Plantar fasciitis
Key points
- Plantar fasciitis is an inflammation (irritation and swelling with presence of extra immune cells) of the thick tissue on the bottom of the foot that causes heel pain and disability.
- The plantar fascia is a very thick band of tissue that covers the bones on the bottom of the foot.
- The most common complaint is pain in the bottom of the heel, usually worst in the morning and improving throughout the day.
- Typical physical exam findings include tenderness on the bottom of the heel, closer to the midline, and mild swelling and redness.
Definition
Plantar fasciitis is an inflammation (irritation and swelling with presence of extra immune cells) of the thick tissue on the bottom of the foot that causes heel pain and disability.
Causes, incidence, and risk factors
The plantar fascia is a very thick band of tissue that covers the bones on the bottom of the foot. This fascia can become inflamed and painful in some people, making walking more difficult.
Risk factors for plantar fasciitis include foot arch problems (both flat foot and high arches), Obesity, sudden weight gain, running, and a tight Achilles tendon (the tendon connecting the calf muscles to the heel). A typical patient is an active man aged 40-70.
This condition is one of the most common orthopedic complaints relating to the foot.
Plantar fasciitis is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On X-ray, heel spurs are seen commonly both in people with and without plantar fasciitis.
Symptoms
The most common complaint is pain in the bottom of the heel, usually worst in the morning and improving throughout the day. By the end of the day the pain may be replaced by a dull aching that improves with rest.
Signs and tests
Typical physical exam findings include tenderness on the bottom of the heel, closer to the midline, and mild swelling and redness.
X-rays may be taken to rule out other problems, but the presence or absence of a heel spur is not significant.
Treatment
Conservative treatment is almost always successful, given enough time. Duration of treatment can be anywhere from several months to 2 years before symptoms resolve, although about 90% of patients will be better in 9 months.
Initial treatment usually consists of heel stretching exercises, shoe inserts, night splints, and anti-inflammatory medications. If these fail, casting the affected foot in a short leg cast (a cast up to but not above the knee) for 3-6 weeks is very often successful in reducing pain and inflammation. Alternatively, a cast boot (which looks like a ski boot) may be used. It is still worn full time, but can be removed for bathing.
Some physicians will offer steroid injections, which provide lasting relief in about 50% of people. However, this injection is very painful and not for everyone.
In a few patients, non-surgical treatment fails and surgery to release the tight, inflamed fascia becomes necessary.
Expectations (prognosis)
Written and revised by
David Cohen, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
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