If you enjoy distance running and have had problems with heel pain, you likely have experienced a case of plantar fasciitis. It is estimated that 10% of all runners will deal with this problem at some time. The good news is that most cases will resolve in a few weeks. However, while present it can be quite bothersome and painful and sometimes requires more aggressive treatment including surgery.
The plantar fascia is the tight tissue stretching from the bottom of the heel to the ball of the foot spanning the arch. Too much pressure and repetitive stress can cause damage and even tearing of the tissue. When this occurs, inflammation can set in as the body attempts to heal itself. The result is heel pain and arch stiffness.
Certain conditions are risk factors in developing plantar fasciitis, though the exact cause is unknown. These include:
- Tight calf muscles and Achilles’ tendon.
- Very high arches
- Repetitive impact (running/ sports)
- New or increased activity
A common misconception is that heel spurs cause plantar fasciitis and heel pain. Statistics show that 1 out of 10 people have heel spurs, but only 1 out of 20 people with heel spurs have heel pain. The pain can and often resolves without removing the spur and conversely, removing the spur does not resolve the pain.
Making the diagnosis is primarily based on symptoms. The most classic symptom is heel pain when taking the first few steps after getting out of bed in the morning. Physical findings on exam include tenderness of the heel and arch. Ankle motion can be decreased. Swelling can sometimes be present. X- Rays may be ordered by your doctor, but these are primarily to rule out other conditions like arthritis or stress fractures. MRI scans or other imaging studies are not needed to make the diagnosis.
Non-surgical treatment is the mainstay of plantar fasciitis management .The following methods may be used alone or in combination, but adherence to treatment is vital.
- Rest! Stop or significantly reduce the activity that causes the pain.
- Orthotics – soft heel cups or rigid arch supports will usually provide some relief
- Stretching! – Calf and Achilles’ stretching and flexibility are the most effective proven treatment
- NSAIDS – Over-the counter medications like ibuprofen or naproxen are just as effective as prescription medications.
- Night splints – These work by keeping a passive stretch on your foot and ankle throughout the night
Your doctor may recommend injections in recalcitrant cases. Cortisone injections are the most common given. However, new evidence suggests that PRP (plasma) injections may be effective.
Other treatments include physical therapy and ultrasound. Another new treatment which has shown promising results is ESWT or extracorporeal shockwave therapy, but more research is needed.
If none of these treatments are working after an extended period of several months to a year, then surgery may be indicated. The surgeries for this condition can be open or endoscopic and involve either a plantar fascia release or gastrocnemius recession. Your surgeon can determine which method would work best for you.
Plantar fasciitis can be very nagging injury! Don’t let it keep you from your sport! Employ a good stretching program, wear good shoes and be smart about training to avoid this common problem.