Pain from Plantar Fasciitis

Dear Sports Doc,

I’ve been having a lot of pain in my heel, and several people have suggested that I might have plantar fasciitis. What is plantar fasciitis, and how can I treat it?

The plantar fascia is a strong band of connective tissue that runs from the bottom of the heel bone, which is called the calcaneus, to the base of the toes. It provides support to the arch of the foot. When the plantar fascia becomes painful, the condition is called plantar fasciitis. It is typically caused more by chronic overuse than by a single specific injury.

When the plantar fascia becomes painful, the condition is called plantar fasciitis.

Why do people get plantar fasciitis?

There are several risk factors for plantar fasciitis, one of which is poor footwear. Wearing old, unsupportive or ill-fitting shoes can create issues. Other potential causes include pro- longed standing, a sudden increase on how much a person runs, and walking or running on hard surfaces.

Even the shape of a person’s foot can bring about plantar fasciitis. Flat feet and high arches both increase risk. While all of these things can be contributing factors, the fact is that often- times there isn’t a clear reason why plantar fasciitis develops when it does.

What are the symptoms of plantar fasciitis?

The pain can range from mild to severe, and it is often worst during the first steps after get- ting out of bed in the morning. Some people find their foot will stiffen up after sitting for a long time, and the first few steps after getting up are particularly painful until it feels like it loosens up again.

How do I know if I have plantar fasciitis?

Plantar fasciitis is common, but it is not the only cause of foot and heel pain. Some other causes of foot pain that can act like plantar fasciitis include bruising of the tissue that pads the heel, stress fractures of the heel bone, and medical problems that cause nerve damage or tendon inflammation.

If your symptoms are mild and seem to fit the characteristics of plantar fasciitis, you can try some basic treatments for plantar fasciitis to see if you feel better. However, if you have severe symptoms, multiple medical problems, symptoms that are not improving despite treatment or other concerns about your condi- tion, then it is a good idea to see a doctor.

How is plantar fasciitis diagnosed?

There is no specific test for plantar fasciitis. The diagnosis is generally made by an examination of symptoms and signs identified by a doctor. Imaging tests, such as X-rays, MRIs or ultrasounds are rarely necessary, but may be appropriate in a small number of cases.

I’ve been told that I have a bone spur on my foot. Is that causing my pain?

No. People with plantar fasciitis often have heel bone spurs, but people with no foot pain at all often have them, too.

While bone spurs look like they might cause pain – they appear sharp and often sit right where the pain is – they develop as a consequence of stress on the heel and are not a cause of pain. This is important, because removing a heel spur does not cure plantar fasciitis.

That’s all very interesting, but my foot hurts! How can I treat my plantar fasciitis?

Plantar fasciitis almost always goes away within a year. That said, a year can be a very long time when you’re in pain, so there are several treatments you can try:

REDUCE YOUR ACTIVITY. That does not mean you need to stop being active, but decreasing the total amount of stress on your foot can help you heal.

WEAR SUPPORTIVE SHOES. Shoes with a firm sole, good heel cushioning and arch support can protect your foot from further injury and support the plantar fascia during recovery.

STRETCH AND STRENGTHEN YOUR FOOT AND ANKLE. Simple exercises are easily found online. These can include stretching your plantar fascia using a towel to pull your toes up toward your head, and strengthening your foot muscles by once again using a towel. Scrunch and release it repeatedly with your toes.

ICE. Apply a bag of ice or frozen vegeta- bles, soak in a bowl of ice water or even use a frozen plastic water bottle for 15 to 20 minutes three to five times per day to help reduce pain and inflammation.

TAKE MEDICINE AS NEEDED. If approved by your doctor, short-term use of over- the-counter medicines, such as NSAIDs – like ibuprofen or naproxen – or acet- aminophen may help relieve pain.

WEAR NIGHT SPLINTS. These can be found in pharmacies and online. They keep your plantar fascia stretched while you sleep, reducing the amount of pain you have with your first steps in the morning.

What if basic treatments aren’t working?

There are many other treatments for plantar fasciitis, including physical therapy; orthotic shoe inserts; shots, such as cortisone and platelet-rich plasm injections; and even surgical treatments. A doctor can help you decide which is most appropriate for you.

About Dr. Josh Berkowitz 1 Article
Dr. Josh Berkowitz is an assistant professor of Orthopaedics, Internal Medicine and Pediatrics who specializes in Sports Medicine at the UNC School of Medicine. He works as a Team Physician for the UNC Tar Heels and serves as an associate director of the combined Internal Medicine-Pediatrics Residency Program at UNC. He enjoys working with athletes of all ages and ability levels, providing care for community events all the way up through professional and international competitions. Locally, he also works with Chapel Hill High School and the Raleigh Flyers.

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