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Plantar Fascitis
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Plantar fasciitis

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Most commonly, heel pain is caused by plantar fasciitis, an inflammation of the fibrous tissue (plantar fascia) along the bottom of your foot that connects your heel bone (calcaneus) to your toes.

The plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. However, if tension on that bowstring becomes too great, minute tears can occur along with inflammation. The result is a stabbing or burning pain that's usually worse in the morning because the fascia tightens (contracts) overnight. Once your foot limbers up, the pain generally decreases, but it may return after long periods of standing or after getting up from a seated position. In severe instances, your foot may hurt with the slightest pressure, making walking difficult. Sometimes, plantar fasciitis is also associated with a growth (bone spur) that develops from tension on your heel bone.

Plantar fasciitis generally gets better with the help of simple treatments for the pain and inflammation. It may take a year or more for the condition to clear completely, but about 90 percent of people with plantar fasciitis improve after two months of initial treatment.

Signs and symptoms

Plantar fasciitis usually develops gradually, but it can come on suddenly and be severe. Although plantar fasciitis can affect both feet, it usually occurs in only one foot. Watch for:

  • A sharp pain in the inside part of the bottom of your heel, when you put weight on it, described by some as a knife sticking in the bottom of your foot

  • An intense pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe

  • Heel pain after long periods of standing or after getting up from a seated position

  • Heel pain after, but not usually during, exercise

  • Swelling in your heel

Causes

The causes of plantar fasciitis can be:

  • Physical activity overload. Plantar fasciitis is common among long-distance runners. However, jogging, walking or stair climbing also can place too much stress on your heel bone and the soft tissue attached to it, especially as part of an aggressive new training regimen. Even household exertion, such as moving furniture or large appliances, can trigger the pain.

  • Arthritis. Some types of arthritis can cause inflammation in the tendons in the bottom of your foot.

  • Diabetes. Although doctors don't know why, plantar fasciitis occurs more often in people with diabetes.

  • Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you're on your feet, putting added stress on the plantar fascia.

  • Improper shoes. Shoes that are thin-soled, overly loose, or lack arch support or the ability to absorb shock don't protect your feet. If you regularly wear shoes with high heels, your Achilles tendon — which is attached to your heel — can contract and shorten, causing strain on the tissue around your heel.

Risk factors

Your risk of developing plantar fasciitis increases if you are:

  • Active in sports. Runners, walkers and step aerobics enthusiasts are more prone to heel pain because of added stress on their heel bone and attached tissue.

  • Female. More women tend to suffer from plantar fasciitis, as a result of wearing higher heels.

  • Flat-footed or have high arches. People with flatfeet may have poor shock absorption, which increases the stretch and strain on the plantar fascia. People with highly arched feet have tighter plantar tissue, which also leads to poor shock absorption.

  • Middle-age or older. Heel pain tends to be more common with aging as the arch of your foot begins to sag, putting stress on the plantar fascia.

  • Overweight. Carrying around extra pounds can break down the fatty tissue under the heel bone and cause heel pain.

  • Pregnant. The weight gain and swelling that accompany pregnancy can cause ligaments in your body — including your feet — to relax. This can lead to mechanical problems and inflammatory conditions.

  • Spending the workday on your feet. People with occupations that require a lot of walking or standing on hard surfaces, including factory workers, teachers and waitresses, can damage their plantar fascia.

  • Wearing shoes with poor arch support or stiff soles. A closet of poorly designed pumps, loafers and boots can mean plantar problems.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
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