So You Have Plantar Fasciitis - An Explanation of Its Cause and Your Treatment

Plantar fasciitis is a common cause of foot pain and many Americans seek treatment for pain relief and a return to normal foot function. Unfortunately, the cause of this condition as well as the treatment required to achieve relief can be a little complicated. It requires medical care. Although most people see a podiatrist for this condition, it is also treated by some orthopedic surgeons and less commonly by family physicians. During the brief time one has with their physician in this day and age of heavily packed offices, a full explanation may not be possible or it may seem confusing initially, even at the foot specialist's office. The purpose of this article is to shed some light on the general causes of plantar fasciitis and the treatment usually given, for those of you who have been diagnosed with plantar fasciitis and may still be confused by what you have and what you can do to get rid of it.

So your doctor has diagnosed you with plantar fasciitis....

The plantar fascia is a band of rubbery tissue under the foot arch that connects to the heel at one end, and the ball of the foot at the other end. Your plantar fascia has been injured. This has likely occurred over a long period of time. Most people with this condition have it because the foot is flattening excessively, which creates strain on this tissue every time one takes a step. Over time, this strain has allowed microscopic tearing of the fascia to occur, which is now worsening daily. A much smaller percentage of people have this condition due to an arch that is too high. In this case, the foot cannot absorb shock well enough because it cannot flatten, which under normal circumstances is how the body absorbs the shock of walking. The plantar fascia becomes inflamed during the process of excess shock being transmitted to the heel and arch. On rare occasions, plantar fasciitis can be caused by injuries due to stepping on a blunt object, excessive use of ladders or stairs, or even ruptures due to various foot injuries. Your doctor likely has explained to you what the cause of your specific fasciitis is. If not, ask him or her to explain this better.

Many people associate their heel and arch pain with a heel spur. Although spurs are often present with this condition on the heel bone, they are rarely ever a contributing cause to foot pain. They simply represent an additional growth of bone tissue in response to the inflammation and strain that is occurring where the plantar fascia attaches to the heel bone. Because you walk parallel with the direction of the spur, instead of the spur facing down into the bottom of the heel tissue, it is not contributing to your pain. You may or may not have a heel spur, and your doctor will likely have seen this on any x-rays taken during your examination.

It is quite common for other tissue to be inflamed along with the plantar fascia. This includes nerve tissue that runs along the side of and under the heel. There can even be entrapment of a large nerve that runs around the inside of the ankle bone and passes through a structure called the tarsal tunnel. A condition can develop in the ankle similar to carpal tunnel syndrome in the wrist that can include heel pain as one of its symptoms. This condition can be present with plantar fasciitis or appear on its own.

Treatment of plantar fasciitis usually involves two steps performed at the same time. The first step is reduction of the inflammation causing the main symptom of pain, at both the fascia and surrounding nerves. You would likely have been given stretching and icing instructions to help make the fascia more limber and reduce inflammation. Be sure to perform them as instructed without skipping days. If medically appropriate, your doctor may have put you on anti-inflammatory medication. It is important you take this as directed daily. It is not a 'pain pill' per se, and may not provide an immediate or noticeable sense of pain improvement. It works to reduce your body's overall inflammatory state, and may take 2-3 weeks to achieve that. You should report any stomach upset or other adverse effects as soon as they occur. Occasionally some patients experience these problems with anti-inflammatory medication. Often, physicians will inject the pain site with a steroid medication. This acts to reduce the inflammation directly in the heel. Most people have significant reduction of their pain after one to three injections split apart by two weeks each. The injections may take up to a week to work, and on rare occasion some people have a one to two day increase in their pain following the injection if the body initially is sensitive to the crystals of the steroid in the tissue. It is unusual and ill-advised to have more than four or so injections during the immediate treatment period, especially if one is have little to no relief. The steroid crystals will eventually accumulate in the heel tissue, and can cause internal tissue irritation if excessive amounts are placed in the heel. Although not toxic, this excessive accumulation can make the heel and arch worse off.

The second step to treat plantar fasciitis is to eliminate the underlying cause of the condition by supporting the foot structure. Unless caused by an injury (which is uncommon), plantar fasciitis is due to flatter feet (most common) or high arches (less common). During your treatment course, your doctor will reinforce the use of shoes appropriate for your foot type. He or she has also likely discussed and recommended the use of high quality inserts to provide increased arch support and shock absorption. Most store bought inserts are poorly designed and inadequate for this purpose, and your doctor may have a preferred brand. These inserts are good for temporary management and control of the foot structure. Unfortunately, in a vast majority of people, plantar fasciitis will eventually return in time unless the foot structure is tightly controlled. To prevent this, your doctor has or will recommend prescription orthotic inserts to control your specific foot structure over the course of many years. The change in your foot function with these inserts will eliminate the forces that caused plantar fasciitis in the first place, and for most people will prevent it from reoccurring. Other treatments for plantar fasciitis can include the use of a night splint to gently stretch the fascia while you sleep. Your doctor will determine if this is necessary and appropriate for you.

If these measures are not effective in relieving your pain, your doctor may order physical therapy or place you in an immobilizing boot to remove the pressure from the ground off your heel and arch. Additional studies may be needed if your pain continues. This can include an MRI to evaluate for subtle tissue tears, masses, or heel bone stress fractures, which are all uncommon. Finally, surgery may be needed ultimately to heal this condition. Many procedures are available today to provide relief with as quick a recovery period as possible. It should be noted that in most practices, the majority of people with plantar fasciitis respond quite well with the initial treatment plan discussed above, with low numbers of people requiring surgery or even immobilization or physical therapy as a whole.

If you have any questions about your diagnosis or treatment plan, don't hesitate to call your doctor's office for answers. It is their goal to provide you with relief as soon as possible. It is important you perform all aspects of your treatment course as a whole, as singling out individual treatment components may not result in effective improvement. If you are having difficulty or concern with any component of your treatment, your doctor needs to know, so that he or she may help guide you through it or offer an alternate treatment.