Plantar Fasciitis

By Candice A. Kepich, DPM –

Plantar FasciitisPlantar fasciitis is the most common cause of heel pain. The plantar fascia is a flat band of tissue that connects the heel bone to the toes and stretches to support the arch of your foot which each step. Overstretching or strain causes the fascia to become thickened, swollen, inflamed and in some cases torn, especially at the heel bone attachment during walking or standing. The most commonly thought cause is due to a heel spur, but this is a misnomer. Heel spurs are present in 15-25% of the general population without symptoms and many symptomatic people do not have spurs. Even if you do have a heel spur associated with your pain, plantar fasciitis can usually be cured without removing it.

Plantar fasciitis can affect both men and women of all ages, especially those who have any of the following risk factors:

  • Age (most common between 40 – 60 years old)
  • High arches, flatfeet or abnormal walking pattern
  • Overweight or sudden weight gain (ie. pregnancy)
  • Your feet roll in too much when you stand or walk (over-pronation)
  • Wearing shoes which are poor fitting with little or no support or worn out (ie, flats, heels, sandals- especially flip flops). You should not be able to fold your shoe in half and it should have a thick cushioned sole.
  • Tight calf muscles or Achilles tendon
  • Jobs or activities which require standing, walking or running for long periods of time, especially on hard surfaces
  • Running downhill or on uneven surfaces (ie, sand or beaches)

The common complaint associated with heel pain due to plantar fasciitis is stabbing, burning or aching pain on the bottom of the heel which is worse on the first step of the day out of bed or after periods of prolonged sitting or rest. The pain slowly worsens over time and can affect one foot or both and gets better as you “warm up” and gradually become more active. The pain may be worse standing in one place on hard surfaces, climbing stairs, or after intense exercise.

There is no one treatment for plantar fasciitis that works for everyone and the time it takes to get better depends on how long you have been in pain. Conservative treatments to try at home include rest, icing (especially by rolling the arch over a frozen bottle of water), stretching exercises and splints worn overnight to help loosen overtight muscles, and over the counter pain relievers like ibuprofen (Motrin and Advil) or naproxen (Aleve). Acetaminophen (Tylenol) may help reduce pain but does not decrease swelling and inflammation, which is a key factor in the pain causing plantar fasciitis. You should also wear shoes with good support and avoid going barefoot. Over the counter shoe inserts are commonly tried but the support they offer is highly variable depending on the material they are made of. Heel cups are also popular and may feel better initially from the added cushion they provide but rarely work long term because they don’t improve your foot’s arch support.

If your pain continues despite all best efforts you should see a podiatrist, who is a doctor that is spe­cially trained in the foot and ankle. lt is very importan1 to seek medical advice before the heel pain causes damage or even worse, reveals other conditions, which may be the true cause of the pain. Your doctor can take -x-rays to check for a break in the bone, a spur and better evaluate the structure of your foot. In some instances when pain continues despite proper treatment, a more detailed test like an ultrasound or an MRI may be necessary 10 look for a tear or rupture of the fascia. Your podiatrist can also give you a cortisone injec­tion to help resolve 1hc pain fas1er, send you for physical therapy or cast you for a pair of custom orthotics for long-term relief and proper control of your feet. With proper treatment you should see results within a few weeks and complete relief in 6-9 months. Greater than 90% of people improve with conservative treatment alone and few require surgery 10 release the plantar fascia. Seeing your podiatrist is the best way lo keep your feel healthy, happy and pain free!

Dr. Michael Petrocelli is available to answer your questions and make your appointment. Please visit their website at, or call them at (239) 775-0019.

NCH Countryside Commons
715 Heritage Trail, Suite 204 Naples. Fl 34112
Phone: (239) 775-0019
Fax: (239) 775-0219

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