What are the symptoms of Plantar Fasciitis?
The pain associated with plantar fasciitis is typically gradual in onset and is usually located over the inner or medial aspect of the heel. Occasionally, the pain will be sudden in onset, occurring after missing a step or after jumping from a height. The pain is commonly most severe upon arising from bed in the morning, or after periods of inactivity during the day. Thus, it causes what is known as "first-step pain." The degree of discomfort can sometimes lessen with activity during the course of the day or after "warming-up", but can become worse if prolonged or vigorous activity is undertaken. The pain is also often noted to be more severe in bare feet or in shoes with minimal or no padding at the sole.
How is the diagnosis of Plantar Fasciitis made?
Plantar fasciitis is one of many conditions causing "heel pain". Some other possible causes include nerve compression either in the foot or in the back, stress fracture of the calcaneus, and loss of the fatty tissue pad under the heel. Plantar fasciitis can be distinguished from these and other conditions based on a history and examination done by a physician.
It should be noted that heel spurs are often inappropriately thought to be the sole cause of heel pain. In fact, heel spurs are common and are nothing more than the bone's response to traction or pulling-type forces from the plantar fascia and other muscles in the foot where they attach to the heel bone. They are commonly present in patients without pain, and frequently absent from those who have pain. It is the rare patient who has a truly enlarged and problematic spur requiring surgery.
What is the treatment for Plantar Fasciitis?
The treatment of plantar fasciitis is relatively simple, yet it may take 6 to 12 weeks or more for symptoms to resolve. In general, the longer symptoms have been present and the more severe the pain, the longer the condition may take to respond to treatment. Additionally, high demand athletes, such as cross-country or marathon runners may require a longer course of treatment to achieve resolution of symptoms. The key components to treatment are as follows (all may not be recommended by the physician in every patient):
Rest and activity modification: decreasing distances and duration of walking or, particularly, running; switching from jumping or running activity to activities such as swimming or cycling to reduce the stress on the foot; changing the exercise surface (e.g. from concrete to grass)
Massage: local, deep massage to the area of pain at the heel (where the fascia attaches); usually done in the morning after a warm bath or shower.