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OVERVIEW

What is the plantar fascia?

The plantar fascia is a band of tissue, much like a tendon, that starts at your heel and goes along the bottom of your foot. It attaches to each one of the bones that form the ball of your foot. The plantar fascia works like a rubber band between the heel and the ball of your foot to form the arch of your foot. If the band is short, you’ll have a high arch, and if it’s long, you’ll have a low arch, what some people call flatfeet. A pad of fat in your heel covers the plantar fascia to help absorb the shock of walking. Damage to the plantar fascia can be a cause of heel pain.

CAUSES & RISK FACTORS

What causes the heel pain?

As a person gets older, the plantar fascia becomes less like a rubber band and more like a rope that doesn’t stretch very well. The fat pad on the heel becomes thinner and can’t absorb as much of the shock caused by walking. The extra shock damages the plantar fascia and may cause it to swell, tear or bruise. You may notice a bruise or swelling on your heel.

Other risk factors for plantar fasciitis include:

• Overweight and obesity
• Diabetes
• Spending most of the day on your feet
• Becoming very active in a short period of time
• Being flat-footed or having a high arch

DIAGNOSIS & TESTS

How will my health care provider know if the pain I have is caused by plantar fasciitis?

Your health care provider will ask you about the kind of pain you’re having, when it occurs and how long you’ve had it. If you have pain in your heel when you stand up for the first time in the morning, you may have plantar fasciitis. Most people with plantar fasciitis say the pain is like a knife or a pin sticking into the bottom of the foot. After you’ve been standing for a while, the pain becomes more like a dull ache. If you sit down for any length of time, the sharp pain will come back when you stand up again.

TREATMENT

What can I do about the heel pain?

If you walk or run a lot, cut back a little. You probably won’t need to stop walking or running altogether.

If you have either flatfeet or a high arch, ask your health care provider about using inserts for your shoes called orthotics. Orthotics are arch supports. You will need to be fitted for them.

If you are overweight, losing weight can help lessen your heel pain. If your job involves standing on a hard floor or standing in one spot for long periods, place some type of padding on the floor where you stand.

Are there any exercises that will help?

Stretching exercises for your foot are important. Do the stretches shown here at least twice a day. Don’t bounce when you stretch.

Plantar fascia stretch

To do the plantar fascia stretch, stand on the ball of your foot at the edge of a step (be sure to hold on the railing).  Slowly let your heels down below the edge of the step as you relax your calf muscles.  You should feel a gentle stretch across the bottom of your feet and up the back of your legs to your knees.  Hold the stretch for 15 to 30 seconds. Then tighten your calf muscles a little to bring your heels back up to the level of the step.  Repeat 2 to 4 times.

Calf stretch

Stand with your hands against a wall and your injured leg behind your other leg. With your injured leg straight, your heel flat on the floor and your foot pointed straight ahead, lean slowly forward, bending the other leg. You should feel the stretch in the middle of your calf. Hold the stretch for 15 to 30 seconds. Repeat the stretch 2 to 4 times.

Other exercises

You can also strengthen your foot by grabbing a towel with your toes as if you are going to pick up the towel with your foot. You can also do marble pick-ups by putting marbles on the floor next to a cup.  Using your toes, try to lift the marbles up from the floor and put them in the cup.  Repeat this exercise several times a day.

Will any medicine help?

Aspirin, acetaminophen (one brand name: Tylenol), naproxen (brand name: Aleve), or ibuprofen (some brand names: Advil, Motrin) can help ease your heel pain. Talk to your health care provider before you take any medicine.

What if my foot still hurts after doing the exercises, using the arch supports and taking other measures?

If stretching, arch supports, medicine and exercises don’t help, your health care provider can suggest other treatments. You may need to wear splints on your foot at night, tape your foot or have injections of corticosteroids (anti-inflammatory medicines) into the plantar fascia. In a few cases, surgery is needed. You and your health care provider can decide which treatment is best for you.

QUESTIONS TO ASK YOUR HEALTH CARE PROVIDER

• What could have caused my heel pain?
• What is the best treatment option for me?
• Do I need to do exercises to strengthen my plantar fascia?
• How long before I can expect relief from my symptoms?
• Is it possible that my symptoms could return, even after treatment?
• Is it safe for me to exercise? What kind of exercise should I do?