Condition: Plantar fasciitis is the inflammation or degeneration of the plantar fascia, the thick, connective tissue that runs from the heel to the ball of the foot.
Background: The condition affects two million people every year and is the third most common injury of runners.
Risk Factors: Obesity and repetitive, weight-bearing activities, such as endurance running or occupations that require prolonged standing, can lead to tearing, swelling and pain of the plantar fascia. Tight heel cords or abnormalities of the foot, leg and ankle also increase risk.
History and Symptoms: Pain typically follows an increase in the amount or intensity of activity, or a change in walking surface or footwear. It occurs in the heel, mid-arch or ball of the foot, and is worse in the morning.
Physical Exam: Patients are evaluated for pain and tenderness along the plantar fascia. Ankle mobility may be limited due to a tight Achilles tendon, and it may be painful to stretch the foot. Limping to avoid pressure on the affected heel may cause hip or lower back pain.
Diagnostic Process:To diagnose plantar fasciitis, a physical medicine and rehabilitation (PM&R) physician will evaluate running form; flexibility and range of motion of a patient’s lower limb joints; and tightness or weakness of calf, knee, hip or core muscles. Physical medicine and rehabilitation (PM&R) physician will educate the patient about the various stages that the condition may present as well as provide a detailed and comprehensive tailored program for the person based on the individual needs of the person and their expectations. X-rays, bone scans, MRIs and ultrasound tests may indicate stress fractures, scar tissue, heel spurs and inflammation.
Rehab Management: Physical medicine and rehabilitation physicians will recommend a variety of treatments that include weight reduction, proper footwear, shoe inserts, orthotic and arch supports, taping, and night splints. Stretching the foot and ankle, massaging the area, and applying ice for 15-20 minute intervals also may relieve pain and promote healing. In some cases, ultrasound, corticosteroid injections and pain medication are recommended.
Other Resources for Patients and Families: Several sources are available about the importance of stretching, appropriate training levels and proper footwear. Education is important regarding pain management and activity levels as well as prognosis about outcomes of this condition tailored to each patient’s individual needs. The condition will involve a comprehensive evaluation provided by a trained PM&R physician with expertise in this condition.