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How Do I Know If I Have It?

Most cases of plantar fasciitis are diagnosed by a healthcare provider who listens carefully to your description of symptoms. During an examination of your feet, your healthcare provider will have to press over the area most likely to be painful in plantar fasciitis.

Because the pain of plantar fasciitis has unique characteristics (pain upon rising; improvement after walking for several minutes; pain produced by pressure applied in a very specific location and not produced with pressure in other areas), your healthcare provider will probably feel comfortable making the diagnosis based on symptom description and physical examination. Rarely, your healthcare provider may suggest that you have an X-ray examination of your foot to verify that there is no stress fracture causing your pain .

What Are the Treatments?

Most healthcare providers agree that initial treatment for plantar fasciitis should be quite conservative. You'll probably be advised to back off on any exercise that is making your pain worse.

A heel pad is sometimes used to cushion the painful heel. Custom-made orthotic devices may be constructed to address specific issues you may have with foot placement or gait.

Stretching exercises performed 3-5 times a day can help elongate the heel cord. You may be advised to apply ice packs to your heel or to use an ice block to massage the plantar fascia before going to bed each night. Ultrasound therapy can be performed; this can increase circulation and aid healing.

Simple over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen) are often helpful in decreasing inflammation and pain. If you have stomach trouble from such over-the-counter NSAIDs, your healthcare provider may prescribe an alternative. A night splint is sometimes used to hold your foot at a specific angle, which prevents the plantar fascia from shortening during sleep.

Most practitioners agree that treatment for plantar fasciitis is a slow process. Improvement usually takes 6-12 weeks, and the condition may still linger at a lower level for up to six months or longer. If, however, the more conservative measures do not provide relief in a reasonable length of time, your doctor may suggest other treatment.

Anti-inflammatory steroid injections directly into the tissue around your heel may be temporarily helpful. However, if these injections are used too many times, you may suffer other complications, such as shrinking of the fat pad of your heel (which is needed for insulation; loss of the fat pad would actually increase your pain) or even rupture of the plantar fascia (in rare instances).

In cases of long-term plantar fasciitis unresponsive to typical treatments, your healthcare provider may recommend that you wear a short walking cast for about three weeks. This ensures that your foot is held in a position that allows the plantar fascia to heal in a stretched, rather than shortened, position.

Finally, if you have heel pain that doesn't improve over a long period of time, or if your heel pain is truly debilitating and interfering with normal activity, your healthcare provider may discuss surgical options with you. The most common surgery is called a plantar fascia release and involves disconnecting the plantar fascia from the heel bone. Plantar fascia release can be performed as a traditional open surgery or as an endoscopic surgery (in which a tiny incision allows a miniature scope to be inserted, through which the surgery is performed). Plantar fascia release surgery is rarely recommended, as there is still some chance that you will continue to have pain after surgery. Furthermore, you may have other complications from surgery, such as a fallen arch in the foot.

How Can I Prevent It?

While there are no sure ways known to prevent the development of plantar fasciitis, reasonable weight control, wearing comfortable, supportive shoes, and using care when starting or intensifying exercise programs may be helpful.