Plantar fasciitis

Definition

Plantar fasciitis is an inflammation (irritation and swelling with presence of extra immune cells) of the thick tissue on the bottom of the foot that causes heel pain and disability.

Causes, incidence, and risk factors

The plantar fascia is a very thick band of tissue that covers the bones on the bottom of the foot. This fascia can become inflamed and painful in some people, making walking more difficult.

Risk factors for plantar fasciitis include foot arch problems (both flat foot and high arches), obesity, sudden weight gain, running, and a tight Achilles tendon (the tendon connecting the calf muscles to the heel). A typical patient is an active man aged 40-70.

This condition is one of the most common orthopedic complaints relating to the foot.

Plantar fasciitis is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On X-ray, heel spurs are seen commonly both in people with and without plantar fasciitis.

Symptoms

The most common complaint is pain in the bottom of the heel, usually worst in the morning and improving throughout the day. By the end of the day the pain may be replaced by a dull aching that improves with rest.

Signs and tests

Typical physical exam findings include tenderness on the bottom of the heel, closer to the midline, and mild swelling and redness.

X-rays may be taken to rule out other problems, but the presence or absence of a heel spur is not significant.

Treatment

Conservative treatment is almost always successful, given enough time. Duration of treatment can be anywhere from several months to 2 years before symptoms resolve, although about 90% of patients will be better in 9 months.

Initial treatment usually consists of heel stretching exercises, shoe inserts, night splints, and anti-inflammatory medications. If these fail, casting the affected foot in a short leg cast (a cast up to but not above the knee) for 3-6 weeks is very often successful in reducing pain and inflammation. Alternatively, a cast boot (which looks like a ski boot) may be used. It is still worn full time, but can be removed for bathing.

Some physicians will offer steroid injections, which provide lasting relief in about 50% of people. However, this injection is very painful and not for everyone.

In a few patients, non-surgical treatment fails and surgery to release the tight, inflamed fascia becomes necessary.

Expectations (prognosis)

Nearly all patients will improve within 1 year of beginning non-surgical therapy, with no long-term problems. In the few patients requiring surgery, over 95% have relief of their heel pain.

Complications

A complication of non-operative therapy is continued pain. In surgical therapy, there is a risk of nerve injury, infection, rupture of the plantar fascia, and failure of the pain to improve.

Calling your health care provider

Contact your health care provider if you have symptoms of plantar fasciitis.

Prevention

Maintaining good flexibility around the ankle is probably the best way to prevent plantar fasciitis.

Illustrations

Plantar fascia

Plantar fasciitis

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