Plantar Fasciitis

Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Generally, our feet can take on a lot of stress as we move around throughout the day, but overuse can cause inflammation, or the plantar fascia may tear where it attaches to the heel. The plantar fascia is a band of tissue that runs from the tip of the big toe all the way to the heel. It supports the arch of the foot and absorbs most of the stresses we place on our feet. When plantar fasciitis occurs, the plantar fascia first becomes irritated and then inflamed, resulting in heel pain.

At Peninsula Podiatry, Dr. Sarah Neitzel frequently sees patients with plantar fasciitis and she offers patients both nonsurgical and surgical treatment options for plantar fasciitis.

What causes plantar fasciitis?

The most common cause of plantar fasciitis relates to the faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.

Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Obesity may also contribute to plantar fasciitis.

What are the symptoms of plantar fasciitis?

The symptoms of plantar fasciitis include:

Pain on the bottom of the heel
Pain in the arch of the foot
Pain that is usually worse upon first standing from rest
Pain that increases over a period of months

People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people, the pain subsides but returns after spending long periods of time on their feet.

How is plantar fasciitis diagnosed?

To arrive at a diagnosis, Dr. Neitzel will ask you to describe your symptoms and discuss your concerns. She will also examine your foot, looking for any of the following signs that are consistent for the diagnosis of plantar fasciitis:

A high arch
Tenderness on the bottom of your foot, just in front of your heel bone
Pain when you flex your foot and the doctor pushes on the plantar fascia. The pain improves when you point your toes down.
Limited “up” motion of your ankle

Throughout this process, the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis.

Tests

Diagnostic imaging studies such as x-rays or other imaging modalities may be ordered for you to make sure your heel pain is caused by plantar fasciitis and not another problem. X-rays provide clear images of bone, so they are useful in ruling out other causes of heel pain, such as fractures or arthritis.

Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.

What treatment options are available for plantar fasciitis?

In the majority of cases, plantar fasciitis resolves within a few months under guided physician care with conservative, nonsurgical treatment. If conservative treatments are not effective in relieving heel pain, surgical options are also available.

Nonsurgical Treatment Options

Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:

Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery.
Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
Ice. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin.
Limit activities. Cut down on extended physical activities to give your heel a rest.
Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia.
Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

If you still have pain after several weeks, Dr. Neitzel may add one or more of these treatment approaches:

Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
Injection therapy. In some cases, corticosteroid or amniotic fluid injections are used to help reduce inflammation and relieve pain.
Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.

Surgical Treatment Options

Although most patients with plantar fasciitis respond to nonsurgical treatment, a small percentage of patients may require surgery. If, after several months of nonsurgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you.

Endoscopic surgery for plantar fasciitis is possible, but it carries a higher risk of complications than open surgery. Endoscopic surgery may not address the full problem at the heel.

Open surgery for plantar fasciitis may involve a partial cut in the plantar fascia to relieve tension. Typically, the tissue is resected in the inside edge of the plantar fascia, leaving the outer bands of tissue intact to prevent the development of a flat foot. The abductor muscle may also be released to prevent Baxter’s nerve entrapment, which can cause pain. If heel spurs are present, they are generally removed during the procedure to prevent potential irritation.

Long-term Care

No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.