Plantar Fasciitis: A Guide for Patients

For many Americans, a stabbing pain in the heel of their foot when they take their first steps each morning is truly a rude awakening.

Plantar fasciitis, a common foot condition, is responsible for this unpleasant sensation. It occurs when the plantar fascia, a thick band of tissue that runs across the bottom of your foot, becomes inflamed or irritated.

“Plantar fasciitis is prevalent in the United States, with millions experiencing heel pain annually. The cause of plantar fasciitis is multifactorial, but most cases result from overuse stress,” says an article in the National Library of Medicine published in January 2024.

If you have experienced this vexing and sometimes excruciating heel pain, you are not alone as the article says:

• There are approximately 1 million patient visits annually due to plantar fasciitis.
  
  
• This condition accounts for about 10 percent of runner-related injuries and 11 to 15 percent of all foot symptoms requiring professional medical care.
  
  
• Plantar fasciitis occurs in about 10 percent of the general population, with 83 percent of these patients being active working adults between 25 and 65 years.
  
  

The American Academy of Orthopaedic Surgeons estimates that the number of patients treated annually for plantar fasciitis may be as high as 2 million.

What is Plantar Fasciitis and its Origins?

The plantar fascia is a ligament that connects your heel bone to your toes, supporting the arch of your foot and absorbing shock when you walk or run.

When this ligament experiences repetitive stress or strain, small tears can develop, leading to inflammation and pain.

The name "plantar fasciitis" comes from:

• "Plantar": Referring to the bottom surface of the foot.
• "Fasciitis": Denoting inflammation of the fascia.

Plantar fasciitis has been diagnosed for more than two years and over the years has gone by other names such as painful heel syndrome, subcalcaneal bursitis, medical arch sprain, and stone bruise.

Many famous athletes have dealt with plantar fasciitis over the years including Kobe Bryant, Peyton Manning, Pete Sampras, Shaquille O’Neal, Tim Duncan, and Albert Pujols.

Symptoms of Plantar Fasciitis

The primary symptom of plantar fasciitis is pain, typically felt:

• Under the Heel: The pain is often sharp and stabbing, especially with the first steps in the morning (known as first-step pain) or after prolonged periods of rest.
  
  
• Along the Arch: Discomfort may also radiate along the underside of the foot, worsening after standing or walking for extended periods.

Patients also may notice:

• Stiffness in the sole of your foot, particularly when you first get up.
• Difficulty bending your foot or feeling like your arch is "collapsed."
• Tenderness when pressure is applied to the bottom of your heel.

Says Johns Hopkins Medicine: “The pain of plantar fasciitis usually increases gradually and is typically felt near the heel. Sometimes the pain can be sudden, occurring after missing a step or jumping from a height. The degree of discomfort can sometimes lessen with activity during the day or after warming up, but it can become worse after prolonged or vigorous activity. The pain may also appear more intense in bare feet or in shoes with minimal support.”

Causes of Plantar Fasciitis

The cause of plantar fasciitis is multifactorial, but most cases result from overuse stress.

Here are typical causes of plantar fasciitis:

• Overuse or Repetitive Strain: Repetitive activities like running, dancing, or standing for long periods can strain the plantar fascia.
  
  
• Increase in Activity Level: Starting a walking or running program can lead to plantar fasciitis.
  
  
• Flat Feet or High Arches: These structural differences can put extra stress on the fascia.
  
  
• Poor Foot Mechanics: Abnormal walking patterns can place additional strain on the ligament.
  
  
• Improper Footwear: Worn-out shoes or shoes without enough arch support can contribute to the problem.
  
  
• Surfaces: The surface on which you are standing, walking, or running can cause the condition.
  
  
• Sudden Weight Gain: The extra pounds can put more pressure on your feet.
  
  
• Certain Medical Conditions: Diabetes, rheumatoid arthritis, lupus, and even pregnancy can increase your risk.
  
  

Risk Factors for Plantar Fasciitis

Several factors increase the risk of developing plantar fasciitis, including:

• Age: The condition is more common in adults between 40 and 60 years old.
  
  
• Certain Activities: Sports that involve running, dancing, or standing for prolonged periods.
  
  
• Foot Mechanics: Flat feet, high arches, or tight calf muscles.
  
  
• Occupation: Jobs that require prolonged standing or walking on hard surfaces, such as teachers and factory workers.
  
  
• Obesity: Being overweight can be a risk factor.
  
  

The Dangers of Untreated Plantar Fasciitis

Ignoring plantar fasciitis can lead to other complications such as:

• Chronic Pain: The discomfort may worsen over time, affecting daily activities and quality of life.
  
  
• Foot, Knee, Hip, or Back Problems: Altered gait due to pain can cause issues in other parts of the body.
  
  

Over time, inflammation and tension on the plantar fascia can cause tiny tears in the fascia. These tears can grow, in size and number, making the plantar fascia more prone to rupture and disablement.

Also, heel spurs are a common consequence of untreated plantar fasciitis.

How Plantar Fasciitis is Diagnosed

Plantar fasciitis is typically diagnosed by a healthcare provider, often a podiatrist or orthopedic specialist. Diagnosis may involve:

• Physical Examination: Your doctor will assess your foot for tenderness, swelling, and range of motion.
  
  
• Imaging Tests: X-rays, MRI, or ultrasound may be used to rule out other conditions and assess the severity of the inflammation.

Your doctor, according to Johns Hopkins Medicine, will want to rule out other causes of your heel pain such as:

• Nerve compression in the foot or the back
• Stress fracture of the calcaneus
• Loss of the fatty tissue pad under the heel

Treatment Options for Plantar Fasciitis

As mentioned earlier, ignoring plantar fasciitis pain can lead to problems such as prolonged treatment time.

“In general, the longer the symptoms have been present and the more severe the pain, the longer the treatment may take. Additionally, high-demand athletes, such as cross-country or marathon runners, may require a longer course of treatment,” says Johns Hopkins Medicine.

Treatment options conclude:

• Home Remedies: Rest, ice packs, stretching exercises, and over-the-counter pain relievers.
  
  
• Orthotic Devices: Shoe inserts or night splints can support the foot and alleviate strain.
  
  
• Physical Therapy: Stretching and strengthening exercises can improve flexibility and reduce pain.
  
  
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections may be prescribed for pain relief.
  
  
• Extracorporeal Shock Wave Therapy (ESWT): High-energy shock waves stimulate healing in the affected tissue.
  
  
• Surgery: In severe cases, surgical procedures to release tension on the plantar fascia may be considered.
  
  

Most cases of plantar fasciitis improve with conservative treatment within a few months.

By working with your doctor and diligently following your treatment plan, you can find your way back to pain-free footsteps.

If you are experiencing heel pain, contact the foot and ankle specialists at Sweeney Foot & Ankle Specialists in The Woodlands and Magnolia today.