When your first few steps out of bed in the morning cause severe pain in the heel of your foot, you may have plantar fasciitis (fashee-EYE-tiss). It's an overuse injury affecting the sole or flexor surface (plantar) of the foot. A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes.

You're more likely to get the condition if you're a woman, if you're overweight, or if you have a job that requires a lot of walking or standing on hard surfaces. You're also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches are also more prone to plantar fasciitis.

The condition starts gradually with mild pain at the heel bone often referred to as a stone bruise. You're more likely to feel it after (not during) exercise. The pain classically occurs again after arising from a midday lunch break.

Early symptoms can be treated with a self directed program of exercises as outlined below.  If you don't treat plantar fasciitis, it may become a chronic condition. You may not be able to keep up your level of activity and you may also develop symptoms of foot, knee, hip and back problems because of the way plantar fasciitis changes the way you walk.

Exercises

A program of home exercises to stretch your Achilles tendon and plantar fascia has been shown in randomized trials to improve symptoms of plantar fasciitis.  These exercises are the mainstay of treating the condition and lessening the chance of recurrence. 

The following exercises should be performed at least three times a day.  The plantar fascia stretching exercise should also be performed prior to getting up from a seated position or before getting out of bed.  The stretches should be held for 10 seconds each and repeated 10 times each session.

In one exercise, you lean forward against a wall with one knee straight and heel on the ground. Your other knee is bent. Your heel cord and foot arch stretch as you lean. Hold for 10 seconds, relax and straighten up. Repeat 10 times for each sore heel.

In the second exercise, you lean forward onto a countertop, spreading your feet apart with one foot in front of the other. Flex your knees and squat down, keeping your heels on the ground as long as possible. Your heel cords and foot arches will stretch as the heels come up in the stretch. Hold for 10 seconds, relax and straighten up. Repeat 10 times.     To stretch the plantar fascia,  cross the affected leg over the opposite leg. While placing the fingers across the base of the toes, the pull the toes back toward the shin until you feel a stretch in the arch or plantar fascia. Confirm that the plantar fascia is being stretched was correct by feeling tension in the plantar fascia with the opposite hand.  Hold the stretch for 10 seconds and repeat 10 times (From: DiGiovanni BF, Nawoczenski DA, Lintal ME, Moore EA, Murray JC, Wilding GE, Baumhauer JF. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am. 2003;85:1270-7.).

Wearing a "posterior splint" while in bed has been shown in randomized trials to decrease intensity and duration of symptoms from plantar fasciitis.  The splint keeps the ankle in a neutral postition and prevents plantar fascial contracture that can occur while asleep.  Night splint pain can significantly help with "first step" pain in the morning.

About 90 percent of people with plantar fasciitis improve significantly after two months of initial treatment. Frequently, in addition to the exercises above, formal physical therapy may be helpful, especially to resotre flexibilty, strength, and balance.  Physical therapists can also apply modalities such as ultrasound and iontophoresis which can decrease inflammation.

With chronic cases, custom orthotics may be helpful, especially if there is malalignment in the foot such as a flatfoot.  In most cases, however, a simple over the counter insert will suffice and expensive custom orthotics are not necessary.

Injections

Corticosteroid injection may be helpful but should be used judiciously as its use can be assoicated with some complications.  Recent evidence has suggested that injection of platelets (the component of blood that promotes clotting) may decrease symptoms and promote healing.  We are currently developing a clinical trial to evaluate the safety and efficacy of platelet rich plasma (PRP) injection for the treatment of plantar fasciitis.  Please call the office if you have interest in participating.

Surgery

With failure of conservative treatment, surgery may be recommended to relieve symptoms.  Because plantar fasciitis almost always gets better with conservative measures, surgery should probably not be considered before 6 months of treatment.  "Non-invasive" treatment includes shock wave orthotripsy, "less-invasive" treatment includes endoscopic plantar fascia release, and "traditional" surgery involves an open incision.