■ ■ ■ Description

Plantar fascitis is characterized by stiffness and inflammation of the main fascia (fibrous connective [ligament-like] tissue) on the bottom of the foot. It is occasionally associated with a bone spur on the heel. Occasionally there may be a partial or complete tear of the fascia of the bottom of the foot. Bone spurs themselves usually do not cause symptoms.

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■ ■ ■ Common Signs and Symptoms

• Pain and tenderness in the sole of the foot, mostly under the heel bone, with standing or walking

• Particularly noticeable pain with the first steps when getting out of bed in the morning or after sitting

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■ ■ ■ Causes

• Stress or injury to the heel tissues, which causes inflammation and calcification of the fascia of the foot

• Irritation of a small nerve that runs under the foot where the main fascia attaches to the heel bone

• Tight calf muscles or flat feet

• Shoes that are poorly fitted, have inadequate arch supports, have with soles that are too stiff, or have rigid arch supports (orthotics)

• Activities that require sudden turns or stops

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■ ■ ■ Risk Increases With

• Sports, including running or jogging, and sudden stops or changes in direction

• Prolonged standing

• Poor physical conditioning (strength and flexibility)

• Inadequate warm-up before practice or play

• Obesity

• Flat feet

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■ ■ ■ Preventive Measures

• Appropriately warm up and stretch before practice or competition.

• Maintain appropriate conditioning:

• Calf, ankle, and foot flexibility

• Strength and endurance

• Cardiovascular fitness

• Ideal body weight

• Avoid activities that put a constant strain on the foot.

• Wear appropriate shoes with a rubber or felt heel cushion and good arches or cushioned arch supports.

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■ ■ ■ Expected Outcome

This condition is usually curable with appropriate conservative treatment. If not, heel spurs are often curable with surgery.

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■ ■ ■ Possible Complications

• Frequent recurrence of symptoms, resulting in a chronic problem; appropriately addressing the problem the first time decreases frequency of recurrence

• Lower back or knee disorders caused by constant limping

• Pain or weakness of the foot during push-off following surgery

• Chronic inflammation, scarring, and partial or complete fascia tear, occurring more often from repeated injections

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■ ■ ■ General Treatment Considerations

Initial treatment consists of medications and ice to relieve pain, stretching exercises of the heel cord and achilles tendon, and modification of activities. A heel cup or felt insert in the shoe to relieve pressure on the heel usually is recommended. Occasionally, wearing splints at night may be offered. Chronic cases may require referral to a physical therapist or athletic trainer for further evaluation and treatment. Arch supports (orthotics) are helpful for people with flat feet to prevent or treat this problem. Occasionally surgery is needed to release the fascia and nerve. Surgery is often effective at relieving the symptoms.

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications , such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Cortisone injections reduce inflammation. However, these are done only sparingly; there is a limit to the number of times cortisone may be given, because it weakens muscle, fascia, and tendon tissue. Anesthetics temporarily relieve pain.

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■ ■ ■ Heat and Cold Therapy

• Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

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■ ■ ■ Notify Our Office If

• Symptoms get worse or do not improve in 2 weeks despite treatment