Fascia is a thick tissue that connects the ball of the foot to the heel. The tissue is responsible for the arch of the foot. When this connective tissue becomes inflamed to the point of pain, it’s called plantar fasciitis.
Patients who suffer with plantar fasciitis often experience sharp pain in the morning. When the fascia loosens during normal physical activity such as walking, the pain will subside a bit. The first few steps of the day are often the most painful because the fascia is not used during sleep.
Risk factors include arch problems such as flat and high arches. Other causes are obesity or sudden weight gain, long distance running, or running on uneven surfaces, and having a tight Achilles tendon. Finally, wearing shoes without proper arch support can cause fascia inflammation as fascia can adjust only so far before it is stretched to the point of pain.
This condition is most commonly found in men age 40-70. It’s the leading cause of orthopedic care. While heel spurs caused by calcium deposits are commonly found in plantar fasciitis patients, they are not the cause of the pain. They are a reaction by the bone to the fascia’s inflammation.
Symptoms include stiffness on the bottom of the heel, an ache on the arch and a sharp pain or burn when first putting weight on the foot. The pain may be more severe if climbing stairs or performing intense activity. The pain may come over a period of time or may be intense and sudden. It is not uncommon for swelling and redness to also be present.
To diagnose plantar fasciitis, a pain physician will take a series of X-rays of the foot. If a bone spur is present, plantar fasciitis is a likely diagnosis. Additionally, physicians will look for a thickening and inflammation of the fascia from the ball of the foot to the heel. The physician may also look for hairpin fractures in the bones around the foot, which are also a common source for this type of pain.
Treatment options range from over-the-counter NSAIDS, such as acetaminophen and ibuprofen to reduce inflammation and stretching. Cortisone shots and sonic wave procedures are also used. Depending on the severity of the inflammation, the patient may respond favorably to stretching, ice, rest, or wearing orthotics when standing. Additionally, athletic tape and splints specifically manufactured for fascia stretching can ease plantar fasciitis-related pain.
- Plantar Fasciitis – PainDoctor.com
- Wapner KL, Parekh SG. Heel pain. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez’s Orthopaedic Sports Medicine.3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:section F.
- Abu-Laban RV, Ho K. Ankle and foot. In: Marx JA, Hockberger RS, Walls RM, et al, eds.
- Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 55. Review Date: 2/19/2011. Reviewed by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.