Plantar Fasciitis: causes, symptoms and treatments

Updated 3/17/2021

What's Plantar Fasciitis?

The plantar fascia is a thick ligament that connects your heel to the front part of your foot and supports your arch. When these ligaments become inflamed it causes heel pain and stiffness, that's plantar fasciitis.

  

Plantar fasciitis is so common and has so many causes it usually takes an experienced doctor to work through the true underlying cause. Too often we see patients who have not received satisfactory relief because previous doctors didn’t seek out the root cause of their plantar fasciitis.

 

Plantar Fasciitis Causes and Risk Factors

On NBC's "The Doctor's" we explain plantar fasciitis and perform three advanced procedures for pain relief before a live audience.

Plantar fasciitis, sometimes mistakenly called "plantar's foot", is generally a chronic condition and rarely caused by a single trauma to the foot. Common causes include

  • Tight calf muscles and tight Achilles tendons
  • If you are a long-distance runner or spend extended periods of time on your feet
  • Wearing shoes with soft soles or poor arch support
  • High arches
  • Flat feet

 

Symptoms of Plantar Fasciitis

  • Morning heel pain.
  • Sharp or “tearing feeling” pain in the heel with the first few steps when they get out of bed or after sitting for an extended period of time. The pain may decrease as the tendon loosens up but almost always returns.
  • Heel pain when climbing stairs, participating in high impact activities, or after standing for long periods

 

Diagnosing Plantar Fasciitis 

There are many sources of heel pain and not all cases are plantar fasciitis. It’s vital to determine the source of your heel pain so your doctor can treat the true cause of your pain, not just the symptoms. To that end, UFAI offers the most advanced technologies to properly diagnose plantar fasciitis including:

 

Advanced Digital X-Ray

Diagnostic Ultrasound

Advanced Extremity MRI

Neurosensory testing

 

Conservative Treatments for Plantar Fasciitis 

Conservative care, usually our first line of care, when properly matched to the patient has a very high success rate. Over 70% of our heel pain patients find relief with physical therapy, orthotics, and shoe change. Less than 5% need advanced treatments and less than 2% require surgery.

 

The goal of conservative treatments is to make the fascia and Achilles tendon more limber and stretched, which decreases stress on the arch and lessens pressure through the plantar fascia. These treatments are used when symptoms have been present for less than six months. They include::

 

Orthotics

Adding support to the arch of the foot through a custom orthotic insole device (which provides more accurate support than over-the-counter insoles) will greatly help support the foot and decrease stress on the arch.

 

Physical Therapy and Stretching Exercises

Stretching your lower leg muscles and plantar fasciitis will relax the tight muscles, reducing heel pain, especially when done prior to getting out of bed in the morning. In addition, a physical therapist can determine the correct stretches for you that will strengthen muscles, improve foot mechanics, and reduce stress on the foot. At UFAI, our physicians work closely with our on-site physical therapist, offering the advanced protocol for successful physical therapy treatment.

 

Steroid Injections for Heel Pain

One, maybe two cortisone steroid injections may be used to calm the severe swelling and pain. We usually try to avoid these injections, as cortisone is known not only to reduce inflammation (a good thing) but also to damage and weaken the tissue (a bad thing), making it more prone to tear. In some cases, we have seen this to be effective and contributed to total recovery, but usually, its effectiveness is temporary.

 

Icing for Heel Pain

Icing is important in the treatment of plantar fasciitis, especially after activity. Icing will reduce swelling and pain, allowing the tissue to heal faster. Combining ice and massage (rolling the bottom of your foot on a frozen water bottle) is very helpful. It not only brings some pain relief and a reduction in inflammation, but it also helps stretch the plantar fascia. This too should be done several times each day.

 

 

 

Proper Foot Gear

We recommend stiffer soled shoes. The upper can be soft but the sole needs to be stiff and a little lift is okay. Women do well with wedges and men do better with stiff running shoes or a cowboy boot or a work boot.

 

Massage

Massaging the heel region will break up scar tissue and increase blood to the area to help with healing.

 

Plantar Fasciitis Night Splints

A night splint may be used in cases that do not respond to physical therapy, stretching, and insole modifications. The goal of the night splint is to keep the calf and Achilles stretched during sleep and rest and allows for less tension and stretching of the fascia for the first steps in the morning or after a period of rest.

