Plantar Fasciitis

During the course of a normal day, the feet are asked to bear much of the burden of our regular locomotion. We often take our feet for granted until they start hurting.

Ideally, the foot is designed to distribute the weight of each step throughout the foot and not just on one particular area.

There are many causes of foot pain including alterations in the bones, tendons, ligaments, circulation, and nerves in the foot. Anatomical differences can predispose a foot to excessive strain on its parts as it “gives” under the weight of the body. For example, some people have flat feet wherein the arch is too relaxed when weight is put on it. This can lead to strain in the bones and ligaments of the foot. It can also translate to pains in the legs, hips, and back.

Many individuals suffer from plantar fasciitis. This malady can be viewed as a tendonitis of the bottom of your foot. There is a band of tissue, called fascia, which stretches from the heel bone, forward across the bottom of the foot, to the toe bones (metatarsals). This fascia is normally flexible and helps support the foot. Also, over the bottom of the heel there is a fat pad. This acts as a shock absorber for the heel and protects the fascia.

With aging and general wear and tear on the feet, the fascia can get less flexible and the fat pad can become thinned. The constant pulling of the fascia on the heel bone over time can produce a bone spur. This is often visible on an X-ray of the foot. However, the spur is not the problem; it is a result of the constant pulling by the fascia.

The main symptom of plantar fasciitis is pain in the bottom of your heel. The pain comes from microscopic tearing and inflammation within the fascia. Individuals with this condition experience a sharp, stabbing pain in the heel when they step down on the foot in the morning. As they begin to walk around, the fascia will stretch and relax and the pain may subside. Any period of inactivity during the day, such as sitting for a while, will relax the fascia. When they stand to walk again the pain can return.

Those who are predisposed to the condition include individuals whose job involves a lot of walking, standing (particularly on concrete floors), or climbing ladders or stairs. People with “flat feet,” those who wear shoes which lack good arch support, and those who are overweight can also be at risk.

There are several conservative treatments for plantar fasciitis. A mainstay is stretching. Before getting out of bed, stretch the fascia by pointing your toes up toward your body (opposite to stepping on the gas pedal). Stretch it several times a day, particularly after sitting for a while.

Wear shoes with good arch supports. Walking barefoot, on sandals, or in flip-flops can aggravate the condition. Try a heel cup in the back of the shoe to support the heel and stretch the fascia. A gel shoe insert may also help. If you walk or run regularly, consider cutting back a little until the foot heals. If you’re overweight, weight loss can do wonders for the heel pain. Other treatments for stubborn plantar fasciitis include individually-fitted orthotics, splinting the foot at night, cortisone injections, and physical therapy.

The content in this column is for informational purposes only. Consult your physician for appropriate individual treatment. Dr. Reynolds practices Family Medicine in Chesterfield.