Plantar fasciitis (fashee-EYE-tiss) is the most common cause of pain on the bottom of the heel. Approximately 2 million patients are treated for this condition every year.
Plantar fasciitis occurs when the strong band of tissue that supports the arch of your foot becomes irritated and inflamed.
The plantar fascia is a long, thin ligament that lies directly beneath the skin on the bottom of your foot. It connects the heel to the front of your foot, and supports the arch of your foot.
The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body's natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis.
In most cases, plantar fasciitis develops without a specific, identifiable reason. There are, however, many factors that can make you more prone to the condition:
Although many people with plantar fasciitis have heel spurs, spurs are not the cause of plantar fasciitis pain. One out of 10 people has heel spurs, but only 1 out of 20 people (5%) with heel spurs has foot pain. Because the spur is not the cause of plantar fasciitis, the pain can be treated without removing the spur.
The most common symptoms of plantar fasciitis include:
After you describe your symptoms and discuss your concerns, your doctor will examine your foot. Your doctor will look for these signs:
Your doctor may order imaging tests to help make sure your heel pain is caused by plantar fasciitis and not another problem.
X-rays provide clear images of bones. They are useful in ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs can be seen on an x-ray.
Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. They are rarely ordered. An MRI scan may be used if the heel pain is not relieved by initial treatment methods.
More than 90% of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods.
Rest. Decreasing or even stopping the activities that make the pain worse is the first step in reducing the pain. You may need to stop athletic activities where your feet pound on hard surfaces (for example, running or step aerobics).
Ice. Rolling your foot over a cold water bottle or ice for 20 minutes is effective. This can be done 3 to 4 times a day.
Nonsteroidal anti-inflammatory medication. Drugs such as ibuprofen or naproxen reduce pain and inflammation. Using the medication for more than 1 month should be reviewed with your primary care doctor.
Exercise. Plantar fasciitis is aggravated by tight muscles in your feet and calves. Stretching your calves and plantar fascia is the most effective way to relieve the pain that comes with this condition.
Cortisone injections. Cortisone, a type of steroid, is a powerful anti-inflammatory medication. It can be injected into the plantar fascia to reduce inflammation and pain. Your doctor may limit your injections. Multiple steroid injections can cause the plantar fascia to rupture (tear), which can lead to a flat foot and chronic pain.
Supportive shoes and orthotics. Shoes with thick soles and extra cushioning can reduce pain with standing and walking. As you step and your heel strikes the ground, a significant amount of tension is placed on the fascia, which causes microtrauma (tiny tears in the tissue). A cushioned shoe or insert reduces this tension and the microtrauma that occurs with every step. Soft silicone heel pads are inexpensive and work by elevating and cushioning your heel. Pre-made or custom orthotics (shoe inserts) are also helpful.
Night splints. Most people sleep with their feet pointed down. This relaxes the plantar fascia and is one of the reasons for morning heel pain. A night splint stretches the plantar fascia while you sleep. Although it can be difficult to sleep with, a night splint is very effective and does not have to be used once the pain is gone.
Physical therapy. Your doctor may suggest that you work with a physical therapist on an exercise program that focuses on stretching your calf muscles and plantar fascia. In addition to exercises like the ones mentioned above, a physical therapy program may involve specialized ice treatments, massage, and medication to decrease inflammation around the plantar fascia.
Extracorporeal shockwave therapy (ESWT). During this procedure, high-energy shockwave impulses stimulate the healing process in damaged plantar fascia tissue. ESWT has not shown consistent results and, therefore, is not commonly performed.
ESWT is noninvasive—it does not require a surgical incision. Because of the minimal risk involved, ESWT is sometimes tried before surgery is considered.
Surgery is considered only after 12 months of aggressive nonsurgical treatment.
Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the plantar fascia, this procedure is useful for patients who still have difficulty flexing their feet, despite a year of calf stretches.
In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope, an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs.
Complication rates for gastrocnemius recession are low, but can include nerve damage.
Plantar fascia release. If you have a normal range of ankle motion and continued heel pain, your doctor may recommend a partial release procedure. During surgery, the plantar fascia ligament is partially cut to relieve tension in the tissue. If you have a large bone spur, it will be removed, as well. Although the surgery can be performed endoscopically, it is more difficult than with an open incision. In addition, endoscopy has a higher risk of nerve damage.
