If the worst pain or discomfort comes when you take your first steps after waking up in the morning or sitting for a long time, it’s likely plantar fasciitis (pronounced: fashee-EYE-tiss). And it’s the most common cause of pain on the bottom of the heel.
About 2 million patients are treated for this condition every year, according to the American Academy of Orthopedic Surgeons. Plantar fasciitis occurs when the strong band of tissue – the ligament called plantar fascia — that supports the arch of your foot becomes irritated and inflamed.
The condition occurs when the plantar fascia is overstretched or overused, making walking painful and difficult. Often, the pain subsides after walking for a while following a prolonged period of sitting or sleeping. Tight Achilles tendons, which are the tendons attaching your calf muscles to your heels, may also result in plantar fascia pain.
“Plantar fasciitis is a terrible problem because it is very difficult to get rid of,” said Christopher Hodgkins, M.D., an orthopedic surgeon with Miami Orthopedics & Sports Medicine Institute. “And it will cause pain with every single step, every single day. Most patients complain of terrible pain during the first couple of steps they take in the morning. The pain can level off as they walk some more, but the pain can increase again later in the day.”
Common Risk Factors
What are some of the contributing factors that can result in plantar fasciitis? In many cases, plantar fasciitis develops without a clear, identifiable cause. There are, however, many factors that can make someone more prone to the condition:
- Tighter calf muscles that make it difficult to flex your foot and bring your toes up toward your shin
- Very high arch
- Repetitive impact activity (running/sports)
- New or increased activity
Being overweight is one of the most common risk factors. Treating both the tightness in the Achilles tendon and plantar fascia is the biggest step toward healing, says Dr. Hodgkins.
“The problem will not go away until you solve two factors: tight plantar fascia and tight Achilles tendon,” he says. “And that’s why the number one treatment modality for this problem is physical therapy.”
Diagnosis and Treatment
A podiatric physician or orthopedic surgeon is best qualified to examine your feet and observe how you stand and walk to reach a diagnosis of plantar fasciitis. Diagnostic imaging, such as an ultrasound or MRI, may be ordered to rule out other possible issues, such as fractures or arthritis. If the pain is chronic and a nerve compression syndrome (which can cause direct pressure on a nerve) is suspected, an EMG or nerve study may be ordered to rule this out.
How It’s Treated
The physician may recommend over-the-counter, anti-inflammatory medicine as well as physical therapy, which can be done at home. Achilles and calf stretching exercises can help alleviate plantar fasciitis, especially after periods of rest or sleeping. There is a stretching exercise that targets the plantar fascia. This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you in a controlled manner.
Ice can relieve inflammation along the affected ligament. In some cases, your doctor may suggest custom-made shoe inserts or orthotics. Additionally, steroid shots or injections into the heel may help if the swelling and pain don’t go away.
Surgery is another potential solution for patients with severe and persistent pain following more than six months of conservative treatment, including physical therapy. Surgery is used as a last resort. 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.
Nonetheless, physical therapy prescribed by a physician and also performed at home comprise the most common and effective treatment. Physical therapy should not entail just two or three visits a week to the physical therapist, insists Dr. Hodgkins.
“You also need a home exercise program to stretch both the Achilles tendon and the plantar fascia, three times a day and at least for ten minutes each time — in addition to your formal therapy,” explains Dr. Hodgkins. “If you do commit to that, the problem will improve. Unfortunately, it can still take months and months to get better.”
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