Understanding Plantar Faciitis
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The symptoms of plantar fasciitis are:
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Pain on the bottom of the heel
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Pain in the arch of the foot
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Pain that is usually worse upon arising
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Pain that increases over a period of months
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Swelling on the bottom of the heel​
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The most common cause of plantar fasciitis relates to faulty structure of the foot. For example, people who have problems with their arches, either overly flat feet or high-arched feet, are more prone to developing plantar fasciitis.
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Wearing nonsupportive footwear on hard, flat surfaces puts abnormal strain on the plantar fascia and can also lead to plantar fasciitis. This is particularly evident when one’s job requires long hours on the feet. Excessive stress on the foot and overuse may also contribute to plantar fasciitis.
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People with plantar fasciitis often describe the pain as worse when they get up in the morning or after they have been sitting for long periods of time. After a few minutes of walking, the pain decreases because walking stretches the fascia. For some people, the pain subsides but returns after spending long periods of time on their feet.
Treatment for Plantar Faciitis
Diagnosis
To arrive at a diagnosis, the foot and ankle surgeon will obtain your medical history and examine your foot. Throughout this process, the surgeon rules out all possible causes for your heel pain other than plantar fasciitis.
In addition, diagnostic imaging studies, such as x-rays or other imaging modalities, may be used to distinguish the different types of heel pain. Sometimes heel spurs are found in patients with plantar fasciitis, but these are rarely a source of pain. When they are present, the condition may be diagnosed as plantar fasciitis/heel spur syndrome.
Home Treatments
Treatment of plantar fasciitis begins with first-line strategies, which you can begin at home:
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Stretching exercises. Exercises that stretch out the calf muscles help ease pain and assist with recovery.
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Avoid going barefoot.
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Ice. Putting an ice pack on your heel for 20 minutes throughout day.
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Limit activities. Cut down on extended physical activities to give your heel a rest.
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Shoe modifications that have good arch support.
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Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
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Lose weight.
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Padding, taping and strapping. ​
When Is Surgery Needed?
Although most patients with plantar fasciitis respond to nonsurgical treatment, a small percentage of patients may require surgery. If, after several months of nonsurgical treatment, you continue to have heel pain, surgery will be considered. Your foot and ankle surgeon will discuss the surgical options with you and determine which approach would be most beneficial for you.
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Non- Surgical Alternatives
Several alternatives prior to considering surgery include:
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Orthotic devices. Custom orthotic devices that fit into your shoe help correct the underlying structural abnormalities causing the plantar fasciitis.
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Injection therapy. In some cases, corticosteroid injections are used to help reduce the inflammation and relieve pain.
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Removable walking cast. A removable walking cast may be used to keep your foot immobile for a few weeks to allow it to rest and heal.
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Night splint. Wearing a night splint allows you to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some patients.
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Physical therapy. Exercises and other physical therapy measures may be used to help provide relief.
Long-Term Care
No matter what kind of treatment you undergo for plantar fasciitis, the underlying causes that led to this condition may remain. Therefore, you will need to continue with preventive measures. Wearing supportive shoes, stretching and using custom orthotic devices are the mainstay of long-term treatment for plantar fasciitis.