Just had to add my 2cents here. Member of the Orthopaedic Foot and Ankle Society.
Classic symptoms of PF are heel pain that is severe in the morning getting out of bed, gets a little better with movement, then is worse at the end of the day and is painful when getting up out of a chair (or out of the car, etc) after sitting for a time. We think that the reason the symptoms follow this pattern is that the PF shortens when we are non-weightbearing.
Plantar fasciitis is incredibly common- at any one point over 60 MILLION people have it. No one knows the specific cause. If you do MRI’s on everyone (and this study has been done) sometimes you see nothing, sometimes inflammation, sometimes a tear, sometimes bone irritation, but often nothing. People have biopsied the PF with the same results, some have inflammation, many nothing. No one knows why this happens, no one knows the trigger. I have seen it in hundreds of patients, from 90# to 350#, people who sit all day, people who stand all day, runners, couch potatoes, etc. I see it in people who pronate, who have high arches, who have flat feet, etc. No common denominator other than almost all are over 25, and there probably some correlation with tightness of the achilles. (If one sees this problem in very young patients, one thinks of other things such as some of the auto-immune inflammatory diseases.)
PF is NEVER DUE TO A SPUR! The spur is an old concept that has been disproven as the source of the problem. If you x-ray all who have PF, some have spurs, some not. We used to cut out the spurs, but found that this did not make people better. The spur is a normal aging change of bone and is not the source of pain. It is not a thorn sticking into the heel!
Research by the Orthopaedic Foot and Ankle Society has shown 4 things that are statistically significant in helping plantar fasciitis and lots of things that do not help.
Things that did not show statistical significance (did not help nor “cure” PF
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orthotics- a large study had several hundred patients, half the group did stretches no orthotics, the other half orthotics, the stretching group was much better
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cortisone injection- no evidence for long term benefit
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medication- might help pain a little, but will not make the PF go away
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ice, heat, rolling foot on ball or frozen bottle, etc- again might help the pain a bit, but will not “cure” the problem
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different shoes- no statistical significance. Interestingly, wearing a high heel (or high heeled cowboy boot) can make it feel better temporarily because this lets the PF shorten- but it thus perpetuates the problem
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surgery- very limited benefit much of the time, most studies indicate only 60% of patients will improve. (versus 90% of patients who improve with bunion surgery, or meniscal tear surgery)
Things that are statistically significant:
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Three stretching exercises and a night splint. It takes about 4 months to improve. The three stretches are a. “the toe pull” pics are on line- sit with one foot crossed up over the other knee (half of “Indian” style) take the hand on the same side, and pull the toes up toward the shin. Hold 5-10sec, repeat 5 reps, 6-8 times per day. This is the most important stretch. b. runners stretch- classic against wall or desk c. stand on stair and drop heel down. All stretches should be done 5 reps, 6-8 times per day but if one gets lazy, the toe pull is the most useful. It should be done before getting out of bed, any time sitting down, before getting out of the car, etc. Night splints can be found on line, they can either go on top or on the back of the leg. They are a must. If one has pain both sides, I tell patients to get one splint and alternate legs.
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a cast- a short leg fiberglass cast (a walking cast) worn for 6 weeks can be highly effective, it probably works by putting the PF on stretch at all times
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Platelet rich plasma injection- only if above fail, should be in a tall walking boot for at least 6 weeks after the injection
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Shock wave- the high intensity type has been the only one to be useful, it requires anesthesia (Ossatron is the brand of machine) and a boot for 6 weeks. Again however, only if 1&2 fail.
