Plantar Fasciitis

Plantar fasciitis is pain on the bottom of one or both heels, caused by irritation to the plantar fascia, which are the dense tissue bands that connect the heels to the toes.

The plantar fascia consists of dense bands of tissue deep below the skin that extend out in a fan like fashion from the heel bone to the toes. If you pull your toes and foot up toward your head, you will feel this tissue tighten.

• Athletes
• Soldiers
• Runners
• People who are overweight or experience sudden weight gain
• Pregnant women
• People who wear shoes that don't provide adequate support
• People with flat feet
• People with high arches
• Women are more likely to develop plantar fasciitis than men

• Don't try running to lose weight after a rapid weight gain. Walk first, and stretch the muscles of the foot and calf to help condition your body before running.
• Wear good, supportive shoes for your athletic activities.
• Always warm up well and stretch before participating in sports.
• Keep the muscles of your feet and ankles strong to support your arch.
• Rest from activities that cause pain to the heel; ice and support the heel. Begin the appropriate exercises as soon as possible.
• See your physician if pain persists despite these measures.

• A sharp pain in the heel
• Pain upon first stepping out of bed, which usually subsides but may return later
• Pain that gets worse when climbing stairs
• Pain that gets worse when standing for long periods of time
• Pulling of the tight plantar fascia on the heel bone during activity can result in the formation of a bone spur off the tip of the heel bone at the origin of the plantar fascia tissue. This bone spur itself is not the cause of pain, but rather the result of chronic irritation to the bone caused by the stretching of the tight tissue.

The cause of plantar fasciitis remains unclear. However, there are several factors that can increase risk for plantar fasciitis.

• Repetitive activities, such as prolonged standing or walking on hard or irregular surfaces
• Running
• Weight gain
• Aging
• An injury, though this is rarely a cause

Your doctor will conduct a physical exam of your child as well as inquire into your child's medical history. The doctor may perform further tests, including observing how your child stands and walks.

In rare cases, your child's doctor may want an MRI or an X-ray. An X-ray won't help very much in viewing the ligaments, but may help find bone spurs.

Surgery is rarely necessary to treat plantar fasciitis. To decrease your pain and symptoms, you may want to:

• Tape the heel and arch.
• Custom shoe inserts may be needed to support the arch and the heel.
• Increase the flexibility of the plantar fascia and calf muscles by doing stretching exercises. Tight calf muscles increase the stress on the plantar fascia and predispose you to plantar fasciitis.
• Stretch the calf muscle as well as the plantar fascia by standing on a step with only the front of the foot supported on the step and the heel free. Hold onto the rail for support and then slowly lower your heels toward the lower step. You should feel this in the calf muscle and in the plantar fascia. Hold the stretch for a count of 10, then slowly return the heel to the level of the rest of the foot. Repeat slowly 10 times.
• Massage the plantar fascia by rolling your foot over a round tube-like object with a diameter of three to four inches. A rolling pin works nicely for this stretch.
• Strengthen the muscles of the foot and ankle that support the arch. One way to do this is to scrunch up a hand towel with your toes or use your toes to pull a towel weighted with a food can across the floor.
• Warm up well before stretching. Cold tissues cannot stretch as effectively. After stretching, ice your heel for 20 to 30 minutes at the point of maximum tenderness to decrease any inflammation that may result from too vigorous a workout.
• Oral anti-inflammatory medications such as aspirin or ibuprofen can decrease the inflammation caused by the irritation of the plantar fascia and decrease your symptoms so that you can stretch and increase your flexibility. In some cases, your physician may recommend a prescription anti-inflammatory for you.
• Try a night splint. These devices, prescribed by your physician, keep the foot flexed at 90 degrees instead of the typical relaxed foot position of toes pointed down that occurs during sleep. Wearing a splint may lessen the pain of the first step in the morning.
• Massage the heel with a sports cream, which may lessen symptoms. A variety of therapeutic treatments can also be administered by a physical therapist.

Plantar fasciitis is rarely serious enough to require surgery. At Boston Children's, doctors can help your child manage pain through exercises to stretch and strengthen the muscles in the foot, ankle, and leg.