Plantar Fasciitis Painful Heel Syndrome Painful heel syndrome is most commonly caused by a condition known as plantar fasciitis, or inflammation of the plantar fascia. The plantar fascia is a ligament that connects the heel bone (calcaneus) to the ball of the foot. The ligament splits into four parts at the ball of the foot and joins in the toe area (Fig. 1). Its function is to maintain a proper arch in the foot.

Symptoms

Plantar fasciitis is one of the most prevalent orthopaedic problems among athletes. As many nonathletes as athletes have the condition. The pain is greatest in the morning but lessen after a few steps. However, the symptoms gradually increase during the day and may become greater after you climb stairs, participate in a weight-bearing activity, or sit for a long period of time.

Cause

The most common cause of plantar fasciitis is overload. Obesity and prolonged standing promote the condition. For runners, wearing inadequate running shoes or running up steep hills leads to plantar fasciitis. Tightness in the Achilles tendon predisposes you to this condition.

Prevention

People of all activity levels can work to prevent plantar fasciitis by wearing shoes that provide excellent arch support. In addition, you need to warm up before participating in any activity that may be stressful to your feet. For example, stretch the plantar fascia and Achilles tendon by leaning forward against a wall while keeping your heels flat on the ground (Fig. 2).

Treatment

If you already have plantar fasciitis, nonoperative treatment will most likely relieve your symptoms. This treatment begins with decreasing activities and stress on the arch and wearing supportive shoes (often with arch supports purchased at your local pharmacy). Stretching the Achilles tendon is very important. Deep massaging the tendon may also help. You may need to take an anti-inflammatory medication, such as aspirin or ibuprofen. Other possible treatments include having injections of cortisone (a strong anti-inflammatory medicine), wearing a night splint, using therapy modalities, and wearing a cast. Surgery is only occasionally necessary.

Finally, be patient. Improvement takes time - often several months. However, treating plantar fasciitis as soon as you detect if will help prevent severe, and often long-term, foot problems.

Leland C. McCluskey

Columbus, Georgia