Plantar Fasciitis (Heel Pain) Treatments

Plantar Fasciitis is one of the most common causes of heel pain.

Cause:

Plantar fasciitis can occur due to tightening and inflammation in the thick connective tissue that extends from the heel all the way to the toes. The plantar fascia is a weight bearing tissue that supports the arch of the foot. Some common causes of heel pain include but not limited to:
  • Weight gain
  • Excessive physical activity
  • Abnormal (gait) walking pattern
  • Improper or ill-fitting shoes
  • High impact activities (i.e. repetitive jumping, certain sports like tennis, basketball and certain exercise programs)
  • Tight calf muscles and achilles tendon

Presentation:

Heel can be painful, red, and/or swollen. First steps out of bed or after a period of prolonged rest are very painful. Sometimes, it is described as a sharp, knife like pain in the heels with that first step in the morning. The pain improves but does not go away after those first few steps. At the end of the day of prolonged standing or walking, the pain can get worse. This can occur in one foot or both feet.  

Diagnosis:

X Rays are taken to evaluate the heel bone for a spur and to rule out other pathologies such as fractures. Ultrasound can be used as needed to assess the thickness of the plantar fascia and assess for any plantar fascia tears. Clinical examination will be done to assess the heel, foot, and also the achilles tendon which plays a significant role in the inflammation of the plantar fascia.  

Treatment:

  • Strapping
  • Stretching
  • Corticosteroid injection(s)
  • Oral anti-inflammatory medication
  • Shoe gear change/modifications
  • Gait exam to evaluate/address the underlying biomechanical problems
  • Custom Orthotics
  • Night Splints
  • Immobilization with a cast or a walking cast boot
  • Extracorporeal Shock Wave Therapy (ESWT)
  • Physical Therapy
  Plantar Fasciitis can become a chronic condition if not treated. It is important to seek care when the problem first appears and to address the underlying cause rather than waiting for it to become worse.