 

Anti-inflammatory Medications

Nonsteroidal anti-inflammatory drugs like Advil can reduce inflammation in the heel and arch of your foot, helping to ease foot pain.

 

 

Advanced Treatment Options for Plantar Fasciitis

While approximately 80% of our patients respond to simple conservative care, heel pain may continue to be a problem for some. This is often due to a lack of blood flow to the damaged tissue resulting in chronic plantar fascia pain and scar formation. In order to correct such issues, the body needs to be alerted to the injury region so it again begins to treat the damaged tissue and help resolve the problem.

 

These treatment options are typically used in chronic cases where plantar fasciitis symptoms have lasted more than six months. They  include:

 

Dysport / Botox Injections

Dysport is injected into the calf muscle or plantar fascia, tone and stiffness are reduced. This prevents the nerve from overstimulating the muscle by blocking the link between the two. This allows tight calf muscles to stretch, relax, and grow. When Dysport is injected into the plantar fascia, it relaxes and weakens the strength of the tendon, relieving swelling and pain.

 

Platelet Rich Plasma Therapy (PRP)  for Plantar Fasciitis

Dr. Baravarian discusses regenerative medicine therapy for the treatment of plantar fasciitis.

 

Platelet-rich plasma (PRP) injections allow growth factors in the blood to be used to cause inflammation of the injured tissue. This increases the healing response of the body.

 

With PRP, the blood is drawn and spun down with a centrifuge. Under ultrasound guidance and local anesthesia, an injection of PRP is placed in the damaged tissue. This sparks an increased growth-factor release in the area, which increases the blood supply to the damaged heel region to facilitate a healing process.

 

Amniotic Stem Cell Therapy for Plantar Fasciitis

During stem cell therapy, the patient's own stem cells are removed by simple blood sample collection. Using a special procedure, unhelpful cells are removed leaving behind the strong healing stem cells. Those cells are injected into the injured area and begin to replicate themselves, making healing possible.

 

Topaz Technology

Topaz, a minimally invasive procedure uses high-frequency energy to spur healing.

Topaz coblation technology combines bipolar high-frequency energy with a saline-based medium to remove damaged tissue with little, if any, damage to surrounding, healthy tissue. Removing tissue irritates the fascia enough to turn a chronic problem into an acute problem by increasing circulation to the damaged area. The patient's body then increases the natural healing properties, which begin to repair the newly injured ligament.

 

TenJet and Tenex Procedure

Doctors use diagnostic ultrasound to identify the exact site(s) of scar tissue. Using the TenJet probe, the scar tissue is broken up using high-pressure streams of water, whereas Tenex uses radio waves. The procedures usually take only 15 minutes and there is usually just some minor swelling after the procedure.

 

Shockwave Therapy

Extracorporeal shockwave therapy is a non-invasive, office procedure that permits new blood flow into the area of fascia damage. It is a long-term solution and there is a slow improvement with maximum pain relief usually at 3 months. However, there’s usually improvement seen at the start of the third week.

 

RELEF

Relef is a restorative technique that uses a radiofrequency heat mechanism to break up and melt the scar tissue in the heel and plantar fascia region. There is also an increase in blood supply to the heel area that helps with tissue healing

 

Endoscopic Plantar Fasciotomy Surgery

Surgery is reserved for the most chronic cases of plantar fasciitis that do not respond to conservative or advanced therapies. In those cases, fascia release surgery is used to release the tight fascia. The fascia is cut to relieve tension or pressure from the loss of circulation to tissue or muscle. The surgeons at UFAI have perfected the approach for fascia release. Our endoscopic and minimally invasive fascia release procedure promotes rapid healing with the quickest surgical recovery.

 

The surgeons at UFAI have perfected the approach for fascia release. Our minimally invasive fascia release procedure promotes rapid healing with the quickest surgical recovery.

 

UFAI, The Right Choice for Your Plantar Fasciitis Treatment

Our physicians are nationally recognized as experts in the treatment of plantar fasciitis. Our results are revolutionary and unmatched in the community; less than 5% of all UFAI patients we see for plantar fascia need surgery and less than 2% need a fascia release.

 

Internationally recognized as experts in the field of plantar fasciitis and heel pain, the specialists at UFAI speak and instruct worldwide on the latest techniques and the most innovative products on the market. They are often asked to share their expertise in various medical publications and to participate in clinical trials, including a new technology, which uses high-frequency ultrasound to treat heel muscle injuries.

