Oh, My Aching Feet

By Peter Galvin, MD

Plantar fasciitis (PF) is a common cause of heel pain in adults (Brandon Nimmo of the Mets suffered from it during this year’s playoffs). The plantar fascia includes three bands of tissue that support the arch of the foot and connect the heel to the toes. Heel pain due to PF is typically most severe when people take their first steps of the day, and it may worsen with prolonged standing. Although the cause is not completely understood, PF may be partly due to small tears in the plantar fascia that occur as a result of repeated stress and strain on the foot. PF accounts for more than one million U.S clinic visits per year and is most common in adults aged 45 to 64 years. People at higher risk of PF include those who are overweight or obese (BMI > 25), those whose work requires prolonged standing, and those with limited ability to move their toes upward towards their knee, known as decreased ankle dorsiflexion.

PF can be diagnosed in people who have characteristic symptoms of heel pain that can be felt when the clinician applies pressure to a certain area of the heel or gently pushed the toes upward toward the knee. Imaging studies like ultrasound or MRI of the ankle and foot are not typically needed to diagnose PF unless the diagnosis is uncertain, or symptoms do not resolve with treatment. Those with PF should avoid activities that worsen their heel pain. There are a number of treatment options including:

• Stretching the calf muscles and stretching and massaging the plantar fascia at home or during physical therapy sessions.
• Using orthotics, which are shoe inserts that decrease the strain on the plantar fascia and reduce force on the foot while walking. Orthotics can be custom made by a podiatrist or orthopedist while OTC orthotics may provide similar relief and are cheaper.
• Wearing a night splint to flex the ankle and extend the toes during sleep or at other times if not tolerated during sleep.
• Receiving a steroid injection in the inner part of the heel by a foot specialist, which may provide relief for several weeks to months.
• Receiving a heel injection of platelet-rich plasma, composed of certain components from the patient’s own blood. This may provide longer-term relief than a steroid injection.
• Undergoing extracorporeal shock wave therapy, which applies high-pressure sound waves to the plantar fascia. This too may provide longer relief than a steroid injection.
• If all else fails to provide relief, surgery on the plantar fascia or calf muscles is a last resort.

Heel pain from PF often goes away on its own, but it may last for months to years despite treatment. Up to 80% of patients may have persistent symptoms a year after diagnosis. Even after 15 years, up to 44% may still have heels pain, although it is usually less severe than it was at the time of diagnosis. For more information go to the American Orthopaedic Foot & Ankle Society at www.aofas.org or the American Podiatric Medical Association at www.apma.org

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