Plantar fasciitis

• Causes, incidence, and risk factors

  The plantar fascia is a very thick band of tissue that holds up 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
  • Running
  • Sudden weight gain
  • Tight Achilles tendon (the tendon connecting the calf muscles to the heel)

  A typical patient is an active man age 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 in people with and without plantar fasciitis.

• Symptoms

  The most common complaint is pain in the bottom of the heel. It is usually worst in the morning and may improve throughout the day. By the end of the day the pain may be replaced by a dull aching that improves with rest.

  Most people complain of increased heel pain after walking for a long period of time.

• Signs and tests

  Typical physical exam findings include:

  • Mild swelling
  • Redness
  • Tenderness on the bottom of the heel

  X-rays may be taken to rule out other problems, but having a heel spur is not significant.

• Treatment

  Conservative treatment is almost always successful, given enough time. Treatment can last from several months to 2 years before symptoms get better. Most patients will be better in 9 months.

  Initial treatment usually consists of:

  • Anti-inflammatory medications
  • Heel stretching exercises
  • Night splints
  • Shoe inserts

  If these fail, putting 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 can provide lasting relief in many 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)

  Nearly all patients will improve within 1 year of beginning non-surgical therapy, with no long-term problems. In the few patients requiring surgery, most have relief of their heel pain.

• Complications

  Complications with surgery include:

  • Infection
  • Nerve injury
  • No improvement in pain
  • Rupture of the plantar fascia

  With other treatments, a complication is continued pain.

• Calling your health care provider

  Contact your health care provider if you have symptoms of plantar fasciitis.

• Prevention

  Maintaining good flexibility around the ankle, particularly the Achilles tendon and calf muscles, is probably the best way to prevent plantar fasciitis.

• References

  Donley BG, Moore T, Sferra J, Gozdanovic J, Smith R. The efficacy of oral nonsteroidal anti-inflammatory medication (NSAID) in teh treatment of plantar fasciitis: a randomized, prospective, placebo-controlled study. Foot Ankle Int. 2007;28:20-23.

  Pasquina PF, Foster LS. Plantar fascitis. In: Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 86.

Review Date: 3/4/2009

Reviewed By: Linda Vorvick, MD, Family Physician, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept. of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.