Plantar Fasciitis

What causes plantar fasciitis?

With every step we take, our body weight comes to rest first on the heel and then gradually over the length of the foot. As the foot begins to bear weight, it flattens. This puts pressure on the plantar fascia, which has very little stretch. As we walk, the plantar fascia pulls on its attachment at the heel.

If the foot is properly aligned, this pull causes no problems. If the foot is pronated — meaning it rolls outward at the ankle — the arch falls too much and there is an abnormal amount of pull on the fairly rigid plantar fascia. This causes an abnormally strong pull on the heel where the plantar fascia attaches.

Something similar happens when the foot has supination, meaning it rolls inward. These type of feet are relatively inflexible, usually have a high arch and a short or unusually tight plantar fascia.

Plantar fasciitis can be caused by:

• A lack of arch support.
• A sudden injury.
• A tendency to roll your feet one way or another.
• An increase in activities such as running, basketball, tennis, soccer or gymnastics that involve repetitive pounding of foot.
• Being overweight.
• Doing a lot of walking barefooted.
• Having one leg that is shorter than the other. This causes the foot on the longer leg to carry the body's entire weight longer than normal, stressing the fascia on that foot. Additionally, the foot of the shorter leg falls to the ground harder, putting more pressure on that foot.
• Poor flexibility in the calf muscle.
• Poor training for physical activities.
• Standing too long.
• Wearing shoes that don't bend easily under the ball of the foot.
• Wearing shoes with too little cushioning.

It's not always possible to identify the cause. Plantar fasciitis tends to develop as we get older and the fascia become less elastic. Women tend to get this condition more than men.

What are the symptoms of plantar fasciitis?

When you have plantar fasciitis, you usually feel pain in the bottom of the heel or the arch of the foot. Some people describe the pain as feeling like a bruise or an ache. The pain tends to gradually go away once you begin walking around. With continued walking, the pain may return, but usually goes away after rest. If the swollen plantar fascia irritated a nerve in the foot, pain may radiate into the ankle.

In the early stages of plantar fasciitis, the pain may go away quickly once you take weight off the foot. Over time, however, it may take longer and longer for the pain to go away. Without treatment, the plantar fascia will eventually tear partially away from the heel. The body fills the torn area in with calcium. This eventually becomes a bone and is called a heel spur.

How is plantar fasciitis diagnosed?

This condition is usually diagnosed on the basis of your description of your symptoms. Your doctor may examine your foot and its structure or look at your shoes to see how they are wearing. (Feet that pronate tend to break down the inner side of the shoe; feet that supinate tend to break down the outer side of the shoe.)

How is plantar fasciitis treated?

Depending on the individual, different treatments may be more effective than others. Approaches include:

• Rest. It can help to do ess weight-bearing exercise that involves running and jumping. Sitting or lying down and raising your feet can also reduce swelling.
• Applying ice. Using ice packs to cool (not freeze) your foot helps reduce pain and swelling. The ice should be used on heels and arches (not toes) for about 20 minutes three times a day. If you have diabetes or poor circulation, you should discuss this with your doctor first.
• Orthotics.
• Heel cushions. These off-the-shelf devices go inside your shoes.
• Splinting your foot at night.
• Avoid going barefoot.
• Stretching your foot.

Key points

• Plantar fasciitis is one of the most common causes of pain in the bottom of the heel, the arch or both areas. The condition comes on with inflammation of the plantar fascia, a ligamentlike band on the bottom of the foot.
• It's not always possible to know which of the numerous causes of plantar fasciitis is at work.
• Rest, ice and heel cushions are some ways to treat the condition.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

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