Plantar Fasciitis

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KEY POINTS

• Plantar fasciitis is painful irritation of the tissue on the bottom of your foot between the ball of the foot and the heel.
• Change or stop doing the activities that cause pain until the injury heals.
• Plantar fasciitis can be treated with shoe inserts, losing weight if you need to, exercise, ice, and sometimes with medicine.

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What is plantar fasciitis?

Plantar fasciitis is painful irritation of the tissue on the bottom of your foot between the ball of the foot and the heel. This tough tissue that supports the arch of your foot is called fascia.

What is the cause?

Plantar fasciitis can be caused by a number of things, like:

• A lot of running, jumping, walking, or stair-climbing
• Wearing high heels for long periods of time
• Gaining weight

If you are a runner, you may get plantar fasciitis when you start running further during each workout or if you run more often. It can also happen if you start running on a different surface or in different terrain, or if your shoes are worn out and don't give enough cushioning for your heels.

If you wear high-heeled shoes, including western-style boots, the fascia can get shorter. You may then have pain when you stretch the fascia. This painful stretching might happen, for example, when you walk barefoot after getting out of bed in the morning.

If you gain weight, you may put more stress on your feet, especially if you walk a lot or stand in shoes with poor cushioning.

If the arches of your foot are unusually high or low, you are more likely to develop plantar fasciitis than if your arches are normal.

What are the symptoms?

The main symptom of plantar fasciitis is heel pain when you walk. You may also feel pain when you stand and possibly even when you are resting. This pain typically occurs first thing in the morning when you get out of bed and put your foot flat on the floor, stretching the fascia. The pain may lessen after you have been up for a while and walking, but then the pain may come back after you have been resting.

You may not have any pain when you are sleeping because the position of your feet during rest allows the fascia to shorten and relax.

How is it diagnosed?

Your healthcare provider will ask about your symptoms, activities, and medical history and examine your foot and ankle. You may have an X-ray or scan of your heel.

How is it treated?

Give your painful heel lots of rest. You will need to change or stop doing the activities that cause pain until your foot has healed. You may need to stay completely off your foot for several days when the pain is severe.

Your healthcare provider may recommend stretching and strengthening exercises or physical therapy to help you heal. Exercises to make the foot stronger and to stretch the fascia are very important.

Your healthcare provider may recommend shoe inserts called arch supports or orthotics. You can buy them at a pharmacy or athletic shoe store or they can be custom made. Make sure the arch supports are firm. If you can easily bend them in half, they may be too flexible. These supports can be particularly helpful if you have flat feet or high arches. Wearing athletic shoes or heel cushions in both shoes may also help. Cushions are most helpful if you are overweight or an older adult.

A night splint may help keep the plantar fascia stretched while you are sleeping.

Your provider may give you a shot of steroid medicine. Your healthcare provider may have other treatments to suggest.

With treatment, plantar fasciitis may take up to several months to heal. You may find that the pain comes and goes. Talk to your healthcare provider if you do not feel improvement with treatment.

How can I take care of myself?

To help relieve pain:

• Rest your heel on an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth every 3 to 4 hours for up to 20 minutes at a time.
• Keep your foot up on a pillow when you sit or lie down.
• Take nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.
  • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
  • Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don't take more than 3000 milligrams (mg) in 24 hours. To make sure you don’t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.

Follow your healthcare provider's instructions, including any exercises recommended by your provider. Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid, including how much you can lift, and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent plantar fasciitis?

The best way to prevent plantar fasciitis is to wear well-made shoes that fit your feet and give good arch support and cushioning. This is especially important if you exercise or walk a lot or stand for a long time on hard surfaces. Get new athletic shoes before your old shoes stop supporting and cushioning your feet.

You should also:

• Avoid repeated jarring to the heel.
• Keep a healthy weight.
• Do leg and foot stretching exercises regularly.