Don’t wait for plantar fasciitis to cause other problems

Dear Doctors: I’m getting this sharp pain under my right heel when I step out of bed in the morning. It feels like it’s bruised, but I know I haven’t injured it. A friend who had plantar fasciitis thinks that’s what it is. Can you please explain plantar fasciitis? How do you get it to go away?

Dear Reader: Plantar fasciitis affects an estimated 2 million Americans each year. That makes it the most common cause of heel pain in the U.S. It occurs when the long, thin band of fibrous tissue that runs just beneath the skin along the bottom of the foot becomes irritated, inflamed or damaged. Known as the plantar fascia, this tissue connects the heel bone to the bones of the toes and plays a role in supporting and stabilizing the arch of the foot.

Plantar fasciitis can be caused by something as simple as a change in the type of shoes you’re wearing or an increase in the types of activities that result in repeated jolts or constant pressure on the foot. Being overweight, having either flat feet or a high arch, rolling inward onto the arch of the foot when walking, having tight calf muscles or a tight Achilles tendon, and running, walking or standing for long periods on hard surfaces can all contribute to developing the condition.

Plantar fasciitis often first makes itself known with a stabbing pain in the bottom of the heel when you take your first steps of the morning. Although the discomfort often goes away as the tissues warm up with continued movement, it can recur when you rise after prolonged sitting or while standing or walking for a period of time.

Diagnosis is based on your medical history and a physical exam of your foot to check for areas of tenderness. The specific location of the pain helps to pinpoint its cause. It’s possible that imaging tests, such as an X-ray or MRI, may be used to rule out other potential causes for the pain, such as a stress fracture.

Elizabeth Ko, MD and Eve Glazier, MD

Because plantar fasciitis often begins with intermittent pain, you may be tempted to ignore it. However, it’s important to see your health care provider for an accurate diagnosis. Left unaddressed, the condition can lead to chronic pain that interferes with daily life. And while it’s possible to mitigate the discomfort by altering your gait, the resulting misalignment can lead to foot, knee or hip problems.

The good news is that most cases can improve with nonsurgical treatment. That includes decreasing or even ceasing the activities that activate the heel pain, switching to cushioned and supportive shoes, and perhaps using orthotic inserts. Because plantar fasciitis is associated with tight muscles in the calves, as well as a tight Achilles tendon, your doctor may recommend targeted stretching exercises. It’s important to be gentle in performing these exercises and not overdo it.

Over-the-counter pain medications can offer relief, and icing the area several times a day can help ease inflammation. Improvement can take from three to 12 months, so it’s important to be patient.

The primary care physicians at UCLA Health offer everything from routine screenings and disease prevention to coordinated treatments for a wide range of health conditions. Talk to your provider about your concerns. Learn more and schedule an appointment.

(Send your questions to askthedoctors@mednet.ucla.edu. Owing to the volume of mail, personal replies cannot be provided.)


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