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Plantar Fasciitis FAQs

 

Q: What is plantar fasciitis?

Plantar fasciitis, pronounced “PLAN-ter fash-ee-EYE-tiss," is a repetitive stress injury affecting the sturdy bands of connective tissue that run from your heel to the base of your toes. It is characterized by numerous tiny micro-tears along with this band, which results in pain ranging from a dull ache to a sharp stabbing feeling in the sole of the foot.

 

If left untreated, plantar fasciitis can last for months or even years. However, we treat patients with this condition every day, and if you’re engaged and active in your recovery, you should expect to be back to normal much sooner.

 

 

Q: Is plantar fasciitis the same thing as a heel spur?

Not technically. These two conditions are often related because heel spurs can actually be one of the causes of Plantar Fasciitis. Since the symptoms can feel the same., heel spurs are sometimes misdiagnosed as plantar fasciitis, but they are two distinct conditions that need to be treated differently.

 

A heel spur is a calcium deposit that causes a build-up of bony tissue on the bottom of the heel bone. Sometimes, a heel spur is completely painless. But other times, it can get intertwined with and pull on the plantar fascia, which can be painful. If that is the case, you need to resolve the heel spur before you can get some resolution to the Plantar Fasciitis.

 

Interestingly, a heel spur can form overtime when a tight plantar fascia pulls on the bone, causing the bone to react by building a calcium deposit. In this case, we also need to resolve the heel spur first.

 

This is why an accurate diagnosis is so important when treating Plantar Fasciitis.

 

 

Q: How did I get plantar fasciitis?

Most patients we are treating for plantar fasciitis cannot pinpoint a specific event that caused the problem. Usually, there was some kind of change in activity that occurred several weeks or months prior to the onset of the heel pain.

 

An example of a change in activity could be increasing mileage for running or walking workouts, walking barefoot on the beach, working long hours on your feet, or spending more time climbing ladders. Weight gain is another common change that affects your gait and your feet. Sometimes we just have to chalk it up to the natural process of aging.

 

Don’t spend too much time focusing on how you developed the heel pain; instead, focus on correcting the underlying factors such as poor shoes, inappropriate orthotics, and biomechanics.

 

 

Q: Is plantar fasciitis a tear in the plantar tendon?

No, it is not a true tear. With any form of injury, there is some mild microscopic tearing that can occur which causes inflammation but with plantar fasciitis, it's not a complete tear. There are a chronic overload stretch and microscopic tears of the fascia.

 

 

Q: What is the best treatment for plantar fasciitis?

There are many treatment options for plantar fasciitis. Treatments are available to help relieve inflammation and pain, allow the torn fascia to heal, improve strength and flexibility, and prevent future injury. With diligent treatment, you should soon be able to return to your normal activities.

 

While severe cases of plantar fasciitis may need surgery, most cases can be treated at home with little interruption to your daily life. We provide patients with a treatment regimen that includes stretching, icing, massaging their feet, and wearing night splints. We recommend giving the feet plenty of rest and taking anti-inflammatories to manage the pain. We can also help you pick out an over-the-counter orthotic, or fit you for a custom one, and point you towards the best, most supportive shoes for your favorite activities.

 

 

Q: How long does plantar fasciitis take to heal? 

Healing usually takes two to six months. More than 95 percent of patients get better just by doing their exercises and managing their pain with over-the-counter drugs. Orthotic inserts are highly recommended, not only to support the plantar fascia and allow it to heal but to prevent recurrence of the pain once the fascia has healed. Few patients require surgery to correct the problem.

 

 

Q: Are there medications I can take for plantar fasciitis?

Over-the-counter anti-inflammatory drugs, such as ibuprofen (Advil) and naproxen (Aleve), are usually effective. Icing for 10-15 minutes throughout the day will also help to relieve the pain.

 

 

Q: What is a night splint and should I use one?

A night splint is used to help relieve plantar fasciitis pain. One of the most painful times of day for a patient with plantar fasciitis is the morning. This is because, at night, fascia’s micro-tears start to heal while the foot is in a relaxed position. When you put weight on your feet again, the tissue is strained again, causing pain and soreness.

