Plantar Fasciitis
Plantar fasciitis is one of the most common causes of
weight bearing heel pain. It is an overuse injury causing
inflammation at the site where the plantar fascia is
located on the inside of the heel bone.
The plantar fascia is a very strong ligament-like
structure that runs from the heel bone to the ball of your
foot. This ligament band helps to create the arch of
your foot as you push off the ground. If your foot moves
incorrectly due to a structure or muscle imbalance, the
plantar fascia may become overstretched.
When this happens, the fascia may swell due to small
fibers in the plantar fascia tearing.
Symptoms
Pain is usually felt with the first step taken in the morning. It then lessens with each step
taken. Pain also may be felt after periods of rest or lots of activity such as walking, running or
standing. Tenderness may be felt on the inside of the heel bone as well as along the entire
arch.
Common Causes
Plantar fasciitis is often caused by improper foot structure alignment. People with flat feet
may have symptoms because when the foot is flattened the plantar fascia becomes
overstretched and swells. People with high arches may have the same symptoms because
the fascia is being pulled too tight, much like a bowstring.
Associated Problems
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Heel Spur: A heel spur is a boney extension of the heel bone where the plantar fascia
attaches to the bone. It is not the heel spur that causes the pain, unless it is growing in a
downward position. Also, a heel spur need not be present to have plantar fasciitis.
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Bursitis: The bursa, or fluid-filled sac located near where the plantar fascia attaches to
the bone, may become inflamed and cause symptoms similar to plantar fasciitis.
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Treatment Options
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Medical Treatment:
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Supportive Shoes: Wear shoes with a good arch support such as athletic or walking
shoes. Bare feet or slipper usage should be avoided.
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Activity: Decrease the activity which aggravates the pain. Try non-weight bearing
activities such as swimming or biking.
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Stretching: Regular stretching (3 times a day) of the Achilles tendon and the plantar
fascia eventually relaxes the chronic tightness of this ligament (See diagrams below).
If these stretches are too difficult, sit in a chair and roll a soup can back and forth
under your foot. Use a moderate amount of pressure to get the same effect.
Keep leg
straight and
foot flat on
the ground
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Nonsteroidal Anti-inflammatory Drugs: These types of medicines may often help
speed pain relief. However, the medicine must be taken in addition to wearing
supportive shoes and doing the exercises.
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Corticosteroid Injections: For patients who are slow to respond to other forms of
treatment, a local injection into the area where the plantar fascia attaches to the bone
may be necessary
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Custom Orthotics: Patients who have foot abnormalities such as flat feet or high
arches may need to wear custom-molded inserts in their shoes for the foot to function
properly.
Surgical Treatment
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Plantar Fasciotomy: After all medical treatments have been tried, a surgical
procedure called a plantar fasciotomy may be recommended by your doctor. This
surgical procedure releases a portion the plantar fascia ligament. A small incision on
the inside of the foot near the heel bone is made. The surgery relaxes the ligament
and stops the chronic small tears of fascia from the heel bone.
Copyright, (5/2000)
Department of Orthopaedic Surgery
The Ohio State University Medical Center
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