Plantar Fasciitis

Do your first few steps out of bed in the morning cause severe pain in your heel? Or does your heel hurt after jogging or playing tennis?

Most commonly, heel pain is caused by inflammation of the plantar fascia — the tissue along the bottom of your foot that connects your heel bone to your toes. The condition is called plantar fasciitis (PLAN-tur fas-e-I-tis).

Plantar fasciitis causes stabbing or burning pain that's usually worse in the morning because the fascia tightens (contracts) overnight. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.

Plantar fasciitis usually develops gradually, but it can come on suddenly and be severe. And although it can affect both feet, it more often occurs in only one foot at a time. Watch for:

• Sharp pain in the inside part of the bottom of your heel, which may feel like a knife sticking in the bottom of your foot
• Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe
• Heel pain after long periods of standing or after getting up from a seated position
• Heel pain after, but not usually during, exercise
• Mild swelling in your heel

Conservative treatment

For most people, the condition improves within a year of beginning conservative treatment. Nonsurgical treatments that may promote healing include:

• Night splints. Your doctor may recommend wearing a splint fitted to your calf and foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight so that they can be stretched more effectively.
• Orthotics. Your doctor may prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.
• Physical therapy. A physical therapist can instruct you in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist may also teach you to apply athletic taping to support the bottom of your foot.
  

Medications and procedures

If conservative treatment doesn't provide relief, you might consider:

• Corticosteroids. When other treatments don't work, your doctor may suggest one or two injections of corticosteroid medication into the region of the plantar fascia attachment at the heel for temporary relief. Multiple injections aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone. Another method for delivering corticosteroid medication is a technique known as iontophoresis (i-on-to-fuh-RE-sis), which uses gentle electric current to draw the medicine into the area of discomfort.
• Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It's usually used for chronic plantar fasciitis that hasn't responded to more conservative treatments. Early studies on this procedure reported positive results, but some recent studies have had limited success in treating plantar fasciitis. More research may determine if extracorporeal shock wave therapy is an effective treatment for heel pain, and if so, what kind of machine and treatment regimen seems to work best.
  Complications of this procedure may include bruising of your skin, swelling, pain, numbness or tingling, and rupture of the plantar fascia. This therapy isn't used for children, pregnant women or people with a history of bleeding problems.
• Surgery. Only a small percentage of people need surgery to detach the plantar fascia from the heel bone (plantar fasciotomy). It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.