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Plantar fasciitis is one of the most common causes of heel pain. It involves pain and inflammation of a thick band of tissue, called the plantar fascia, which runs across the bottom of your foot — connecting your heel bone to your toes. Plantar fasciitis causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position. Plantar fasciitis is particularly common in runners. People who are overweight, women who are pregnant and those who wear shoes with inadequate support are at a higher risk of plantar fasciitis.

Complications of Plantar Fasciitis

Ignoring plantar fasciitis may result in a chronic condition that hinders your regular activities. You may also develop foot, knee, hip or back problems because of the way plantar fasciitis changes your walking motion.

Causes of Plantar Fasciitis

Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. But, if tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.

Signs & Symptoms of Plantar Fasciitis

In most cases, the pain associated with plantar fasciitis:

  • Develops gradually
  • Affects just one foot, although it can occur in both feet simultaneously
  • Is worst with the first few steps after awakening, although it also can be triggered by long periods of standing or getting up from a seated position
  • Feels like a sharp pain in the heel of your foot

Diagnosis of Plantar Fasciitis

  • Your doctor may suggest an X-ray or magnetic resonance imaging (MRI) to make sure your pain isn't being caused by another problem, such as a stress fracture or pinched nerve.
  • Sometimes, an X-ray shows a spur of bone projecting forward from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain.

Treatments of Plantar Fasciitis

About 90 percent of the people who have plantar fasciitis recover with conservative treatments in just a few months.

Medications

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve), may ease pain and inflammation, although they won't treat the underlying problem.
  • Corticosteroids. This type of medication may be delivered through a process called iontophoresis, in which a corticosteroid solution is applied to the skin over the painful area and the medication is absorbed with the aid of a nonpainful electric current. Another delivery method is injection. Multiple injections aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone. Ultrasound guidance is sometimes used for more accurate placement of the corticosteroid injection.

Therapies

  • Physical therapy. A physical therapist can instruct you in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist may also teach you to apply athletic taping to support the bottom of your foot.
  • Night splints. Your doctor may recommend wearing a splint fitted to your calf and foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight so that they can be stretched more effectively.
  • Orthotics. Your doctor may prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.

Surgical or other procedures

  • Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It's usually used for chronic plantar fasciitis that hasn't responded to more-conservative treatments. This procedure may cause bruises, swelling, pain, numbness or tingling, and has not been shown to be consistently effective.
  • Surgery. Only a small percentage of people need surgery to detach the plantar fascia from the heel bone. It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.

Prevention of Plantar Fasciitis

You can take some simple steps now to prevent painful steps later:

  • Maintain a healthy weight. This minimizes the stress on your plantar fascia.
  • Choose supportive shoes. Avoid high heels. Buy shoes with a low to moderate heel, good arch support and shock absorbency. Don't go barefoot, especially on hard surfaces.
  • Don't wear worn-out athletic shoes. Replace your old athletic shoes before they stop supporting and cushioning your feet. If you're a runner, buy new shoes after about 500 miles of use.


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