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Plantar Fasciitis

Plantar fasciitis is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia). Plantar fasciitis commonly causes stabbing pain that usually occurs with your first steps in the morning. As you get up and move, the pain normally decreases, but it may return after long periods of standing or when you stand up after sitting. Plantar fasciitis is more common in runners. People who are overweight and those who wear shoes with inadequate support also have an increased risk of plantar fasciitis.

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Plantar fasciitis typically causes a stabbing pain in the bottom of your foot near the heel. The pain is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or when you get up after sitting. The pain is usually worse after exercise, not during it.

Your plantar fascia is in the shape of a bowstring, supporting the arch of your foot and absorbing shock when you walk. If tension and stress on this bowstring become too great, small tears can occur in the fascia. Repeated stretching and tearing can irritate or inflame the fascia, although the cause remains unclear in many cases of plantar fasciitis.

Even though plantar fasciitis can develop without an obvious cause, some factors can increase your risk of developing this condition. They include:

  • Those between the ages of 40 and 60 most commonly deal with plantar fasciitis.
  • Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing and aerobic dance — can contribute to the onset of plantar fasciitis.
  • Flat feet, a high arch or even an abnormal pattern of walking can affect the way weight is distributed when you’re standing and can put added stress on the plantar fascia.
  • Excess pounds put extra stress on your plantar fascia.
  • Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage the plantar fascia.

Most people who have plantar fasciitis recover in several months with conservative treatment, including resting, icing the painful area and stretching. Pain relievers may ease the pain and inflammation caused by plantar fasciitis. Stretching and strengthening exercises or using special devices may relieve symptoms. They include:

  • Physical therapy to show you a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles. A therapist might also teach you to apply athletic taping to support the bottom of your foot.
  • Wearing night splints that stretch your calf and the arch of your foot while you sleep. This holds the plantar fascia and Achilles tendon in a lengthened position overnight to promote stretching.
  • Your doctor might prescribe off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to your feet more evenly.

If more-conservative measures aren’t working after several months, your doctor might recommend:

  • Injecting steroid medication into the tender area to provide temporary pain relief. Multiple shots aren’t recommended because they can weaken your plantar fascia and possibly cause it to rupture. Using ultrasound imaging, platelet-rich plasma obtained from the patient’s own blood can be injected to promote tissue healing.
  • Few people need surgery to detach the plantar fascia from the heel bone. It is generally an option only when the pain is severe and other treatments have failed. It can be done as an open procedure or through a small incision with local anesthesia.

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