Have you ever stepped out of bed and started to walk, only to feel pain and stiffness in your heel or ankle? If so, you may have a condition called plantar fasciitis, which is an inflammation of the band of tissue that connects your ankle to the arch of your foot. It is a painful condition, but one that can be corrected with a variety of treatments, from a simple change in footwear to surgery for extreme cases.
Let’s take a look at what plantar fasciitis is, what causes it, how to prevent it, and how to treat it.
To understand plantar fasciitis, you need to know a little about foot and ankle anatomy. The heel bone, called the calcaneus, is connected to the bones in the upper part of the foot by a thick band of tissue. This tissue is called the plantar fascia. It provides support for the foot and arch.
Plantar fasciitis is when the plantar fascia becomes inflamed. This can happen for a variety of reasons, including:
Performing new or increased activity without proper foot support from footwear can also contribute to plantar fasciitis.
Over time, the plantar fascia becomes stiff. If left untreated, that stiffness can become inflammation, which can be painful with every step. It can even lead to tearing in the tissue. Symptoms include pain on the bottom of the heel, particularly in the morning or after a long period of inactivity, stiffness, and greater pain during exercise or heavy activity.
Mild cases of plantar fasciitis usually can be treated without surgery. Often, minor changes and treatments can treat and prevent plantar fasciitis. Most patients improve in less than a year without surgery.
Patients may be asked to simply rest the foot and heel to reduce pain by stopping the activity causing the inflammation, such as running or stepping exercises. Patients will also be instructed to ice the foot and heal for about 20 minutes at a time, 3-4 times a day. Ideally, this can be done by rolling the foot over a frozen bottle of water. The motion helps massage the plantar fascia while spreading the cold over the length of the tissue.
Doctors may also recommend a regimen of nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or naproxen. Doctors may also recommend special exercises or physical therapy such as calf or feet stretching exercises, which loosens the muscles tightening the plantar fascia. They can also recommend special orthotics to help with the pain, from over-the-counter heel pads to custom-fit orthotics to support the foot properly and reduce or eliminate pain.
If these solutions don’t work, your doctor may recommend more intense treatments, including cortisone injections for the pain, night splints to hold the foot in a certain position at night, physical therapy to loosen the muscles tightening the plantar fascia, or even extracorporeal shockwave therapy (ESWT), which uses shockwave impulses to stimulate healing of the tissue.
If none of these methods work, surgery may be necessary to relieve pain.
If there is little to no improvement after a year of treatment, surgery may be necessary to alleviate the pain. There are two options for plantar fasciitis: gastrocnemius recession and plantar fascia release.
With gastrocnemius recession, one of the muscles of the calf is lengthened to increase the ankle’s motion. The procedure can be performed as a traditional open surgery or with a small incision and an endoscope. The procedure gives the patient more motion when flexing their feet, which reduces stress on the plantar fascia.
Plantar fasciitis release is for those who still have a normal range of motion in the ankle, but the heel pain has not subsided. In this surgery, the plantar fascia is cut partially to relieve the tension. If there is a large bone spur on the heel (a portion of bone jutting out from the surface), that may be removed. While this surgery can be done endoscopically, it’s easier to do with an open incision, particularly if the surgeon must remove a bone spur.
Recovery time can take anywhere from 6-12 weeks.