Plantar Fasciitis: Overview

Plantar Fasciitis: Overview

Plantar fasciitis, the most common cause of heel pain in the united States, is a condition affecting the broad band of connective tissue called the plantar fascia located on the bottom of the foot just beneath the skin. The plantar fascia plays a large role as a shock absorber during weight-bearing activities, in addition to its contribution to stability and control of the foot. However, repetitive stress to this tissue can lead to micro-tears resulting in inflammation and pain.

Plantar fasciitis can affect people of any age, but most commonly affects middle-aged women and is considered an overuse injury seen in runners. Overall, 2,000,000 individuals in the United States are affected every year, with 10% of the population experiencing it in their lifetime.

There are many different factors that are thought to contribute to the onset of plantar fasciitis. Some of these include tight hamstring and calf muscles, an excessive force placed on the tissue, such as with repetitive high-impact activities, or prolonged standing. As we age, the reduced ability of the tissue to absorb shock and the decrease in fatty tissue around the heel bone is also thought to play a role. Other associated risk factors include obesity and those with high arches or flat feet.

If we take a closer look at the bottom of the foot, we can see the plantar fascia is a broad band of tissue just beneath the skin. The plantar fascia attaches at the bottom of the heel bone called the calcaneus more towards the inside of the foot. The tissue travels towards the toes and branches off to find separate attachment points towards the base of the toes, also referred to as the phalanges of the foot.

Patients with plantar fasciitis will report pain specifically under the heel bone that is described as worse with weight bearing first thing in the morning and again towards the end of the day. The healthcare provider will ask questions regarding whether the pain has started recently or if it is more long-term. They will also ask about activities that may aggravate the pain and what type of footwear they use.

A full physical examination of the foot and ankle will be performed. Specifically, they will look for tenderness to palpation under the heel bone closer to the inside of the foot. Pain as the provider extends your foot, bringing the toes closer to you, is also a common exam finding. They will also evaluate for tightness of the Achilles tendon and calf muscles.

Often, the diagnosis of plantar fasciitis can be made with the description of symptoms provided by the patient and the physical exam findings. However, your provider may order imaging tests like an x-ray, ultrasound, or MRI to rule out other causes of heel pain like tendinitis, arthritis, or a stress fracture. Once the diagnosis is made, the provider will discuss all available treatment options with the patient.