Plantar fasciitis affects as many as two million Americans and is one of the most common causes of heel pain. It affects both active and sedentary people, and has been linked to a variety of conditions, though none are the definitive cause of the condition. Conditions thought to contribute to plantar fasciitis include:
Evaluated on the RESCU Rating Scale
R = Risk E = Effectiveness S = Self-Care
C = Cost U = Usefulness (overall rating)
1 = Least Favorable 5 = Most Favorable
| R | E | S | C | U(overall rating) | |
| Ice/Heat | 5 | 5 | 5 | 5 | 4 |
| Shock Wave Therapy | 4 | 3 | 0 | 2 | 3 |
| Laser | 5 | 2 | 0 | 4 | 3 |
| Cortisone | 2 | 2 | 0 | 3 | 2 |
| Orthotics | 5 | 3 | 5 | 4 | 4 |
| Surgery | 3 | 3 | 0 | 2 | 3 |
| Exercise | 5 | 4 | 5 | 5 | 4 |
Perhaps surprisingly, no one is exactly sure. The plantar fascia is the strong connective tissue just under the skin of the sole of the foot. It travels from the heel bone (calcaneus) to the base of the toes and is a mixture of connective tissue and fat. PF was originally thought to be an inflammatory process (the “it is” in fasciitis) but recent studies indicate it is more likely to be a degenerative process, including tiny tears in the fascia or connective tissue, which over time weaken the connective tissue and produce pain.
Heel spurs are commonly associated with PF, but the causative relationship is unclear. Many people with PF have no heel spur, and patients with heel spurs do not necessarily have PF.
The most common symptom is pain in the bottom of the foot, usually near the heel, which is worst when getting out of bed or when standing after being off the feet for a while. Standing stretches the plantar fascia, causing pain which usually improves after walking for a few minutes. There is usually a tender spot on the bottom of the foot just in front of the bottom of the heel. Symptoms are often worse with prolonged standing or weight-bearing, and at the end of the day. PF usually affects only one foot, but is can affect both feet, and usually affects the back of the foot but can spread to involve the whole foot. It rarely is associated with tingling or numbness. Pulling the toes back or standing on tip-toes can aggravate the pain.
Typically the diagnosis is made based on the history and physical examination. X-rays may be taken to see if there is a heel spur or to rule out other causes. Diagnostic ultrasound may be performed to look for heel pad thickening, characteristic of PF. MRI studies are typically not done unless other causes are suspected after a trial of conservative care. In any event, most cases resolve or improve within a year.
Sources:
Tahririan MA, Motififard M, Tahmasebi MN, Siavashi B. Plantar fasciitis. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences. 2012;17(8):799-804.
Schwartz EN, Su J. Plantar Fasciitis: A Concise Review. The Permanente Journal. 2014;18(1):e105-e107. doi:10.7812/TPP/13-113.
There are a variety of things you can do for yourself at home if you suspect you have or have been diagnosed with plantar fasciitis. These include: