Section 5. Bone, Joint, and Muscle Disorders

Chapter 72. Foot Problems

Topics: Introduction | Foot Pain | Ankle Sprain | Tarsal Tunnel Syndrome | Plantar Fasciitis | Achilles Tendon Bursitis | Ingrown Toenail | Onychomycosis | Onychia | Corns and Calluses | Onychauxis and Onychogryphosis | Hallux Valgus and Bunion | Hammer Toe | Sesamoiditis

Plantar Fasciitis

Plantar fasciitis is inflammation of the dense band of tissue called the plantar fascia that extends from the bottom of the heel bone to the base of the toes (ball of the foot).

The plantar fascia connects the bottom of the heel bones to the ball of the foot and is involved in walking and running, giving spring to the step. Although the term fasciitis means "inflammation" of the fascia, the disorder is primarily one of repeated stress to the fascia rather than one of inflammation. Often a small tear results from excessive strain placed on the plantar fascia. Plantar fasciitis is one of the most common causes of heel pain. Pain may occur anywhere along the course of the plantar fascia but most commonly is located where the fascia joins the bottom of the heel bone. Many people who develop the disorder have very high or very low arches in their feet. Tight calf muscles or a tight Achilles tendon (which attaches the calf muscles to the heel bone) may cause the foot to flatten, which can lead to a painful "bowstringing" of the fascia.

The disorder is common in runners and in dancers and may occur in people whose occupations involve standing for prolonged periods. A change in shoe style can also lead to plantar fasciitis. Disorders that may cause or aggravate plantar fasciitis are obesity, rheumatoid arthritis, Reiter's syndrome (reactive arthritis), psoriasis, and fibromyalgia.

Symptoms and Diagnosis

A person with plantar fasciitis often feels a great deal of pain after resting, particularly when placing weight on the foot first thing in the morning. The pain temporarily diminishes after the person first walks. It may also begin when the person walks or runs; in this case, the pain radiates from the bottom of the heel toward the toes.

The doctor may make the diagnosis after examining the foot. Tenderness is evident where the plantar fascia enters the heel bone or at the bottom of the ball of the foot.

X-rays may reveal the presence of a heel spur protruding from the bottom front edge of the heel bone. This heel spur is a growth of extra bone produced over time because of a combination of the increased strain on the fascia and foot dysfunction. Other diagnostic tests, such as a bone scan, magnetic resonance imaging (MRI), and ultrasound, are rarely needed.

Treatment

To alleviate the stress and pain on the fascia, the person can take shorter steps and avoid walking barefoot. Activities that involve leg impact, such as jogging, should be avoided. The person may need to lose weight. Stretching the calf muscles often accelerates healing. Orthotics placed into well-fitting supportive shoes can help to cushion, elevate, and support the heel.

Other measures that may be needed include use of adhesive strapping or arch-supporting wraps, ice massage, use of nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections into the heel, physical therapy, use of orthotics, and splinting at night to stretch the calf muscles and fascia during sleep. If these measures do not help sufficiently, surgery is occasionally required to attempt to partially release pressure on the fascia and remove any heel spurs.