Heel pain is a common condition in adults that can result in symptoms ranging from mild discomfort to debilitating agony. Such pain may be due to a stress fracture, tendonitis, arthritis, nerve irritation, or a cyst. However, the most frequent source of heel pain is plantar fasciitis.

The Anatomy of the Plantar Fascia

The plantar fascia ligament is the long, thin filament that connects the front of the foot to the heel and supports the foot’s arch. Sitting directly beneath the skin on the bottom of the foot, the plantar fascia stretches and contracts like a rubber band to help the foot absorb the stresses and strains as it moves. But excessive pressure on the foot can damage or tear the tissues.

Plantar Fasciitis

Simply put, plantar fasciitis occurs when the plantar fascia becomes inflamed. With advancing age, the plantar fascia loses some of its elasticity and resembles a rope that is not very stretchable. In addition, the fat pad on the heel thins out and is less able to absorb the shock that is caused by walking. This “unabsorbed” shock begins to damage the plantar fascia by causing it to swell, tear, or bruise, which results in inflammation.

The most common cause of the condition is too much physical activity or exercise. If the plantar fascia is continuously pulled away from the heel bone, it eventually may lead to the development of a heel spur. This bony growth on the heel is seen in about 70 percent of patients with plantar fasciitis and can be detected on an X-ray.

Because the plantar fascia hardens as people grow older, the condition is frequently seen in middle-aged people. However, it can also occur in younger people who spend an extraordinary amount of time on their feet. Recreational athletes may put repetitive or excessive stress on the ligament, which can lead to tears and inflammation of the plantar fascia. Arthritis sufferers can develop plantar fasciitis due to inflammation that can develop in the tendons. Among elderly people, diabetes is also a factor that can contribute to heel pain and ligament damage.

Plantar fasciitis is also common in people whose feet are pronated, or tend to roll inwards while walking. Wearing shoes that are inappropriate for a particular sport, do not fit properly, or provide inadequate support or cushioning can also aggravate the condition. Other factors known to increase the risk of plantar fasciitis are obesity, a very high arch, flat footedness, or tighter calf muscles (that cause difficulty in flexing the foot and bringing the toes up toward the shin).

A person suffering from plantar fasciitis may experience pain on the bottom of the foot near the heel. Onset of this pain may occur during the first few steps after getting out of bed in the morning or after a long period of sitting or resting. It also may increase in intensity after (but not during) exercise or other physical activity. However, the pain may often subside after a few minutes of walking.

Diagnosis

To diagnose plantar fasciitis, the doctor will take a detailed medical history, concentrating on past illnesses or injuries, pain location and triggers, and the level and types of physical activity in the patient’s daily routine. During a physical examination, the doctor will look for an area of tenderness on the bottom of the foot just in front of the heel bone. Plantar fasciitis sufferers might be unable to flex the foot without pain or display a wide range of motion in the ankle.

The doctor will likely order imaging tests to confirm if the heel pain is caused by plantar fasciitis. X–ray imaging will help rule out fractures, arthritis, or other sources as the cause of the heel pain; plus, it can also detect the presence of heel spurs. Other tests such as magnetic resonance imaging (MRI) scans and ultrasound scans are only performed if the heel pain persists after initial treatment.

There is no single treatment that cures plantar fasciitis in every patient. However, there are many things that can be done to reduce the pain and help the affected foot heal. A person who runs or walks frequently may benefit from cutting back on those activities to some extent. Placing pads in shoes can soften the impact of walking or running. People with a long plantar fascia (or “flat feet”) or a short plantar fascia (“high arch”) may consider using orthotic inserts in their shoes. Losing weight may help overweight individuals find relief from their pain.

Over-the-counter medicines such as aspirin, acetaminophen, naproxen, and ibuprofen may help in reducing heel pain. If a person’s job involves standing in one spot or on a hard floor for long periods of time, it may help to place some type of padding on the floor where he or she stands. Some other preventive measures include avoiding walking barefoot to prevent undue strain and stress on the plantar fascia, putting an ice pack wrapped in a wet towel on the heel for 20 minutes each day, and wearing shoes which have good arch support.

Exercises that stretch the calf muscle can help facilitate recovery from plantar fasciitis. The person stands with the palms of the hands against a wall and the injured leg slightly behind the other leg. With both heels flat on the floor, the patient bends the knee of the non-injured leg and leans forward, feeling the stretch in the lower part of the injured leg. The stretch should be held for 10 to 15 seconds and then repeated 6 to 8 times.

Another exercise that can strengthen the leg muscles involves standing on the ball of the injured foot on the edge of a step. The patient then lifts up on the toe as high as possible, and then allows the heel to fall slightly below the edge of the step.

A person can also place a towel under the injured foot and then try to pick it up with the toes. This action helps tighten and strengthen the muscles in the foot.

In some patients, stretching, arch supports, medication, and exercise may not reduce the pain. These people may have to wear a splint on the foot while sleeping to maintain an extended stretch of the plantar fascia at night. This may help reduce the morning pain that is experienced by some patients.

A removable walking cast may be used to immobilize the foot for a few weeks to allow it to rest and heal. Injections of corticosteroid medications into the tender area may reduce inflammation and provide pain relief in severe cases. A few individuals may need surgery to loosen the plantar fascia manually.

Outlook

Every person responds to plantar fasciitis treatment differently, so recovery time from the condition may vary. But traditional methods of treatment are generally successful; therefore, patients usually do not require surgery or invasive procedures to eliminate their pain. However, even when plantar fasciitis goes away, the underlying causes that lead to the condition often remain. So it is vital that preventive measures be taken such as wearing supportive shoes, icing sore heels, stretching, and using customized orthotic devices if necessary, because preventing plantar fasciitis is much easier than treating the condition.