Plantar Fasciitis

This diagnosis is often made when a patient presents with a complaint of pain under their heel bone, or calcaneus. It can affect one foot at a time, or both feet simultaneously. The patient usually gives a history of pain after a period of rest. The first few steps after getting up in the morning are the worst, usually followed by a period of improvement, but then after sitting for a while or driving and then walking again can produce the same complaint. Xrays are usually taken to rule out different causes of heel pain, but are often read as normal.

Initial treatment is conservative, with instructions on stretching the Achilles tendon several times a day, icing the painful area, and ibuprofen or other non steroidal anti inflammatory agents of choice. Physical therapy including ultrasound and TENS may be helpful. Running shoes or at least a soft-soled shoe should be worn most of the time, and not wearing flip-flops are important. Walking barefoot on hard surfaces should be avoided. Cortisone injections and orthotics are often prescribed if initial treatment is not successful, and surgery to incise part of the plantar fascia or shock wave therapy are performed in the more recalcitrant cases.

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The heel of your foot accepts and transfers an enormous amount of force over a relatively small surface area with each normal step. Now think about how much more force is borne when you are landing from a jump or when running. The tissues in the human heel and foot (the tendons, ligaments, muscle, fascia and bone) are designed for the repetitive stress and strain from normal and even some abnormal activities of daily life, whether wearing a shoe or not. But all it takes is one day where you are more active than usual, are on a hard surface for a prolonged time, or are wearing the wrong shoes for the activity you are involved in, and the result can be heel pain.

If there is an overuse injury to the plantar fascia, which runs along the bottom of the foot from the heel out towards the toes, pain in this area is usually the first symptom a patient will notice. While there can be secondary symptoms such as swelling or bruising, the majority of people presenting with heel pain have just that, pain. In my office, most patients will relate a history of pain on the bottom of the heel when first getting up in the morning. Most patients seem to wait for about a month or longer before making an appointment, and by this time they have seen a pattern of pain after rest, so there is a daily cycle of pain that coincides with their activity level. At this point, most people rate their pain between a 5 to 8 on a scale of 10, and are experiencing pain every day to the point where it is affecting their work or performance in athletic activities.

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