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Plantar Fasciitis

Plantar fasciitis is the most common cause of heel pain. The plantar fascia  is the flat band of tissue (ligament) that connects your heel bone to your toes. It supports the arch of your foot. If you strain your plantar fascia, it gets weak, swollen, and irritated (inflamed). Then your heel or the bottom of your foot hurts when you stand or walk.


Heel Pain (Plantar Fasciitis)

Heel pain is most often caused by plantar fasciitis, a condition that is sometimes also called heel spur syndrome when a spur is present. Heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation, or, rarely, a cyst.

Because there are several potential causes, it is important to have heel pain properly diagnosed. A foot and ankle surgeon is able to distinguish between all the possibilities and determine the underlying source of your heel pain.


What Is Plantar Fasciitis?

Plantar fasciitis is an inflammation of the band of tissue (the plantar fascia) that extends from the heel to the toes. In this condition, the fascia first becomes irritated and then inflamed, resulting in heel pain.

Plantar fasciitis is common in middle-aged people. It also occurs in younger people who are on their feet a lot, like athletes or soldiers. It can happen in one foot or both feet.

Plantar fasciitis is caused by straining the ligament that supports your arch. Repeated strain can cause tiny tears in the ligament. These can lead to pain and swelling.


What Causes Plantar Fasciitis?

The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.

Wearing non-supportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Obesity may also contribute to plantar fasciitis. 

This is more likely to happen if:

  • Your feet roll inward too much when you walk (excessive pronation ).
  • You have high arches or flat feet.
  • You walk, stand, or run for long periods of time, especially on hard surfaces.
  • You are overweight.
  • You wear shoes that don’t fit well or are worn out.
  • You have tight Achilles tendons or calf muscles.

Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps. But your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time.

If you have foot pain at night, you may have a different problem, such asarthritis, or a nerve problem such as tarsal tunnel syndrome.

Your doctor will check your feet and watch you stand and walk. He or she will also ask questions about:

  • Your past health, including what illnesses or injuries you have had.
  • Your symptoms, such as where the pain is and what time of day your foot hurts most.
  • How active you are and what types of physical activity you do.
  • Your doctor may take an X-ray of your foot if he or she suspects a problem with the bones of your foot, such as a stress fracture.
  • No single treatment works best for everyone with plantar fasciitis. But there are many things you can try to help your foot get better:
  • Give your feet a rest. Cut back on activities that make your foot hurt. Try not to walk or run on hard surfaces.
  • To reduce pain and swelling, try putting ice on your heel. Or take an over-the-counter pain reliever like ibuprofen (such as Advil orMotrin), naproxen (such as Aleve), or aspirin.
  • Do toe stretches , calf stretches  and towel stretches several times a day, especially when you first get up in the morning. (For towel stretches, you pull on both ends of a rolled towel that you place under the ball of your foot.)
  • Get a new pair of shoes. Pick shoes with good arch support and a cushioned sole. Or try heel cups or shoe inserts (orthotics). Use them in both shoes, even if only one foot hurts.

If these treatments do not help, your doctor may give you splints that you wear at night, shots of steroid medicine in your heel, or other treatments. You probably will not need surgery. Doctors only suggest it for people who still have pain after trying other treatments for 6 to 12 months.


What are the Symptoms for Plantar Fasciitis?

The symptoms of plantar fasciitis are:

  • Pain on the bottom of the heel
  • Pain in the arch of the foot
  • Pain that is usually worse upon arising
  • Pain that increases over a period of months

People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they’ve been sitting for long periods of time. After a few minutes of walking the pain decreases, because walking stretches the fascia. For some people the pain subsides but returns after spending long periods of time on their feet.


How is Plantar Fasciitis Diagnosed?

To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process the surgeon rules out all the possible causes for your heel pain other than plantar fasciitis.

In addition, diagnostic imaging studies such as x-rays or other imaging modalities may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.


What are the Treatment Options for Plantar Fasciitis?

Non-Surgical Treatment
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:

  • Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery.
  • Avoid going barefoot. When you walk without shoes, you put undue strain and stress on your plantar fascia.
  • Ice. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin.
  • Limit activities. Cut down on extended physical activities to give your heel a rest.
  • Shoe modifications. Wearing supportive shoes that have good arch support and a slightly raised heel reduces stress on the plantar fascia.
  • Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.

If you still have pain after several weeks, see your foot and ankle surgeon, who may add one or more of these treatment approaches:

  • Padding and strapping. Placing pads in the shoe softens the impact of walking. Strapping helps support the foot and reduce strain on the fascia.
  • Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
  • Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
  • Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
  • Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
  • Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.

When Is Surgery Needed?
Although most patients with plantar fasciitis respond to non-surgical treatment, a small percentage of patients may require surgery. If, after several months of non-surgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you.

Long-term Care
No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching, and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.

Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves pain and inflammation of a thick band of tissue, called the plantar fascia, that runs across the bottom of your foot and connects your heel bone to your toes.

Plantar fasciitis commonly causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.

Plantar fasciitis is particularly common in runners. In addition, people who are overweight and those who wear shoes with inadequate support are at risk of plantar fasciitis.


What are the Risk factors?

Factors that may increase your risk of developing plantar fasciitis include:

  • Age. Plantar fasciitis is most common between the ages of 40 and 60.
  • Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing and dance aerobics — can contribute to an earlier onset of plantar fasciitis.
  • Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you’re standing and put added stress on the plantar fascia.
  • Obesity. Excess pounds put extra stress on your plantar fascia.
  • Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.

What are the Complications?

Ignoring plantar fasciitis may result in chronic heel pain that hinders your regular activities. If you change the way you walk to minimize plantar fasciitis pain, you might also develop foot, knee, hip or back problems.