Plantar fasciitis: causes, symptoms, treatment, and prognosis.

What is plantar fasciitis?

The plantar fascia is a thick band of tissue that supports the bottom of the foot. It starts at the inside of the heel bone and inserts onto the toes. Plantar fasciitis is one of the most common causes of foot pain.

Plantar fascia pathology can be classified into three general categories:

• Plantar fasciitis is acute inflammation of the fascia. This occurs after an injury or trauma.

• Plantar fascia tears can occur after severe injuries.

• Plantar fasciopathy is chronic overuse or overload of the fascia. This usually occurs after prolonged repetitive and overuse activities.

Risk factors for plantar fasciitis:

• Prolonged standing

• Repetitive jumping

• Flat feet

• Restricted range of motion

• Overweight or obesity

Plantar fasciitis occurs very commonly in runners. Causes may include:

• Excessive training or a sudden increase in mileage

• Faulty running shoes

• Running on uneven surfaces

• Flat feet or very high arch foot

• Tight achilles tendon and calves

How does plantar fasciitis occur?

Plantar fasciitis can occur after high impact activities that cause inflammation of the plantar fascia. People can usually pinpoint a specific activity or injury that triggered the symptoms. Plantar fasciitis can also result from repeated stress. Pain typically gets worse over the course of days to weeks.

Plantar fasciitis symptoms

Plantar fasciitis pain occurs at the bottom of the heel. The pain is typically worse with the first steps in the morning or after long periods of inactivity. Physical activity tends to lessen the pain.

Diagnosis of plantar fasciitis

Plantar fasciitis can be diagnosed with a thorough physical exam. Swelling and pain may be present around the inside of the heel. There can be tenderness along the distribution of the plantar fascia.

X-rays may be necessary in the setting of injury or trauma to rule out fracture.

Ultrasound can look for inflammation and assess the integrity of the plantar fascia.

Plantar fasciitis treatment

Initial treatment involves resting and protecting the foot. Avoid or modify activities that exacerbate pain. Once pain improves, gradually increase physical activity.

Acute pain

• Icing the area can help reduce pain and swelling. Apply ice 15-20 minutes at a time. Do this every 4 hours for the first two to three days or until pain improves.

• Oral or topical anti-inflammatory medications can help decrease inflammation and control pain.

Supportive devices

• Modify activity and avoid repetitive movements that cause pain.

• Orthotic inserts can help address flat feet and provide more arch support. This relieves the pressure on the plantar fascia.

• Heel pads and heel lifts can also help provide support to the plantar fascia.

• Severe cases may need a walking boot for immobilization.

Persistent symptoms

• Patients with persistent symptoms may need injections. Many studies show platelet rich plasma injections can help treat those with plantar fasciitis. This specific study compared platelet rich plasma injections to cortisone injections. They found that platelet rich plasma injections outperformed cortisone injections at 12 months follow up.

Plantar fasciitis rehabilitation

The goal of rehabilitation is to return to activity as quickly and as safely as possible. Returning too soon can exacerbate symptoms. It can also weaken the plantar fascia and lead to plantar fascia tears.

A home exercise program will help improve range of motion, stability, and strength. Some people choose to participate in physical therapy. Physical therapists assess, guide, and teach you exercises and stretches. They also individualize a training program for you and your body.

Here is a link to a great example of a home exercise program for plantar fasciitis:

Plantar fasciitis stretches and exercises

Try to do your home exercise program twice a day. When pain is severe, focus on stretching and range of motion. Include strengthening exercises as pain improves.

Recovery for plantar fasciitis

Recovery is determined by the duration and severity of the injury. The longer you have symptoms, the longer it will take to get better. Use symptoms as a guide for progression. Avoid using time in days or weeks as a marker for recovery.

Decrease the frequency of your home exercise program as your symptoms improve. For example, if doing the exercises twice a day, decrease to once a day. Do this for about one week.

Many people choose to incorporate these exercises into their weekly workout routine. This can help prevent reinjury as well as maintain strength, mobility, and range of motion.

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Some pictures were taken without permission from the Sports Medicine Patient Advisor. They are intended for educational purposes only.