PlanterFasciaPlantar fasciitis (pronounced PLAN-tar fashee-EYE-tiss) is an inflammation of the plantar fascia. "Plantar" refers to the bottom of the foot. "Fascia" is tissue that surrounds muscle and separates the skin from muscle or other deep tissue. The plantar fascia is thickest beneath the skin on the bottom of the foot. It functions as a bowstring to maintain the arch of the foot by connecting the heel bone to the ball and toes.

The fascia endures a great amount of tension (approximately 2 1/2 times bodyweight) while walking. There two times during gait the fascia is under maximum stress: when all body weight is on one foot causing maximum flex in the arch and at the moment when the heel of the trailing leg lifts off the ground. The tension is greatly increased if there is lack of flexibility in the calf muscles. A percent increase in body weight causes the same percent increase in tension in the fascia.

The classic sign of plantar fasciitis (which is often confused with heel spurs) is heel pain with the 1st few steps in the morning. If this symptom is not present then the diagnosis of plantar fasciitis has to be checked more carefully. Many of the treatments listed can help even if the diagnosis is not certain. The pain is usually in the front and bottom of the heel, but it can also be over any portion of the bottom of the foot where the fascia is located. Patients sometimes report the pain moves to different areas of the foot. The pain can be mild or debilitating. It can last a few months or become very chronic. In some cases, the injury hurts when the heel strikes the ground, but it is not caused by the heel striking the ground. Every year, about 1% of the population goes to the doctor with this condition.

Plantar fasciitis is related to heel spurs, but they are not the same. The heel spurs are on the front and bottom of the heel and sometimes on the back of the heel. Heel spurs are bony growths that may result from too much tension in the plantar fascia or Achilles tendon . Heel spurs may or may not cause pain. A heel spur and/or the plantar fascia may "trap" or irritate nerves in the heel area (if only by inflammation) and cause more pain. It is often difficult and usually unnecessary to distinguish between plantar fasciitis and heel spur syndrome. Causes and treatments for the two conditions are often the same. Most people and physicians use the terms "heel spurs" and "plantar fasciitis" interchangeably.
This condition is causes by the mechanics of the foot and is aggravated by any combination of circumstances that can cause consistent increased stress on the planter fascia. Leg length discrepancy, lack of flexibility in the calf muscles, being overweight, a sudden injury, using bad shoes on hard ground, or spending too much time on the feet along with many other situations. Over time this consistent stress causes the fascia to tear which starts the first stage of the healing process (that's inflammation) and the healing process is chronically irritated by daily activity and is never allowed to go to completion. Those with flat feet or high arches are more likely to get plantar fascistic (heel spurs). It can run in the family. Arthritis, heel bone damage ("stress fracture"), loss of cushioning under the heel ("fat pad atrophy"), tarsal tunnel syndrome (the foot's version of carpal tunnel syndrome), and other conditions can cause similar foot and heel pain.

Unfortunately there is no "cure-all". Different combinations of treatments help different people. Patients must be active in their treatment. The three most successful treatments are:

Foot taping, Arch support or functional orthotics to reduced stress on planter fascia while weight bearing.

Decreasing or changing activities. Swimming and bicycling are the best alternative exercises (if the heels and not balls of the feet are used to push on the pedals).

Night splints causes gentle stretching of the planter fascia and calf muscles.

Losing weight remember the fascia endures a great amount of tension
(approximately 2 1/2 times body weight) during walking and an increase in
body weight causes the same percent increase in tension in the fascia.

Heel pads The purpose of heel pads is not usually to cushion the heel, but to add height to make up for lack of flexibility in the calf muscles.

Anti-inflammatory medication such as aspirin, Aleve, or Ibuprofen (but not Tylenol).

Treating any underlying arthritis if it is in both feet and/or there is pain in the lower back, it increases the probability of arthritis.
Better shoes with an arch support, more cushion, and a raised heel.
Just switching shoes can be a cure (or a cause).

Applying ice for 5 minutes immediately after activities and keeping the injury "cool" with ice intermittently applied for 1 or 2 hours after the injury.

Trying to "walk-through the pain" can cause a mild case to become long-term and debilitating. Pain is our body's way of telling us not to do something. Being gentle on the feet for several months until there is no pain and then very slowly increase activity is often a cure. Do not be fooled about being "cured". The pain often comes back in full force unless something is done to reduce the stress on the planter fascia.

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Angelo Podiatry Associates, P.A.

(325) 658-4020
3162 Appaloosa Cir San Angelo, TX 76901