Health & Fitness

Plantar Fasciitis

A common cause of heel and foot pain

by Dr. Jeffrey Gundel

Foot pain is severely limiting to athletes, especially runners. The most common cause of foot and heel pain is an overuse injury called plantar fasciitis. Runners and walkers are commonly affected, as are those who spend a lot of time standing or walking on hard surfaces. Women and those that are overweight are also at increased risk. Shoes that have worn out or are too stiff will stretch the plantar fascia, as will certain foot abnormalities such as high arches or flat feet. Tight or weak calf muscles will limit ankle flexion leading to plantar fasciitis.

Plantar refers to the sole of your foot and fascia is a type of connective tissue. The plantar fascia is a thick, tough band of tissue connecting your heel bone to your toe bones. Often this tissue is tight. When overstretched, the plantar fascia will partially tear. The tear heals with inflexible scar tissue, making the fascia even tighter. When inflamed, the plantar fascia causes heel and foot pain. Pain is typically worse first thing in the morning or after remaining immobile for a while. Stretching of the fascia occurs while walking and eases the pain, only to recur after resting. The pain initially feels similar to a stone bruise and is usually worse after exercise, rather than during.

Prevention is the best medicine. As with all overuse injuries, warming up and stretching is key. A simple stretching program can also eliminate pain when symptoms are present. The calf muscles attach to the back of the heel through the Achilles tendon. The plantar fascia originates on the front of the heel bone and will get overstretched when the calf muscles are tight.

Regular stretching of the calf muscles will decrease the stretch on the plantar fascia. A simple calf stretch is performed by keeping your foot flat on the ground with your knee out straight and the other knee bent as you lean forward against a wall. A second calf stretch is accomplished by standing on a step while lowering your heels off the edge. Don’t bounce up and down while performing the second stretch – it can make things worse! Place a towel on the ground and attempt to grab and lift it with your toes. Hold your foot in the air and write the alphabet in the air with your foot. These simple exercises will stretch the plantar fascia.

Should preventive measures fail and pain occurs, the following treatments should be attempted at home.

• Limit your walking and running until the pain lessens – continued activities would prolong the inflammation.
• Avoid going barefoot – this puts undue strain on your foot.
• Examine your footwear – your shoes should be comfortable and support your arch. An over-the-counter shock-absorbing shoe insert, such as a rubber or gel heel cup, can provide relief.
• Ice massage will decrease the inflammation and pain – freeze a bottle of water and roll it under your foot.
• Lose weight – even a few extra pounds puts excess stress on your plantar fascia.
• Nonsteroidal anti-inflammatory medications such as naproxen and ibuprofen will ease the pain and decrease the inflammation.

Despite your best efforts, pain may persist and this is the time to visit your health care provider. The treatments discussed above will be reviewed and reinforced. Additional treatments may be recommended. Sometimes resting the inflamed foot in a removable walking cast or boot will eliminate the pain, making rehabilitation easier. Orthotic devices may be prescribed for those with underlying flat feet, high arches or other foot disorders. Night splints are braces that stretch your plantar fascia while you sleep, decreasing initial pain when getting out of bed. Physical therapy assists with stretching and strengthening of the foot. About 90-95 percent of those with plantar fasciitis will improve with the non-invasive treatments discussed above.

Should all this fail to relieve your pain, an evaluation by a foot care specialist would be your next visit. Corticosteroid (cortisone) injections can decrease the pain and swelling but need to be used sparingly. A new treatment is extracorporeal shock wave therapy (ESWT). This is a surgical procedure in which strong sound waves are directed at the source of pain, stimulating a healing response. This procedure is similar to the one being used to break up kidney stones. It is still relatively new for the foot and long-term results are not available. A more commonly performed surgical procedure involves releasing or cutting the plantar fascia. This reliably relieves the pain but is only necessary approximately five percent of the time.

Plantar fasciitis is a very common but preventable problem that can easily be avoided with a simple stretching program and proper footwear. When symptoms do occur, treating them promptly will avoid a chronic and painful condition. Most episodes will resolve within six weeks if addressed early. The longer symptoms are present, the more difficult they can be to treat. However, most occurrences are treated successfully using non-invasive techniques. Timely consultation with your health care provider will insure proper evaluation and appropriate recommendation for further care.

Jeffrey Gundel, MD, of Saratoga Springs is an orthopedic surgeon specializing in sports-related injuries and arthroscopy at North Country Sports Medicine in Queensbury. He participates in hiking, mountain biking and cross-country skiing.

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