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Dr. Gary Pichney, podiatric surgeon at the Institute for Foot and Ankle Reconstruction at Mercy Medical Center.
Dr. Gary Pichney, podiatric surgeon at the Institute for Foot and Ankle Reconstruction at Mercy Medical Center. (Photo courtesy of Mercy Medical / HANDOUT)

Many runners are familiar with the pain that comes from plantar fasciitis, inflammation in the connective tissue on the bottom of the foot. It can cut a workout short and sideline athletes for weeks. But normally, all that's needed is conservative treatment until the symptoms subside, says Dr. Gary Pichney, podiatric surgeon at the Institute for Foot and Ankle Reconstruction at Mercy Medical Center. When the pain doesn't go away, there are other options, he said.

What is plantar fasciitis, and what causes it?

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Plantar fasciitis is a common cause of pain on the bottom of the foot and along the arch. It is an inflammation of the thick band of connective tissue that runs from the heel to the toes along the bottom of the foot.

Plantar fasciitis is mostly due to the repetitive stresses placed on the heel, which typically lead to micro-tears in the fascia [or connective tissue] where it connects onto the heel bone. A lack of flexibility in the calf muscle, along with shortening and contracture of the fascia that occurs during rest, will place an increased strain on the plantar facial attachment to the heel. This is seen as we take the first few steps after resting, noticed mostly first thing in the morning. These combined stresses result in inflammation and pain.

What can you do at home to reduce pain and promote healing?

Home treatments can include calf-stretching exercises to increase flexibility, use of shock-absorbing replacement insoles to reduce weight-bearing forces on the heel, ice therapy, and over-the-counter nonsteroidal anti-inflammatories to reduce inflammation and pain.

How long should you avoid activities such as running, a common cause of the condition?

The heel bears the brunt of the weight-bearing forces during walking and running. Normally, the heel is protected by a pad of fat beneath it, but that can thin over time and with age. Each step can produce forces three to four times body weight, so while symptomatic it is best to cross-train. Choose nonheel impact options such as cycling and swimming as part of your conditioning program until symptoms subside. Use pain as a guide. If symptomatic, you need to refrain from running often for a minimum of two to four weeks during treatment.

What steps should you take to avoid a repeat episode?

The key to long-term successful management of plantar fasciitis is to maintain adequate flexibility, control abnormal foot motion, replace insoles frequently when no longer resilient, make smart shoe choices and reduce activities that seem to produce symptoms. Custom orthotics to control abnormal foot motion can sometimes provide lifelong management of this condition in the appropriate patient with heel pain.

When do you need to see a doctor?

It is time to contact a foot specialist when the pain persists beyond home treatments.

X-rays are taken to rule out stress fractures of the heel, arthritic conditions and the rare bone tumor. Diagnostic tests may be used to rule out tarsal tunnel nerve entrapments or symptoms associated with lumbar disk disease.

Treatment options such as steroid injections may be offered to deliver anti-inflammation medication directly to the site. Appliances such as a custom orthosis and night splints may provide significant benefit. Shock wave therapy has shown some positive results in the select patient.

As a very last resort, surgical partial plantar fasciotomy has been successful in cases where conservative management over time has failed to improve symptoms.

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