Plantar fasciitis is a painful condition of the foot that can lead to significant activity limitation in adults. Plantar fasciitis is caused by damage to the plantar fascia, which is primarily responsible for support of the arch of the foot and shock absorption. Repetitive stress on the foot causes microtears of the plantar fascia; the body is unable to keep up with repair of these tears, resulting in collagen degeneration and pain. Plantar fasciitis can occur at any age, although it is more common in women aged 40 to 60 years. Most people who develop plantar fasciitis are runners or participate in sports; however, it can also occur in the general population.
Symptoms of plantar fasciitis include pain that is severe with the first steps in the morning, pain with standing, and pain that becomes less bothersome with increasing time of physical activity. Individuals are at increased risk for developing plantar fasciitis if they have flat feet, high-arched feet, are older, have a family history of plantar fasciitis, run on hills or very soft surfaces, have poor arch support in their running shoes, and increase their activity level quickly.
Individuals with plantar fasciitis are often frustrated because time to resolution of symptoms can be anywhere from 6 to 18 months. The best treatment for plantar fasciitis is rest, but this might not be possible for athletes and active adults. Additionally, problems leading to the development of plantar fasciitis should be addressed, such as type of weight-bearing activity or intensity of activity. Stretching and strengthening programs can help individuals with plantar fasciitis by correcting biomechanical problems, including weakness of foot muscles and tightness of the calf muscles.
Proper footwear is equally important for managing plantar fasciitis. Shoes that are thick, well-cushioned, and made up of high-density ethylene vinyl acetate can decrease plantar fasciitis pain. For the problem of flat feet, shoes with motion control or good longitudinal arch support can be helpful.
For those with low arches, taping of the arch of the foot, arch supports, and orthotics are commonly used. Night splints, which keep the individual’s ankle in a neutral position while sleeping, can also be useful but can be uncomfortable and interfere with sleep. Other treatments for plantar fasciitis include ice, non-steroidal anti-inflammatory drugs, iontophoresis (electrical impulses used in conjunction with topical corticosteroids), and cortisone injections. In rare cases, surgery may be necessary.
With early identification and treatment, plantar fasciitis can be managed, and physical activity can resume. Most individuals see good results with rest, stretching and strengthening exercises, and finding proper footwear.
