Plantar Fasciitis (pronounced plan-tar fash-itis) is classic heel pain. Some people consider this pain "heel spurs." Plantar fasciitis is actually a repetitive strain injury of the plantar fascia. The plantar fascia is a thick, strong band-like ligament on the bottom of the foot that extends the length of the arch. It is the strongest supporting structure of the arch in most people. When there is prolonged repetitive pulling strain on the ligament beyond that which it is designed to withstand, the ligament starts to experience inflammation. This inflammation is called Plantar Fasciitis. Acute plantar fasciitis is fast onset-you wake up one day and the pain in the area of the heel is present. Chronic plantar fasciitis comes on gradually. You notice the pain every so often, but not consistently enough to seek treatment. As the process continues, the pain becomes more chronic-gradually affecting you every day and even during the day.
The pain is due to the injury to the ligament. As the ligament is placed under strain, small tears begin to occur at the area that the ligament inserts into the front of the heel bone. These tears are microscopic and are not large enough to cause debilitation. They are large enough in size and number to cause inflammation in the area. This inflammation, when present over a certain period becomes chronic. An inflammation cycle develops. Over time, a heel spur, a small growth of bone can develop in the area where the ligament inserts into the heel bone. It is now accepted that the pain in this condition is not caused by the heel spur, but the tension on and tearing of the ligament. The presence of the heel spur on x-ray evaluation is an indication that the strain on the plantar fascia has been present for a long time. The size of the heel spur has not been shown to have any direct correlation with the level of heel pain or degree of inflammation of the plantar fascia. As a matter of fact, most Podiatric Physicians will take x-rays of both feet and it is quite often that we see that there are heel spurs on both feet, while only one is symptomatic.
In plantar fasciitis, patients present complaining of pain in the heel that is most evident on getting up and taking the first few steps in the morning. The pain is fairly intense and can be sharp/shooting, deep aching, burning or the patient relates that it feels like they are stepping on a stone. Many come in thinking that they are suffering from a stone bruise. Sometimes, the symptoms can include a tearing sensation further up in the arch. They state that when they get up in the morning, they have to stand there and let the arch stretch out before they walk or they have to walk on the ball of the foot and toes. After a few minutes, the pain may decrease, but there is some sensation there most of the time. As the problem persists, the pain in the morning becomes present every day. It also starts to hurt after the patient has been sitting for a while and stands up during the day.
Causes of Plantar Fasciitis
- A dramatic increase in activity level. This is commonly seen in athletes when they increase their physical activity/routine either in preparation for an event or as a permanent change in routine. Too dramatic an increase can cause the onset of Plantar Fasciitis. This can also be seen in the non-athlete as a change in the amount of standing/walking at work, etc. It can also be seen at the dramatic start of a new exercise/walking for exercise routine. This is commonly seen in those people that make New Year's resolutions to start more physical activity. A change in jobs to one requiring more standing and walking may start the inflammation. Six weeks to three months after starting the new activity, most patients will start to notice the symptoms. Here in Phoenix, Arizona we see quite a bit of Plantar Fasciitis. There are many very active individuals in this area including a very large number of professional athletes who use our long season of great weather for better training. Unfortunately, the flip-side of that is that during the hottest months of the year in Phoenix, many will elect to stay indoors on those 110 degree days. In essence, these usually active individuals who may hike, bike, run and walk regularly will stop their training fairly abruptly. When the weather starts to cool off again, they may consider themselves to be picking up the activity where they left off and start back too quickly. This may lead to Plantar Fasciitis.
- A dramatic decrease in activity level-the exact opposite of the previous cause. In those people who had always been active, when there is a decrease in activity level, they may start to notice the symptoms of Plantar Fasciitis. This may include someone who changes jobs from one requiring a lot of standing and walking to one where they sit a lot. It can also be seen in someone who is usually active, but due to illness or other reasons had to dramatically curb their physical activity. A typical example is retired postal worker/letter carrier. The symptoms may occur six to eight months after the decrease in activity level.
- A change in weight-usually increase. This causes an increase in the strain on the plantar fascia and can trigger the start of inflammation. Weight loss may lessen the symptoms, but probably not resolve the problem.
- Very rarely the problem may be caused by trauma. These patients will relate a history of landing wrong on the foot when stepping from a height, jumping from a height, missing a rung on the ladder, hitting a shovel wrong while digging, etc. They will also present with different symptoms as their pain will usually persist at the same level during the entire day and will cause them to present sooner.