Complications. The most common complications of release surgery include incomplete relief of pain and nerve damage.
Recovery. Most patients have good results from surgery. However, because surgery can result in chronic pain and dissatisfaction, it is recommended only after all nonsurgical measures have been exhausted.
Many people think a bunion is a simple bone prominence by the big toe. Actually, a bunion can be a progressive deformity of bones and joints. These mal-aligned structures can cause a painful “bump,” but can also cause functional problems, leading to other regions of foot pain.
Bunions develop slowly. Pressure on the big toe joint causes the big toe to lean toward the second toe. Over time, the normal structure of the bone changes, resulting in the bunion bump. This deformity will gradually increase and may make it painful to wear shoes or walk.
Anyone can get a bunion, but they are more common in women. Many women wear tight, narrow shoes that squeeze the toes together—which makes it more likely for a bunion to develop, worsen and cause painful symptoms.
In most cases, bunion pain is relieved by wearing wider shoes with adequate toe room and using other simple treatments to reduce pressure on the big toe.
Treating a “simple” bunion may not be so simple! An orthopedic surgeon, especially a foot and ankle specialist, would be best trained to correct a bunion, achieving lasting improvements in pain relief and function.
In most cases, bunions are treated without surgery. Although nonsurgical treatment cannot actually "reverse" a bunion, it can help reduce pain and keep the bunion from worsening.
In the vast majority of cases, bunion pain can be managed successfully by switching to shoes that fit properly and do not compress the toes. Some shoes can be modified by using a stretcher to stretch out the areas that put pressure on your toes. Your doctor can give you information about proper shoe fit and the type of shoes that would be best for you.
Protective "bunion-shield" pads can help cushion the painful area over the bunion. Pads can be purchased at a drugstore or pharmacy. Be sure to test the pads for a short time period first; the size of the pad may increase the pressure on the bump. This could worsen your pain rather than reduce it.
To take pressure off your bunion, your doctor may recommend that you wear over-the-counter or custom-made shoe inserts (orthotics). Toe spacers can be placed between your toes. In some cases, a splint worn at night that places your big toe in a straighter position may help relieve pain.
Applying ice several times a day for 20 minutes at a time can help reduce swelling. Do not apply ice directly on your skin.
Nonsteroidal anti-inflammatory medications such as ibuprofen and naproxen can help relieve pain and reduce swelling. Other medications can be prescribed to help pain and swelling in patients whose bunions are caused by arthritis.
Your doctor may recommend surgery for a bunion or bunionette if, after a period of time, you have pain and difficulty walking despite changes in footwear and other nonsurgical treatments. Bunion surgery realigns bone, ligaments, tendons, and nerves so that the big toe can be brought back to its correct position.
There are several surgical procedures to correct bunions. Although many are done on a same-day basis with no hospital stay, a long recovery is common after bunion surgery.
Once arthritis sets in there is no way to reverse the damage that is done. Treatment can range from things as simple as exercise to as involved as injections and medications.
Most patients are given an overall program that includes a variety of treatment options. The goals of treatment are therefore to decrease the patient's discomfort, increase the patient's function, and to hopefully protect the joints from further damage. Our doctors believe that a crucial part of the treatment plan is to educate the patient regarding their condition so that they may be an integral part of the treatment plan.
When the pain and other symptoms can no longer be managed by non-operative methods then surgery is your best option. The belief that one needs to be completely disabled before considering joint replacement is not only false but dangerous. Studies have shown that patients that wait too long to have their joints replaced can have a harder recovery and poorer outcomes.
This procedure involves making 2-3 poke holes into the joint and removing torn cartilage or loose material from the joint. Although this procedure was commonly used in the past to treat arthritis, there are limited indications at this time for using arthroscopy in the knee. The main reason that its used less often is that is has not shown to provide any long lasting relief for moderate to severe arthritis. Its commonly used for treating cartilage tears.
Joint replacement can relieve the pain and disability of arthritis. Most patient can return to full function.
Click on the images below to learn more about joint replacement.