefit. Autologous blood injections are another new procedure to stimulate healing which may be of benefit. Finally, either open or minimal incision release of the plantar fascia from the heel bone can solve the problem, but loss of the support can cause eventual problems in other areas of the foot.

Plantar fasciitis can be a chronic condition, much like diabetes or high blood pressure. Watching your weight, wearing supportive shoes and avoiding high impact activities will significantly reduce the risk of this painful condition.

Ronald Hull is a podiatrist at Bay Valley Medical Group, which offers multi-specialty services and has offices in Hayward, Castro Valley, Danville and Pleasanton. Dr. Hull is located at Bay Valley Medical Group offices in Hayward, (510) 785-5000 and Castro Valley, (510) 581-2559.