Plantar fasciitis is a foot condition that involves inflammation of the plantar fascia. It is characterized by intense pain in the heel, which is usually aggravated by movement and holding weight.
The plantar fascia is a strong band of tissue that extends from the heel to the middle foot bones and is responsible for supporting the arch of the foot and helping to absorb shock in the foot. When this tissue becomes injured and inflamed, symptoms of plantar fasciitis can present.
Most patients that present with symptoms of plantar fasciitis report participating in situations that are likely to increase the pressure on the plantar fascia and likelihood of injury prior to the initiation of symptoms. This may include:
- Extended periods of time on feet
- High-impact exercise on a hard surface
- Shoes that do not provide adequate cushioning and arch support
- Overuse or over stretching of the sole
Additionally, individuals with a tight Achilles’ tendon are more susceptible to plantar fascia injury as the foot is less flexible. Individuals who are overweight are also at an increased risk as there is constant more weight and pressure placed on the feet.
The primary symptom of plantar fasciitis is pain, which can affect any area underneath the heel but is most common a few centimeters forward from the heel. Usually just one foot is affected, although approximately 1 in 3 cases involves symptoms in both feet.
The pain typically presents gradually and may be described as tender at first but can worsen over time. It is usually most severe when weight is placed on the foot after long periods of rest, such as in the morning when an individual first gets out of bed. Often, the pain can improve slightly throughout the day with gentle exercise, but extended or high-impact exercise can worsen symptoms.
Some individuals may develop an altered gait as a result of the pain in the heel, which may cause them to limp slightly to reduce the pain during movement.
A diagnosis of plantar fasciitis can usually be made based upon the reported symptoms of the patient and a simple physical examination. Possible causes of the condition should be discussed, as well as any previous or current medical condition that may have an impact on the treatment plan for the condition.
However, further diagnostic tests may be needed in some circumstances to rule out other health conditions that may be responsible for causing the heel pain. Markers that suggest the cause of the pain is not related to inflammation of the plantar fascia and warrant further investigation include:
- Numbness or tingling sensation – possible sign of peripheral neuropathy
- Fever – possible signs of infection of the bone
- Stiffness and swelling – possible sign of arthritis
If these signs are present X-ray imaging, magnetic resonance imaging (MRI) of the heel or an ultrasound scan of the plantar fasciitis can be used to investigate the cause of the problem further and make the best treatment decision.