Plantar Fasciitis

Plantar fasciitis, or foot ligament inflammation, can be painful.

The sole of the foot is referred to as the plantar area. Plantar fasciitis is a chronic local inflammation of the "bowstring-like" ligament stretching underneath the sole, also referred to as the plantar fascia, that attaches to the heel.

Plantar fasciitis is most commonly caused by repetitive strain injury to the ligament of the sole of the foot. Such strain injuries can be from excessive running or walking, inadequate footgear, and jumping injuries from landing.

Plantar fasciitis can also be caused by certain diseases, including reactive arthritis and ankylosing spondylitis.

There are many causes of plantar fasciitis and certain factors can increase your risk of developing it, such as:

• Obesity: People who are overweight or obese tend to be at greater risk of developing plantar fasciitis due to the increase in pressure on the foot. This is especially true if your weight gain is sudden.
• Physical activity: Recreational factors can play a role in increasing the risk of plantar fasciitis. If you're a long-distance runner, for example, you are more likely to eventually develop plantar fascia problems.
• Occupation: People with jobs that require prolonged periods of standing and walking, like waiters or factory workers, have higher instances of getting plantar fasciitis.
• Pregnancy: Studies have shown that plantar fasciitis is more prevalent in women and that pregnant women commonly develop it, especially during the third trimester.
• Foot structure: Structural foot problems like flat feet or very high arches can increase your chances of developing plantar fasciitis, as can a tight Achilles tendon.

It is estimated that 1 in 10 people will develop plantar fasciitis in their lifetime. Middle-aged obese women and young male athletes have higher incidences than the rest of the population.

Plantar fasciitis causes pain and tenderness in the bottom of the foot. The tenderness is usually toward the heel, but the entire sole of the foot can be affected. A sign of abnormal tension or tightness that can lead to plantar fasciitis is a bony prominence (heel spur) that develops where the inflamed plantar fascia attaches to the heel bone (calcaneus).

Plantar fasciitis can make walking and running difficult. It can make the foot feel particularly stiff and sensitive in the morning or when rising after sitting or getting out of a car. Walking on tip toes may make it feel better during the first few steps until the area warms up from increased blood flow from moving. Plantar fasciitis makes it difficult to walk barefoot on hard surfaces. Sometimes the bottom of the foot can feel warm, swollen, and tender.

Plantar fasciitis is diagnosed based on the history of the condition as well as the physical examination. Plantar fasciitis will have localized tenderness along the sole of the foot, most commonly at the inside arch of the heel. Usually, no further testing is necessary.

• X-ray testing can reveal an associated heel spur is present and rule out other causes of heel pain, such as fractures or tumors. The fascia can be inflamed without a bony spur present on X-ray.
• Ultrasound imaging can also help diagnose plantar fasciitis.

Plantar fasciitis is treated by measures that decrease the associated inflammation and avoid reinjury. Local ice massage applications both reduce pain and inflammation.

• Physical therapy methods, including stretching exercises, are used to treat and prevent plantar fasciitis.
• Anti-inflammatory medications, such as ibuprofen (Advil) or cortisone injections, are often helpful.
• Sports running shoes with soft, cushioned soles can help reduce irritation of inflamed tissues from plantar fasciitis. Custom orthotic shoe inserts are used to reduce the excess motion of the foot and decrease strain on the plantar fascia.

Infrequently, surgery is performed on the chronically inflamed plantar fascia (plantar fasciosis) if conservative treatments fail. Newer treatments for these cases such as cobaltion, PRP, prolotherapy, ESWT, and micro-debridement are utilized as well.

The following exercises are not only effective but also easy to perform at home daily. If you aren't sure about how to perform them correctly, ask your doctor or physical therapist.

Toe stretch

1. Sit on the floor and keep your leg extended.
2. With the help of your hand on the affected side, pull your big toe on the affected foot towards you.
3. Hold this position for 15-30 seconds.

Towel stretch

1. Sit on the floor or a chair holding a folded towel under the ball of your affected foot.
2. Keeping your back and knees straight, try pulling the feet towards you with the help of the towel.
3. Hold this position for 15-30 seconds.

Calf stretch

1. Stand facing a wall with your back straight and arms extended on the wall.
2. Bring your affected leg backward, a step away from the unaffected leg.
3. With the heel of the back leg on the floor, bend your front knee so that you feel a stretch in the back leg.
4. Keeping your back heel on the floor, bend your front knee until you feel a stretch in the back leg.
5. Hold the stretch for 15-30 seconds.

A slight variation in the exercise involves bending your back knee a little and then performing the exercise. However, your back heel should be still on the floor. This will stretch a different set of muscles in the back leg.

Towel curl

1. Sit in a chair and place a small towel on the floor.
2. Curl the towel towards you using only your toes on the affected foot.
3. Release the towel by pushing the towel away from you.

Tennis ball roll

1. In a sitting position, roll a tennis ball under your affected foot using the arch of your foot.
2. As your condition improves, perform the same exercise in a standing position.

Marble pickups

1. Put 10-20 marbles and a bowl on the floor.
2. Sit in a chair in front of the marbles, keeping your feet on the floor.
3. Using the toes of your affected foot, try to pick up one marble at a time and place it in the bowl, doing this until all the marbles are in the bowl.

Aim to do each exercise 2-3 times a day, but not necessarily all at once.

Some home remedies that may help treat plantar fasciitis include:

• Wearing well-cushioned shoes when walking (never walk barefoot)
• Avoiding wearing sandals without built-in arch support
• Using shoe inserts, arch supports, or customized foot orthotics (your doctor may recommend seeing a podiatrist to learn about which insoles to use)
• Using a night splinting device when sleeping to provide constant passive stretching of the related Achilles tendon and plantar fascia (Achilles tendon attaches the calf muscles to the heels, and plantar fascia is the thick band of tissue along the bottom of the foot that connects the heel bone to the toes)
• Massaging the area
• Applying ice on the affected area 3-4times a day for 10-15 minutes
• Avoiding prolonged standing
• Taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen
• Losing weight, if overweight
• Using crutches to limit the strain on your feet
• Rolling the affected area over a golf ball to massage and provide some myofascial release

The prognosis for plantar fasciitis is usually very good. Plantar fasciitis generally resolves with the conservative measures described above. However, in some cases, the condition can evolve into plantar fasciosis, which responds to a different set of treatments than those used for plantar fasciitis.

Plantar fasciitis can only be prevented by treating any underlying associated inflammatory disease and wearing optimal footwear, orthotic shoe inserts, and stretching.