The plantar fascia is an inelastic fibrous tissue layer extending from the heel bone to the ball of the foot (metatarsophalangeal (MTP) joints). The plantar fascia functions to elevate the arch during walking and is the most significant stabilizer of the arch. Typically repetitive injury (strain) to the attachment of the plantar fascia to heel bone causes small painful tears to develop. This causes inflammation and pain at the base of the heel. It is important to differentiate plantar fasciitis from other causes of heel pain such as stress fractures, nerve irritation and problems with the heel pad.
The most common symptom of plantar fasciitis is pain at the bottom of the heel. It may feel as if you have a stone bruise on your heel. Pain may be sharp, dull or achy. Pain is usually relieved when you are off of your foot, and is typically worse when you get up out of bed or when you get up after sitting for a while. Pain can get worse towards the end of the day and is often worse barefooted and on hard surfaces. Rarely, but occasionally, some mild swelling may occur. If substantial swelling or bruising develops it may suggest a plantar fascial rupture (especially if you feel a “pop”).
Treatment of plantar fasciitis consists of relieving the strain (pull) on the torn plantar fascial attachment. This gives it an opportunity to heal and reduces the painful inflammation. The mainstay of treatment is plantar fascial stretching, i.e. the step stretch, runner’s stretch, plantar fascial specific toe stretch and towel stretch. Rolling a frozen water bottle or golf ball under the heel to massage it can also relieve pain and inflammation. A night splint helps reduce pain and heal the plantar fasciitis, especially if morning pain is present. Orthotics are also very helpful in reducing pain and healing the plantar fasciitis. Nonsteroidal inflammatory medications used judiciously are typically prescribed.
Using stiff soled shoes with good support is also helpful in reducing pain. Other options for treatment include cortisone shots, physical therapy or casting. Non-operative treatment will help cure the plantar fasciitis in approximately 90% of cases, but it can often take over six months for complete resolution.
If conservative treatment does not relieve the pain, options may include an endoscopic plantar fascial release, open plantar fascial release, or shock wave treatment.