Plantar fasciitis (inflammation of the plantar fascia) is the most common cause of heel pain seen by an orthopedist. It is common in several sub-groups of people, including runners and other athletes, people who have jobs that require a fair amount of walking or standing (especially if it is done on a hard surface), and in some cases it is seen in people who have put on weight -- either by dietary indiscretion or pregnancy.
The plantar fascia is a broad ligament-like structure that extends from the heel bone to the base of the toes, acting like a thick rubberband on the bottom arch of the foot. With a few extra pounds on board, or with activities such as exercise, the plantar fascia can develop microtrauma at its insertion into the heel bone, or anywhere along its length. This causes pain which can be quite severe at times.
One disturbing fact about plantar fasciitis is that it sometimes takes many months to resolve. Indeed, it takes approximately 6 months for 75% of people to recover from this problem. 98% of people seem to be better at 12 months.
Treatment of plantar fasciitis consists of 3 stages:
Stage 1 involves prescribing the patient a heel cushion to decrease shock absorption of the plantar fascia, as well as a short course of medication to decrease inflammation in the heel.
Stage 2 may involve cortisone injections into the heel region, if Stage 1 has failed to bring significant relief. Other modalities in Stage 2 include: orthotics, taping, physical therapy, and night splinting.
Stage 3 is for those who have had plantar fasciitis for one year or longer, whose symptoms are severe and preventing them from their job or recreation. It involves a surgical release of part of the insertion of the plantar fascia. However, this surgery is rare, as most people do have significant relief from non-surgical treatment.
Text prepared by Jonathan S. Jaivin, MD
Southern California Orthopedic Institute