Plantar Fasciitis

(Heel Spur, Heel Spur Syndrome)

The Facts

To find out where this condition gets its name, we need to look at a specific area of the foot. Your foot is made up of bones, muscles, tendons, and ligaments. The plantar fascia is a relatively inflexible, strong, fibrous band on the bottom of the foot that supports the arch of your foot.

Beginning at the heel bone, the plantar fascia extends the length of your foot to connect with your toes at the ball of the foot. When you walk, your weight is distributed across your feet. Any imbalances in the mechanics of your foot and distribution of weight can potentially cause pain.

Diseases involving inflammation end with "itis." This explains the name of the condition as being an inflammation of the plantar fascia, thus plantar fasciitis.

Repetitive movements such as walking or running stretch the plantar fascia. Because it is not very flexible, this can cause small tears in the fascia, which leads to inflammation and pain. Other factors such as high arches, fallen arches, or a change in the walking surface contribute to the stress placed on the plantar fascia and heel.

The Causes

A variety of causes exist for plantar fasciitis. Some of the most common causes include:

excessive weight load on the foot due to obesity or prolonged standing
mechanical imbalances of the foot
osteoarthritis and rheumatoid arthritis
sudden increase in body weight (e.g., pregnancy)
sudden increase in walking or running
tight calf muscles
wearing shoes with poor support, including flip-flops or high-heels

Having very high or low foot arches increases risk of developing plantar fasciitis. Other disorders that increase risk include ankylosing spondylitis and psoriatic arthritis.

Another cause of pain is the shortening of the plantar fascia overnight due to the ankle bending, causing the toes to point towards the ground. The plantar fascia stretches in the morning when you stand. The act of lengthening it causes a great deal of pain. However, this is not limited to an overnight occurrence – it can happen any time the foot is flexed (i.e., pointed) for extended periods of time. For example, driving in the car for long periods can cause fasciitis in the right foot, which steps on the accelerator.

Symptoms And Complications

People with this condition sometimes describe the feeling as a hot, sharp sensation in the heel. You usually notice the pain first thing in the morning when you stand. After walking for a period of time, the pain usually lessens or even disappears. However, sharp pain in the center of the heel may return after resting for a period of time and then resuming activity. The pain is usually worse when pushing off with the heel.

Making A Diagnosis

Physical examination is the best way to determine if you have plantar fasciitis. Your doctor examines the affected area to determine if plantar fasciitis is the cause of your pain. The doctor may also examine you while you are sitting, standing, and walking.

It is important to discuss your daily routine with your doctor. An occupation in which you stand for long periods of time may cause plantar fasciitis.

An X-ray is not commonly used, but may reveal a heel spur. The actual heel spur is not painful. The presence of a heel spur suggests that the plantar fascia has been pulled and stretched excessively for a long period of time, sometimes months or years. If you have plantar fasciitis, you may or may not have a heel spur. Even if your plantar fasciitis becomes less bothersome, the heel spur will remain.

Treatment And Prevention

Your doctor will determine what treatment is best for your condition.

The most common treatments for plantar fasciitis include:

avoid aggravating activities such as excessive running, dancing or jumping
icing the affected area
inserting gel heel cups into your shoes
massaging the plantar fascia
nonsteroidal anti-inflammatory drugs (NSAIDs)
physical therapy
steroid injections into the heel
strengthening the foot
wearing a night splint
avoid walking barefoot
wearing shoes with arch support
stretching the calf muscles
shockwave therapy or radiotherapy
topical pain or anti-inflammatory creams

To keep the plantar fascia lengthened as you sleep, your doctor may ask you to wear night splints. In the morning, taking your first steps is less painful because the plantar fascia remains stretched throughout the night.

Avoiding activities such as walking or running helps the healing process. Losing weight, if it is a factor in the condition, may help to reduce the stress placed on the plantar fascia. Taking shorter strides while walking can help reduces stress on the plantar fascia.

Surgery is not a common treatment for this condition. Less than 5% of people with plantar fasciitis require surgery if non-surgical methods do not help to relieve pain within a year. The surgical procedure involves making an incision in the plantar fascia in order to decrease the tension of the ligament.

Potential risks of this surgical procedure include:

irritation of the nerves around the heel
continued plantar fasciitis
heel or foot pain
infection
flattening of the arch
problems relating to the anesthetic

A new treatment called EPAT (extracorporeal pulse activation therapy) is a type of shockwave therapy. In this therapy, your doctor will use a device to apply pressure waves of sound to your heel. It has proven effective for many patients in treating pain and discomfort in the tendons and muscles, but it can take up to 4 weeks for pain relief to begin.

There is some limited evidence to support the use of chiropractic treatments such as manipulative therapy of the ankle or the foot combined with multimodal or exercise therapy to manage pain for those who suffer from plantar fasciitis.