Without any prior injury you wake up in the morning and experience pain on the bottom inside of your heel/arch. This pain initially limits your ability to get your heel to the ground, causing you to hobble until it eventually eases after several steps. The pain then recurs with extended weight bearing, worsening toward the end of the day after prolonged standing. In the evening, after sitting at dinner, when you get up from that seated position you're limping again due to the pain. Does this sound like you? You probably have plantar fasciitis.
Plantar fasciitis is the most common cause of heel pain, accounting for up to 20% of common foot conditions. Plantar fasciitis is a strain injury caused by inflammation of the fascial band, the band that extends from that heel to the bottom of the forefoot. Commonly, long-term inflammation where the fascial band attaches to the heel leads to the development of a boney spur. Causes of this fascial injury includes aberrant foot biomechanics, foot overpronation, tightness of the Achilles tendon or calf muscles, a rigid high-arched foot, decreased ankle or big toe joint motion, leg length discrepancy, rotational abnormalities of leg, or improper footwear. Other conditions may mimic plantar fasciitis related heel pain, including lumbar spine disorders, neuropathies, tarsal tunnel syndrome, fat pat atrophy, heel contusion, plantar fascia rupture, and bursitis.
So what do you do when this pain occurs? First, you should consider consulting a podiatric foot and ankle specialist to ensure that nothing more serious is occurring. Self-treatment includes OTC NSAID's, stretching exercises, and supportive shoe gear with a stiff heel/rearfoot counter. Special Plantar Fasciitis Sleeves may also offer initial self treatment. Other conservative treatment modalities include physical therapy, supportive tapping, custom orthotics, corticosteroids both oral and/or injectable, and extracorporeal shockwave. In a small percentage of patients, surgical intervention may be required for treatment.
Lastly, let's discuss prevention: for those athletic individuals a supportive shoe with a stiff heel/rearfoot counter is the preferred recommendation. Custom foot orthotics should be utilized for individuals that have had an occurrence of plantar fasciitis. Orthotics reduces re-occurrence caused by biomechanically derived fascial strain.
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About Dr. Jay LeBow
For 29 years, Dr. Jay LeBow ran a medical and surgical foot and ankle care clinical practice. He was recruited to be Team Podiatrist for the Baltimore Orioles, a position he has held for the past 20 years. Dr. LeBow is also the Footwear Medical Consultant for Under Armour. He was appointed by Governor Martin O’Malley to serve on the Maryland Board of Podiatric Medical Examiners and then voted to serve as President. In addition, Dr. LeBow works as a consultant to the FDA General and Plastic Surgery Devices Panel.
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