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Treating plantar faciitis

plantar faciitis illustration

What is plantar faciitis?

Plantar fasciitis is an inflammatory condition involving the plantar fascia, a thick band of connective tissue found on the bottom of the foot. This thick band of tissue extends from the heel to the ball of the foot, and aids in support and stabilization of the foot (especially the arch) during walking and running.

Symptoms involve two areas: the arch and, more commonly, the inside heel arch. Severe pain can be present especially in the morning on arising and after periods of rest. This pain usually decreases somewhat with initial activity and then, as the day progresses, can become quite painful, depending on the activity level.Swelling, redness, and heat are usually not apparent.  Many patients use the term “stone bruise” to describe this condition because of the intense, localized area of discomfort.

Causes

The most common cause of plantar fasciitis is overuse, an excessive amount of activity over a given period of time. This excessive activity causes a stretching or pulling force on the heel area, resulting in a fatigue failure or breakdown of the fascial tissue. Over a period of time, this traction, or pulling force, can result in heel spur formation, which can be clearly seen on x-rays. Certain generalized arthritic problems can also be responsible for plantar fasciitis/heel spur syndrome and should be considered.

Treatment initially consists of:

  • Supportive/stable shoes
  • Stretching exercises to stretch the Achilles tendon and plantar fascia. This should be done in the morning or before activity. Ice application after activity.
  • Temporary over-the-counter (OTC) arch supports
  • The use of oral anti-inflammatory agents (ie., Advil, Aleve, or Ibuprofen)

Four to twelve weeks is usually the amount of time necessary for symptoms to improve significantly. In resistant cases the following may be necessary to obtain a cure:

  • Local anesthetic steroid injections
  • Custom orthotics
  • Night splint – stretches plantar fascia while at rest
  • Physical therapy; deep tissue massage and ultrasound
  • Heel cups
  • Surgery

Conservative treatment is effective 95% of the time for plantar faciitis.  During treatment,  use your pain tolerance as a guide for activity type and endurance.