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Getting to the bottom of foot pain: Inside plantar fasciitis

Dr. Helen Cho
Getting to the bottom of foot pain: Inside plantar fasciitis
Dr. Helen Cho is a podiatrist at Harvard Vanguard Medical Associates. (Photo: Harvard Vanguard)

You may not know the name for the piercing pain in your heel, but anyone who has suffered from plantar fasciitis certainly knows how painful it can be.

What is plantar fasciitis?

It is the most common cause of heel pain. The plantar fascia is the ligament that runs along the bottom of your foot from the heel to the toes. When it is strained, it can become inflamed, or tender. People of all ages and shapes are affected — it can happen to men and women, people with high arches and those with flat feet, athletes or couch potatoes, and those who are thin or overweight.

What causes it?

One of the most prevalent causes of plantar fasciitis is over-activity. Athletes are particularly likely to develop plantar fasciitis, as all the running and jumping can put wear on the ligament and cause small tears in the fascia.

Also, wearing shoes that don’t provide the proper support can bring it on. In the nice weather, that means flip-flops and other flats for women. It’s like walking on concrete. Walking barefoot continually, even around the house, can be equally problematic. Another common cause is the failure to stretch the Achilles tendon or calf muscles, which in turn causes everything below them to tighten up as well.

Can it be prevented?

Not completely. But stretching and wearing the right shoes are two steps you can take to try to avoid it. And it’s worth trying, because once you get plantar fasciitis, there is a very good chance it will recur.

How do you treat it?

Your podiatrist will likely first recommend stretching your Achilles tendon and stretching your heel by straightening out your foot. Sometimes icing can help. There are also night splints that can be prescribed and worn to keep the foot “dorsi-flexed” while sleeping. Changing shoes, wearing orthotics and taking over-the-counter pain medication are other treatment options.

The good news is that these non-surgical treatments generally work, and there is usually improvement within a year. If the pain continues, physical therapy can be prescribed. If that is unsuccessful in alleviating the symptoms, the next step might be a local injection of cortisone, which can be painful itself. Other new and less proven treatments, such as electroshock therapy and platelet concentrates, are being developed. If none of these work, surgical release of the plantar fascia is a last resort.

Dr. Helen Cho is a podiatrist at the Post Office Square practice of Harvard Vanguard Medical Associates, located at 147 Milk Street, Boston. For more information, call 617-654-7000 or visit http://www.harvardvanguard.org.