 

A night splint can ease this discomfort. It’s a partial boot that straps on to your foot and lower calf to hold the foot in a flexed position, keeping the plantar fascia and Achilles tendon stretched throughout the night. Your foot and ankle specialist can dispense one to you through your health insurance, or you can buy one online or at a pharmacy.

 

 

Q: Can plantar fasciitis come back?

Yes. Always ask for a thorough history and physical exam from your podiatrist to determine the exact cause of your plantar fasciitis. Correcting the root cause of a problem is always better than treating its symptoms. If the doctor determines that your plantar fascia became inflamed as a result of another foot condition, he or she will want to tailor your treatment plan to reduce the chance of recurrence.

 

 

Q: Can I still wear heels if I have plantar fasciitis?

Technically, yes you can. A lot of patients with plantar fasciitis actually feel better when they wear heels because it reduces the pull of the Achilles on the plantar fascia. However, wearing heels will shorten and tighten the Achilles over time, leading to worsening heel pain. If you’re a regular heel wearer, we recommend gradually switching from high heels to flats. Quitting your heels “cold turkey” might actually cause more harm.

 

If you make a quick switch from heels to flats, your shrunken Achilles tendon might overstrain itself, increasing the risk of a tear. Instead, you should transition gradually to flats by wearing shoes with a lower heel for a few weeks. If you’ve been wearing three or four-inch heels, try two inches for a couple of weeks, then one inch, and then flats. This will slowly stretch the Achilles tendon to prepare your muscles for flat shoes.

 

When you’re back to wearing flats, make sure they have enough support and if you can, get custom orthotics. They can make a world of difference and help prevent further heel pain.

 

 

Q: I have had plantar fasciitis for over a year and it is now very severe. I have tried ice rolling, taping, night splints, physiotherapy, and ultrasound. All of which provided temporary relief. I am now completely frustrated with the pain and am unable to do the things I need to do. Is there anything you can do to help me?

Yes. In your case, we would recommend a PRP (platelet-rich plasma) stem cell injection. PRP therapy will slowly help improve the affected area over a month or so. If you would like to read more about PRP therapy for plantar fasciitis, please click here.

 

 

Q: If I have to have surgery for plantar fasciitis, what type of recovery can I expect?

Plantar fascia release surgery involves cutting part of the plantar fascia ligament to release tension and relieve inflammation of the ligament. At UFAI, we perform plantar fascia release endoscopically through a minimally invasive half-centimeter incision. This allows for a much shorter recovery period than is with traditional open surgery. Our patients are weight-bearing after one week and back in shoes in 3 weeks

 

 

Q. I just had the Tenex procedure for my plantar fasciitis and I still have pain. When can I expect the pain to go away?

Heel pain should be gone approximately six weeks following the Tenex procedure.

 

 

Q. What is a typical recovery for plantar fasciitis restorative procedures?

For restorative procedures such as PRP, amniotic cell therapy, and topaz, patients are in a boot for 2 weeks but immediately weight-bearing. Totally recovery time is about 6 weeks because, as with all restorative procedures, we need to give the body time to heal itself.

 

 

Q. What are the success rates of shockwave therapy for the treatment of plantar fasciitis? How many sessions would it take?

Shockwave therapy for plantar fasciitis usually takes 3-4 sessions and we see a 70% success rate. Our physicians can also discuss other options once they get a sense of your exact condition.

 

 

Q. Can an altered gait, due to a history of knee and or ankle injury, cause one to develop plantar fasciitis?

Yes, this can definitely be a cause of plantar fasciitis.

 

  • Foot and Ankle Surgeon and Director of University Foot and Ankle Institute
    Dr Bob Baravarian, University Foot and Ankle Institute

    Dr. Bob Baravaria DPM, FACFAS is a Board-Certified Podiatric Foot and Ankle Specialist. He is currently a member of UCLA Medical Group, Chief of Podiatric Surgery at Santa Monica/UCLA medical center and Orthopedic Hospital, and an assistant clinical professor at the UCLA School of Medicine. He also serves as Director of University Foot and Ankle Institute.

     

    Dr. Baravarian has been involved in athletics his entire life and played competitive tennis in high school and college. He has an interest in sports medicine, arthritis therapy, and trauma/reconstructive surgery of the foot and ankle. He is also fluent in five languages (English, French, Spanish, Farsi, and Hebrew),

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