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Plantar Fasciitis

By Asheesh Bedi, MD

Plantar fasciitis is an inflammation of the thick, supportive tissues on the bottom of the foot, and is one of the most common causes of heel pain.

As many as 2 million Americans are affected by plantar fasciitis each year, making it a problem that affects both competitive and recreational athletes alike. While the precise cause remains unknown, it is thought to result from repetitive microtrauma and inadequate stretching of the plantar fascia, a thick supportive band of connective tissues running between the heel bone and the toes. Plantar fasciitis can affect athletes of virtually every sport, but is particularly common among runners. Overweight people are at a greater risk as well.

Athletes with plantar fasciitis symptoms will complain of heel pain that is often worst in the first few steps in the morning, and gradually improves with walking throughout the day. There is also often discomfort along the inner aspect of the foot with flexing the toes upward towards the shin bone (“tibia”). The region at the inner aspect of the heelbone where the plantar fascia attaches is often tender to palpation as well. Plain x-rays may sometimes show a spur in the bone at this location, although they are often normal. MRI or ultrasound of the plantar fascia is usually much more effective in confirming the diagnosis.

The first line of treatment is nonsurgical and is usually very effective. Treatments include stretches for the plantar fascia and Achilles tendon, as well as splints for use at night time to keep the foot in a neutral position. Arch support orthotics and taping of the foot can help to provide support and relief with walking as well. Nonsteroidal medications are also effective in helping to relieve severe bouts of inflammation. Corticosteroid injections can also be used but must be done so judiciously, as their overuse can increase the risk of rupture of the plantar fascia and loss of its support in maintaining the arches of the foot. For longstanding cases, shock wave therapy has recently been used with good success. Surgical procedures such as cutting or removing the plantar fascia are reserved for only those refractory cases which have failed to respond to all other interventions.