Definition

Plantar fasciitis (pronounced PLAN-tar fashee-EYE-tiss) is an inflammation of the plantar fascia ("plantar" means the bottom of the foot, "fascia" is a type of connective tissue, and "itis" means "inflammation").

Description

The classic sign of plantar fasciitis (which is often confused with or considered the same as a heel spur) is heel pain with the first few steps in the morning. The pain is usually in the front and bottom of the heel, but the definition of "plantar fasciitis" indicates it can be over any portion of the bottom of the foot where the fascia is located. Patients often report that the pain "moves around" to different areas of the bottom of the foot. The pain can be mild or debilitating. It can last a few months, become permanent, or come and go with every other full moon. The heel may hurt or the condition may become worse from the heel striking the ground, but plantar fasciitis is not caused by the heel striking the ground.

Despite the claims of various product manufacturers, there is no cure-all. Different combinations of treatments help different people. Patients often learn they need to be an active force in their treatment. Experimenting with several different treatments is often necessary before finding those that help. The pain usually increases gradually over weeks or months before help is sought, and improvement once treatment has begun is usually just as slow. Patients often have to be patient. Setbacks are the norm, and simply preventing the daily and occasional minor injuries is crucial if not the cure. A portion of a patient's lifestyle (excessive running or standing, over-eating, inactivity, or bad shoes) has often caused the pain, and it is that portion of their lifestyle that has to change.

Plantar fasciitis is related to "heel spur syndrome", but they are not the same. Heel spurs are deposits of calcium in the plantar fascia near its attachment to the heel that result from repetitive stresses and inflammation in the plantar fascia. Heel spurs are the body's response to injury and inflammation. Many people have heel spurs and they do not have any pain. A heel spur and/or the plantar fascia may "trap" or irritate nerves in the heel area (if only by inflammation) and cause more pain. It is often difficult and usually unnecessary to distinguish between plantar fasciitis and heel spur syndrome, if there is a difference. Causes and treatments for the two conditions are the same. Many doctors use the terms "heel spurs" and "plantar fasciitis" interchangeably. The phrase "heel spur" is used more often than "plantar fasciitis" because a heel spur can be seen on an x-ray and because it is easier to pronounce and spell than "plantar fasciitis".

Causes

The condition is usually caused by a change or increase in activities, no arch support in the shoe, lack of flexibility in the calf muscles, being overweight, a sudden injury, using shoes with little cushion on hard floors or ground, using shoes that do not easily bend under the ball of the foot, or spending too much time on the feet. The cause is often unknown and mysterious.

Diagnosis

The diagnosis of heel pain and heel spurs is made by a through history of the course of the condition and by physical exam. Weight bearing x-rays are useful in determining if a heel spur is present and to rule out rare causes of heel pain such as a stress fracture of the heel bone, the presence of bone tumors or evidence of soft tissue damage caused by certain connective tissue disorders.

Treatment

Treatment of heel pain generally occurs in stages. At the earliest sign of heel pain, aggressive calf muscle stretching should be started. Additionally, taking an oral anti-inflammatory medication and over-the-counter arch supports or Dr. Scholl's Dynastep Arch Support may be beneficial. This can be found at most grocery stores or pharmacies. No walking, barefoot, stocking feet or flats. Try and wear shoes with good arch supports (sport or hiking shoes).

The next phase of treatment might consist of continued calf muscle stretching exercises, cortisone injections and orthopedic taping of the foot to support the arch.

If this treatment fails, or if there is reoccurrence of the heel pain, then functional foot orthotics might be considered. A functional orthotic is a device that is prescribed and fitted by your foot doctor, which fits in normal shoes like an arch support. Unlike an arch support, however the orthotic corrects abnormal pronation of the subtalar joint. Thus orthotics address the cause of the heel pain - abnormal pronation of the foot.

When conservative therapy fails after 6 months of treatment, then Extracorporeal Shock Wave Therapy (ESWT) might be considered. Shockwaves sent through the foot to the plantar fascia cause micro-trauma which triggers revascularization, healing and pain relief. This noninvasive, outpatient procedure requires only a single 30-minute session, a short recovery period and little or no side effects.

Surgery to correct heel pain is generally only recommended if orthotic treatment has failed and ESWT is not an option. There are some exceptions to this course of treatment and it is up to you and your doctor to determine the most appropriate course of treatment.