Plantar Fasciitis


The vast majority of heel pain is caused by a problem with the medical name of plantar fasciitis.  You may have also heard it called "heel spurs".  People sometimes assume they have plantar fasciitis just because it is a common diagnosis, but the truth is there are countless causes of heel pain.  Due to the numerous causes of heel pain it is important to seek medical treatment if you have pain that does not resolve after a few weeks of simple home treatments.  You most likely have plantar fasciitis if you have pain getting out of bed in the morning and pain after being on your feet at work all day.  But, most cases of plantar fasciitis will resolve with a few simple treatments outlined below. The podiatrists at Neuhaus Foot and Ankle see patients from all over the Nashville area. They see patients from Brentwood, Smyrna, Hermitage, Lebanon, Nashville, Murfreesboro, Antioch, and other local cities.  All the Neuhaus Foot and Ankle podiatrists are well-trained and can help you get to the bottom of what's causing your heel pain.

What Is the Plantar Fascia?

The plantar fascia is a thick band of  tissue that connects the ball of the foot to the heel bone.  If you lift your toes and feel the arch of your foot you will feel the medial band of the plantar fascia.  The most common area of inflammation with plantar fasciitis is where the tissue attaches to the heel at the back fo the arch.

Causes of Plantar Fasciitis

Plantar fasciitis is most commonly caused by having a foot type that results in instability of the foot.  A foot that is overly flat is more prone to plantar fasciitis.  Likewise, those with high arch feet are also susceptible. Shoes can play an important role as can not wearing shoes.  Barefoot walking does not provide the support the plantar fascia needs and can cause pain.  Flip flops or poorly made shoes can contribute to the pain as well.  Those who are heavy are more likely to have increased strain on the plantar fascia.  Trauma to the heel or arch can induce plantar fasciitis.  Working on a hard surface like concrete can be a cause.  Often it is a combination of things that ultimately leads to the pain starting.

What are the symptoms of plantar fasciitis?

1.  Pain in the arch or bottom of the heel-usually described as a sharp, stabbing pain
2.  Heel pain with walking-pain is usually worse at the end of the day
3.  Pain when getting out of bed in the morning that resolves with "stretching the foot out"
4.  Pain is typically worse going from sitting to standing.  People say the feet are okay until they have a break and sit down during the day-they don't want to get up and going again because of the terrible pain.

How do you diagnosis plantar fasciitis?

In the office, I will do a complete exam which will involve localizing the painful area of the foot, a complete history to understand when it hurts and what makes it better.  Xrays to evaluate for a stress fracture, bone spur or other unusual cause of the pain such as a cyst or tumor in the bone.  An ultrasound can be done to evaluate the plantar fascia and look for thickness of the fascia, a tear in the fascia or fluid in the area that can mimic the signs of fasciitis. Throughout this process it is important to rule out all the other potential causes for your heel pain to make sure it is indeed plantar fasciitis.  It is of interest to note that heel spurs are sometimes discovered in patients suffering from plantar fasciitis, but the heel spurs are rarely the cause of the patient's pain. If a heel spur is found, the patient's condition may be diagnosed as plantar fasciitis or heel spur syndrome.  Below you see ultrasound images.  Normal thickness of the plantar fascia on this ultrasound is .40cm.


Plantar fasciitis, or fasciosis as it is sometimes called, is easily identified on ultrasound.


Note the normal thickness in the plantar fascia.  Symptoms in this patient were typical of fasciitis but it was really the fluid that caused the pain.  It would not have been treated accurately without identification using ultrasound.  It is a great diagnostic tool!

How can you treat plantar fasciitis?

Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:

-Stretching the calf and arch will be very helpful for most people. The following video or the handout can show you some of the basic stretching exercises I recommend for this problem.

-Avoid going barefoot in the house.  The plantar fascia needs support.  I will typically recommend something like Crocs be worn inside.
-Applying ice will help.  Roll a frozen water bottle in your arch 10-15 minutes 2-3 times a day-it will help!
-Change your workouts-stop running on the treadmill and do a low impact exercise such as swimming or an elliptical machine for a few days. 
-Wear supportive shoes that have good arch support and a slightly raised heel to lessen pressure on the plantar fascia. I have a video outlining how to choose the best shoe that you can watch.  The Perfect Shoe Selection.
-Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may help reduce pain and inflammation.
-An over the counter insert to support the arch can be beneficial.  I typically recommend a brand such as powerstep or superfeet.  Avoid Dr. Scholl's products as they do not typically provide the support you need.  They are more cushioning than supportive.  Plantar fasciitis requires support, not cushion.  

If you still have pain after some or all of the above, your podiatrist may add one or more of these approaches in the office:

-Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
-Steroid injections can be very helpful and are used to help reduce the inflammation and relieve pain.
-At times the plantar fascia just needs more rest and a removable walking cast (a cam walker as we call it) may be used
-A night splint is a brace you sleep in that helps the plantar fascia and Achilles tendon to be stretched out and this will help relieve pain when getting out of bed in the morning. 
-Some home exercises and even physical therapy may be used to help provide relief.

Most cases of plantar fasciitis are treated successfully with non-surgical methods. However, for a small percentage of patients, surgical treatment may be necessary. It is important to remember that most people with plantar fasciitis have relief with aggressive treatment, and the longer the symptoms persist the longer it can take to resolve with conservative treatment.  Your podiatrist will most likely discuss surgery with you if you have been through several months of conservative treatments with no relief from your pain. Your podiatrist will talk about the different surgical options available with you and will choose the best option for your specific case.

Long-term-What to expect

Even after your pain is gone, you may need to continue some form of treatment. The problem can certainly recur after it has resolved.  If it recurs you will need to wear an orthotic - typically a custom device, and continue stretching, and wearing supportive shoes. For overweight patients, weight loss may be recommended.

To learn more or to schedule an appointment, you can contact us using the appointment request or contact us form. You can also call the Neuhaus Foot and Ankle office at 615-220-8788 or at our toll-free number 888-713-0906.

CONTACT US

Neuhaus Foot & Ankle
300 Stonecrest Blvd. Suite 450
Smyrna, TN 37167
(615) 220-8788