Plantar Fasciitis

What is it?

The plantar fascia (FASH-ee-ah) is a long band of fibers that go from the bottom of the heel bone to the beginning of the toes. The plantar fascia helps support your arches and provides shock absorption for the bottom of the foot. Plantar fasciitis (fas-ee-EYE-tis) is inflammation (swelling and redness) of the plantar fascia. It is a common cause of heel pain, especially in older adults and athletes such as runners. Healing time for plantar fasciitis depends on the activities or problems that caused it. It may take weeks to months of treatment for your plantar fasciitis to go away.

What causes plantar fasciitis?

When tiny areas of the plantar fascia are torn, this causes inflammation and pain (plantar fasciitis). Some common things that may cause stress and tears in the plantar fascia are as follows:

• Over-use or exercising too much. Your plantar fasciitis may be caused by repeated stress (force or pressure) on the ligament in the arch of the foot. It may be caused by having a job that requires standing or walking a lot on hard surfaces.
  
  
• Exercise conditions. You may develop plantar fasciitis if you run or exercise too much on hard surfaces. You may get it from changes in your regular workout. These include a sudden change in the time and distance that you normally run, or doing more uphill running than usual. You may be exercising in a way that causes plantar fasciitis or that makes it worse.
  
  
• The way your feet and legs are made. You may have flat feet or arches that are too high or low. You may have a heel spur (bony growth on your heel). You may have tight calf muscles and tendons, especially the Achilles tendon. You may have one leg that is shorter than the other. You may have weak foot muscles. Your feet may roll inward too much when you run. This is called overpronation (over-proh-NAY-shun).
  
  
• Weight gain. You may get plantar fasciitis after gaining weight too quickly. This includes women who have a normal increase in weight during pregnancy.
  
  
• Wearing shoes that do not fit or support your feet. This includes wearing shoes that are too small or that do not support and fit your feet correctly. This includes wearing running shoes with worn out treads. This includes women who wear high heels all day, then change into flat shoes. While in high heels, the fascia shortens and becomes tight. When you change into flat shoes, this puts stress on the short, tight fascia.

What are the signs and symptoms of plantar fasciitis?

• Redness, swelling, or warmth over the injured part of your foot. It may be on the inside edge of the arch of the foot or the inside back edge of the heel.
  
  
• Sharp pain when you first get out of bed in the morning. You may feel sharp pain when you stand up after sitting for a long time. This pain usually decreases as you walk around and warm up your muscles. Your pain may come back after exercise or toward the end of the day.

How is plantar fasciitis diagnosed?

A caregiver will examine your foot and ask you questions about your exercise and activities. Sometimes caregivers do x-rays or bone scans. These tests show a picture of the bones inside your foot. Caregivers may use them to look for a fractured (FRAK-churd) (cracked or broken) bone, heel spurs and other problems.

How is plantar fasciitis treated?

• Rest: Try to stay off your feet as much as possible while you have pain and inflammation. Resting your feet may decrease swelling and keep the fasciitis from getting worse. You may gradually increase the amount of weight you put on your foot when caregivers say it is OK. Do not return to running until you are pain-free and your caregiver says it is OK.
  
  
• Ice: Ice causes blood vessels to constrict (get small) which helps decrease inflammation (swelling, pain, and redness). Use an ice bag, ice massage or ice bath. Do not go to sleep while icing your injured foot. Keeping your foot on ice longer than directed could lead to frostbite, especially to your toes.
  
  
  • To make an ice bag, put crushed ice in a plastic bag or use a bag of frozen corn or peas. Cover it with a towel. Put this on your heel for 15 to 20 minutes, three to four times each day.
    
    
  • To ice massage, fill a paper cup with water and freeze to make a large ice cube. Peel the paper away and put the ice cube on the injured area. Rub in circles using medium pressure for five to ten minutes.
    
    
  • For an ice bath, fill a shallow bowl with ice and water. Soak your heel in the ice bath for 10 to 15 minutes. Keep your toes out of the bath because they may become too cold.
  
  
• Foot aids: You may be given night splints to wear. These keep your foot in a certain position so that the fascia does not get short and tight while you sleep. Sharp pain when getting out of bed is caused by stress on plantar fascia that shortened and tightened overnight. You may need to wear specially-made orthotics (or-THOT-iks) or over-the-counter inserts in your shoes. These may be rubber, silicone or felt pads for your heel, arch or the entire sole (bottom) of your foot. These may give the control, support or padding that is needed to decrease stress on your feet.
  
  
• Medicine:
  
  
  • NSAIDs: Nonsteroidal anti-inflammatory (NSAID) medicine may decrease swelling and pain or fever. This medicine can be bought with or without a doctor's order. This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine.
    
    
  • Steroid injections: You may be given shots of medicine called steroids (STER-oids) to decrease inflammation. Caregivers may add local anesthesia (an-es-THEE-zah) to the steroids. This medicine helps decrease heel pain. Because these shots decrease swelling and pain, you may feel like your heel is healed and that you can return to heavy exercise. It is important not to exercise until your caregiver says it is OK. You could make the plantar fasciitis worse if you exercise too soon.
    
    
  • Steroids by iontophoresis: Iontophoresis (eye-on-toh-foh-REE-sis) is a procedure that uses electric currents to give medicine. Caregivers attach electrodes (patches or buttons) to your skin. They will use a small amount of electric current to push steroids in through your skin. This procedure may decrease pain quickly.
  
  
• Physical therapy: Physical (FIZ-i-kal) therapists (THER-ah-pists) can help you with special exercises and treatments to help your fasciitis heal faster. These may include ultrasound treatments to increase blood flow to the injured area. These may include massaging your foot to stretch the tissue and bring heat to the area to increase blood flow. These caregivers may wrap tape around your arches to support them. This may help decrease stress on your plantar fascia.
  
  
• Stretching and strengthening exercises: Your caregiver may tell you to do stretches and special exercises at home. Stretching and making certain muscles stronger may help decrease stress on the plantar fascia.
  
  
• Surgery: You may need surgery to release the plantar fascia from your heel or remove heel spurs. Surgery is usually not necessary unless the plantar fasciitis is very bad and does not heal with other treatments.

How can I help prevent plantar fasciitis?

• Wear shoes that fit correctly and support your feet. Replace your running or exercise shoes before the padding or shock absorption is worn out. Shock absorption is greatly decreased when the treads on the bottom or sides of the shoe begin to wear down. Ask your caregiver which shoes are best for you. Make sure your shoes fit your feet well and offer good arch support.
  
  
• Stretch often. Massage across the bottoms of your feet or do stretching exercises as directed by your caregiver. Do these before you get out of bed in the morning and after sitting for a long time. Warm up and stretch before exercise. Cool down and stretch after exercise. Rest between workouts.
  
  
• Wear orthotics or shoe inserts. Wear orthotics that have been specially molded to your foot shape or shoe inserts advised by your caregiver. These may help line up your feet for correct movement and decrease stress on the plantar fascia. They may also support your arches and provide cushioning (padding) and protection for your heels and feet.
  
  
• Exercise the right way. If you are a runner, increase your time and distance slowly over time. If your plantar fasciitis is caused by the way that you exercise, ask a trainer, coach, or caregiver for help. They can teach you how to train or exercise differently to help prevent plantar fasciitis. For example, you may be told to exercise on flat, even surfaces that are not too hard.
  
  
• Use ice after your workouts. Put ice on your heels after exercising, stretching and standing for a long time. Do this any time you feel plantar fasciitis pain.

Call your caregiver if:

• Your pain and swelling increase.
  
  
• You have new symptoms.
  
  
• You have a fever.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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