Pain at the Soles of the Feet: Do Not Ignore It

Plantar fasciitis is a condition involving pain on the soles of the feet caused by a ligament called the plantar fascia. It is most often seen in people who do much standing, walking, or running. Even though it can be effectively treated, complications can occur if you ignore the symptoms.

Key takeaways:
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    Plantar fasciitis causes pain in the soles of the feet.
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    Most commonly, the pain presents during the first few walking steps of the morning.
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    Risk factors for plantar fasciitis include age, excessive weight, heel spur, or a profession that involves much standing or walking.
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    Most cases can be treated non-surgically; however, plantar fasciitis is not to be ignored since it can result in tears, a heel spur, or fibrous nodules.

What are the foot structures involved in plantar fasciitis?


As seen in the diagram above, the plantar fascia is on the sole; it is a thick band of connective tissue running from the calcaneus (heel bone) to the toes. Since it connects bones to bones, it is considered a ligament.

The word plantar comes from the Latin word "plantaris," meaning the sole of the foot. The word fasciitis is from two different word origins. “Fascia” comes from the 16th-century Latin word meaning a band or ribbon, while “itis” is from Greek, meaning inflammation. Thus, plantar fasciitis is inflammation of the plantar fascial band (sole of the foot).

How common is plantar fasciitis?

In the United States, it is estimated that 2 million people suffer from plantar fasciitis. In addition, 1 million visits per year to primary care physicians and foot specialists are for plantar fasciitis.

What are the symptoms of plantar fasciitis?

Plantar fasciitis causes a sharp, stabbing pain at the undersurface of the heel, midfoot, or toes.

A person with plantar fasciitis can wake up with soreness or have sharp pain with the first few steps of the morning walk. Since the plantar fascia supports the arch, allowing proper foot function for walking and running, it can cause difficulty with these activities.

The pain can also present when first walking after a period of resting. The plantar fasciitis pain is usually less during a time of foot activity; however, the pain can return after the activity has ended.

What are the causes of plantar fasciitis?

Even though the exact cause of plantar fasciitis is unknown, there are risk factors for the condition.

Age, since plantar fasciitis is most associated with persons aged 40-60.

Increased muscle foot tension from increased activity, such as standing, walking, or exercising.

Presence of a heel spur: a protuberance (lump) of the calcaneal bone.

Flat feet (pes planus) or having a high arch (pes cavus).

Being overweight, obesity is present in 70% of people with plantar fasciitis.

Tightness of the calf and Achilles tendon.

Excessive stretching of the foot.

Certain professions or lines of work where people spend much time walking or standing on their feet, including teachers, factory workers, and postal delivery workers.

How is plantar fasciitis diagnosed?

History usually reveals sharp pain, especially after the first few steps of the day. A physician should ask about occupation, including the amount of time standing and walking.

Physical exam demonstrates tightness and tenderness of the plantar fascia. In addition, if a heel spur is present, there will be calcaneal tenderness.

Plain X-rays can evaluate for underlying bony abnormalities, including fractures, osteoporosis (bone thinning), and spurs (a growth occurring at the bone's periphery).

If a more detailed imaging study is needed, your physician can order an ultrasound, computed tomography (CT or CAT) scan, or a magnetic resonance imaging (MRI) test, all of which can show swelling and thickness of the plantar fascia.

Even if there is no significant trauma, a type of fracture called a stress fracture can occur (see diagram below). Stress fractures are small breaks (fractures) in the bones caused by cumulative or repeated stress. In cases of suspected plantar fasciitis, stress fractures need to be ruled out.


What are the conservative treatments that can help plantar fasciitis pain and inflammation?

Medications such as non-steroidal anti-inflammatories, like aspirin (Bayer, Ecotrin, Anacin), ibuprofen (Advil, Motrin), naproxen (Aleve), Celebrex, Voltaren, Meloxicam, and others.

Heat before activity and ice after activity.

Orthotics (shoe inserts) and special orthopedic shoes.

Stretching of the calf, foot, and Achilles tendon.

A special type of night splint keeps the plantar fascia stretched out (lengthened) during sleep.

Maintaining a healthy weight.

What procedures can be done if the above treatments do not work?

Injections directly into the plantar fascia of corticosteroids (mixed with a local anesthetic like lidocaine) or platelet-rich plasma (PRP), a substance derived from the person's blood, with the red blood cells centrifuged out.

Extracorporeal shock wave therapy involves using high-energy acoustic (sound) waves to break down the scarring and stimulate healing. Even though there have been promising results with this kind of treatment, it does not always work.

Percutaneous ultrasonic fasciotomy uses an ultrasound-guided probe to break up and remove the damaged plantar fascial tissue.

Plantar fascial release surgery can be done, but only as a last resort when all other treatments have failed. The surgeon partially cuts the plantar fascial ligament to reduce tension and allow healing.

What happens if you ignore plantar fasciitis?

It is estimated that 90% of cases can be successfully treated with conservative methods; however, if left untreated, there can be complications:

The plantar fascia can undergo microtears, causing partial or complete rupture; this can cause an inability to walk, and the person may require a boot and crutches. When the plantar fascia ruptures, there is usually a loud, popping noise.

A heel spur (discussed above) may result.

Plantar fascial fibromatosis may occur when thick nodules form along the plantar fascia, making it painful to walk.

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