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January 02, 2012

Ask the Practitioner - Plantar Fasciitis

Written by Dena Evans
PlantarThis month, we investigate Plantar Fasciitis with one of the nation's most well regarded podiatrists.  Caring for world class as well as recreational athletes in need of top-shelf care, Dr. Amol Saxena of the Palo Alto Medical Foundation has operated on some of the fastest feet in the world.  

What is Plantar Fasciitis?

AS: Heel pain accounts for over 20% of patient visits to foot specialists and a third of all patient visits I see. Over 50% of Americans will experience heel pain during their lifetime. The most common form of heel pain is known as Plantar Fasciitis or “Heel Spur Syndrome”. The Plantar fascia is a thick ligament on the bottom of your foot spanning from your heel to the base of your toes. It supports the arch and several muscles under the bones that support the foot. Over time, most people will develop some degree of calcification within these muscles on the bottom of their heel, which is called a “spur” but is entirely innocuous. Hence, the term “Heel Spur Syndrome” is a misnomer.


Plantar Fasciitis is a condition of irritation to the Plantar Fascia, the thick ligament on the bottom of your foot. It classically causes pain and stiffness located on the bottom of your heel and feels worse in the morning with the first steps out of bed and also in the beginning of an activity after a period of rest. For instance, after driving a car, people feel pain when they first get out, or runners will feel discomfort for the first few minutes of their run.


There are a few “Plantar Fascia-like” conditions one should be aware of. The most common occurs acutely: the patient continues to exercise despite the symptoms and experience a sudden sharp pain on the bottom of the heel, with the inability to stand on their toes and subsequent bruising in the arch. This is a rupture of the Plantar Fascia.


The Achilles tendon (the cord-like structure attaching your calf muscle to your heel) is another region where heel pain is common, either through chronic inflammation (Tendonosis), acute rupture, or calcification near the attachment.


One should also be aware that heel numbness can be the first sign of a back problem.


What are some common causes of plantar fasciitis?

AS: Plantar Fasciitis occurs because the tendon is not well-supplied by blood (which makes this condition slow in healing) and a certain amount of activity is needed to get the area to warm up.

Plantar Fasciitis can occur due to various reasons: use of improper, non-supportive shoes, over-training in sports, lack of flexibility, weight gain, prolonged standing and interestingly, prolonged bed-rest.


What are some simple steps we can take to address plantar fasciitis?

AS: Treatment initially is adding support to the foot, including better shoes and an over-the-counter arch support/insole, resting from the sport or activity exacerbating it, stretching the calf and arch muscles, and anti-inflammatories including ice and massage. The latter two can be accomplished simultaneously by taking a filled water bottle, freezing it solid & then using the now frozen ice cylinder, to massage your foot for 5-10 minutes by rolling it underneath at least two times per day.  This injury often takes time to resolve.  It is not unusual for symptoms of Plantar Fasciitis to persist for 6-12 months despite trying the myriad of treatment options.


Last modified on October 07, 2019
Dena Evans

Dena Evans

Dena Evans joined runcoach in July, 2008 and has a wide range of experience working with athletes of all stripes- from youth to veteran division competitors, novice to international caliber athletes.

From 1999-2005, she served on the Stanford Track & Field/ Cross Country staff. Dena earned NCAA Women’s Cross Country Coach of the Year honors in 2003 as Stanford won the NCAA Division I Championship. She was named Pac-10 Cross Country Coach of the Year in 2003-04, and West Regional Coach of the Year in 2004.

From 2006-08, she worked with the Bay Area Women’s Sports Initiative, helping to expand the after school fitness programs for elementary school aged girls to Mountain View, East Menlo Park, and Redwood City. She has also served both the Stanford Center on Ethics and the Stanford Center on the Legal Profession as a program coordinator.

Dena graduated from Stanford in 1996.

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