Christopher R. Hood JR, DPM

Plantar fasciitis is the most common cause of heel pain and probably the most common foot and ankle disorder we see at the office. The plantar fascia is a flat band (“ligament”) of tissue on the sole of your foot that connects your heel bone (calcaneus) to your toes. Its main purpose is to support your arch. The condition of plantar fasciitis is caused by straining of this fascia with resultant micro-tears leading to pain and swelling.

Heel pain can have a few different causes and is not always plantar fasciitis. This includes: structural abnormalities (ex. biomechanics, bone tumor), trauma (ex. calcaneal stress fracture, plantar fascia tear), neurologic (ex. nerve entrapment), or arthritic (ex: inflammatory or osteo- arthritis). One common condition that mimics plantar fasciitis is tarsal tunnel syndrome. It is important to see a foot and ankle specialist to differentiate plantar fasciitis from tarsal tunnel syndrome or another potential diagnosis, as each entity has a different treatment course. If you have been treated for plantar fasciitis by another physician with limited results, it may in fact be a tarsal tunnel syndrome or one of the other differentials listed above.

For plantar fasciitis, the most common locations of pain are the central-medial arch, plantar-medial heel just at the beginning of one’s arch, or the central-plantar heel. The pain, usually described as a non-radiating sharp/stabbing pain, occurs with weight-bearing often after a period of rest (ie. first steps in the morning after sleep). It gradually improves as you become more mobile but can also be a dull ache to your heel for the rest of the day without relief until you get off of your feet.

Most of the time, the cause is mechanical overload: high arch foot, excessive pronation; tight Achilles, lack of support (ex. flip-flops, flat sneakers, old sneakers), obesity, work-load (standing/walking for long periods on hard surfaces), poor posture, or change in activity level.

When you visit your doctor, he may ask about your shoe gear choices, recent changes in activity, work habits, history of trauma, and any attempted treatments. The visit typically starts with a weight-bearing radiograph to evaluate the biomechanical structure of the foot. Your doctor may or may not find the quoted “heel spur” which is believed to be caused by tension of the plantar fascia pulling on the bone. This is often an incidental finding and not the reason for your pain as only 50% of patients with plantar fasciitis are found to have the spur.1

Once the diagnosis is made, your physician will make recommendations for treatment. This typically includes some combination of the following: dispensing a stretching exercise protocol or formal physical therapy; night splint to keep the fascia stretched during the sleeping hours; oral anti-inflammatory medication; steroid injection to the target site of pain; arch support. Follow-up is typically 2-4 weeks later to evaluate the treatments and make changes as needed.

Treatments are targeted at eliminating the pain and then promoting a lifestyle to prevent recurrence, avoiding triggers and maintaining good habits. One studied reported upwards of 80% of patients with plantar fasciitis has resolution of pain with conservative treatment alone.2 The sooner you are evaluated, the better the prognosis. Patients with untreated pain for 6-12 month are less likely to respond to conservative measures alone and may require surgery.

If you’ve been dealing with heel pain, or any other foot and ankle pains, schedule an appointment with a foot and ankle specialist at Premier Orthopaedics to discuss your treatment options. Your Premier physician will help you determine the best course of action for your situation.

References:
1. Karr SD. Subcalcaneal heel pain. Orthop Clin North America 25: 161-175, 1994
2. Wolgin M, Cook C, Graham C, Mauldin D. Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle Int 1994;15:97-102.