Plantar Fasciitis and Heel Spur Syndrome Introduction

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This is the introduction to the more complete book which is available online.

Plantar fasciitis (pronounced PLAN-tar fashee-EYE-tiss) is an inflammation of the plantar fascia ("plantar" refers to the bottom of the foot, "fascia" refers to two different types of connective tissue, and "itis" means "inflammation"). The plantar fascia encapsulates foot muscles, but it has another important function.  It is thickest beneath the skin on the bottom of the foot where it functions as a "bowstring" that connects the heel bone to the ball and toes in order to maintain the arch of the foot. It experiences tension that is approximately 2 times a person's body weight during walking at the moment when the heel of the trailing leg begins to lift off the ground.  This moment of maximum tension is increased and "sharpened" (it increases suddenly) if there is lack of flexibility in the calf muscles. A certain percentage increase in body weight causes the same percentage increase in tension in the fascia.

The classic sign of plantar fasciitis (which is often confused with or considered the same as heel spurs) is heel pain with the first few steps in the morning (84% of our visitors). If this symptom is not present then the diagnosis of plantar fasciitis has to be checked more carefully.   The pain is usually in the front and bottom of the heel, but the definition of "plantar fasciitis" indicates it can be over any portion of the bottom of the foot where the fascia is located.  Patients often report that the pain "moves around" to different areas of the bottom of the foot. The pain can be mild or debilitating. It can last a few months or become permanent. The heel may hurt or the condition may become worse from the heel striking the ground, but plantar fasciitis is not caused by the heel striking the ground. Every year, about 1% of the population seeks medical help for this condition (one company claims it's 2.5%).

Plantar fasciitis is related to "heel spur syndrome", but they are not the same. The heel spurs to which this web site refers are on the front and bottom of the heel, not the back of the heel, but many of the ideas presented here may be helpful for dealing with other types of heel spurs and heel pain.  Heel spurs are deposits of bone in the plantar fascia near its attachment to the heel that result from repetitive stresses and inflammation in the plantar fascia. Heel spurs are the body's response to injury and inflammation. Since they begin as deposits in tissue ("calcification"), they are often bendable and not hard like bone. Pain probably does not result from heel spurs poking into tissue. Many people have heel spurs and they do not have any pain. A heel spur and/or the plantar fascia may "trap" or irritate nerves in the heel area (if only by inflammation) and cause more pain. It is often difficult and usually unnecessary to distinguish between plantar fasciitis and heel spur syndrome. Causes and treatments (except for surgery and injections) for the two conditions are the same. Many doctors use the terms "heel spurs" and "plantar fasciitis" interchangeably.

These conditions are usually caused by a change or increase in activities, no arch support in the shoe, lack of flexibility in the calf muscles, being overweight, a sudden injury, using shoes with little cushion on hard floors or ground, using shoes that do not easily bend under the ball of the foot, or spending too much time on the feet. The cause is often unknown and mysterious to the patient. It has often been said that those with flat feet or high arches are more likely to get plantar fasciitis (heel spurs). 30% of our visitors indicated they have high arches and 20% indicated they have flat feet. It can run in the family. Arthritis, heel bone damage ("stress fracture"), loss of natural tissue for cushioning under the heel ("fat pad atrophy"), tarsal tunnel syndrome (the foot's version of carpal tunnel syndrome), and other conditions can cause similar foot and heel pain. Many of the ideas presented here can be helpful in dealing with these other conditions.

Despite the claims of various product manufacturers, there is no cure-all. Different combinations of treatments help different people. Patients often learn they need to be an active force in their treatment. Experimenting with several different treatments is often necessary before finding those that help. As in exercising and working out, actively finding a way to enjoy the daily routines that are often helpful can be crucial in continued improvement. Applying ice, stretching, and taping are not inherently enjoyable activities, and it is not always obvious that they are helping. The pain usually increases gradually over weeks or months before help is sought, and improvement once treatment has begun is usually just as slow. Patients often have to be patient. Setbacks are the norm, and simply preventing the daily and occasional minor injuries is crucial if not the cure. A portion of a patient's lifestyle has often caused the pain, and it is that portion of their lifestyle that has to change. Walking and standing on two feet are inherent and defining characteristics of being human (few mammals can do it), so a holistic approach in dealing with heel pain may be necessary.

The most successful treatments reported by our visitors are the following:

Other treatments:

Trying to "walk through the pain" can cause a mild case to become long-term and debilitating. Pain is our body's way of telling us not to do something.  Being gentle on the feet for several months until there is no pain and then very slowly increasing activity is often a cure. Do not be fooled about being cured. The pain often comes back in full force.

The most common complaints about doctors in our message board is that they do not seem to understand how terrible the condition can be, or that they make the patient feel as if they are unusual or otherwise at fault for showing up in their office with heel pain. Visitors are frequently very thankful for because it shows them they are not alone.

To my knowledge, the largest "study" of heel pain, plantar fasciitis, and heel spurs is being conducted here at In the first 10 months of the year 2000, we had 2,655 people fill out an 80-question survey. The results are available through an interactive program that enables sufferers to identify and communicate with others who have their same symptoms. This allows them to identify the most successful treatments. The data provides an extensive profile of web surfers who have heel and/or fascia pain. Although one would assume the data is biased towards chronic sufferers who are more willing to complete the survey, one question surveys on the home page gave similar results. 46% of the visitors who filled out the survey had it over a year. Average age was 41. 85% said it's worse in the morning. 24% said it takes less than 5 minutes of being on their feet to cause the pain to increase. 36% did not know what caused it. When sitting, 22% had no pain and 7% had severe pain. The primary type of pain (visitors could choose only one) was sharp (38%), like a stone bruise (30%), throbbing (19%), or dull (10%), but rarely tingling or numb (2%). 37% had injections. 27% who had an injection indicated the pain from the injection was "horrific", but overall, injections were rated as one of the better treatments (even if it is only temporary relief). There are some studies that indicate injections are doing significant harm by increasing the chances that the fascia will detach completely from the heel. Male sufferers weighed 12 pounds above the average American male (which is already hefty) and female sufferers weighed 30 pounds above their counterparts (our data was compared to 1999 CDC data). More than 2 out of 3 visitors are female. 6 out of 7 of our heaviest visitors were female (n=442, BMI>=35). Journal articles report it's in both feet in 15% to 35% of the cases. Our surveys indicated it was in both feet 45% of the time, but only 14% of the respondents said their feet were equally painful. Our visitors ranked podiatrists, physical therapists, and acupuncture better than orthopedic surgeons. 8% of our visitors have had surgery. About 25% of the 267 surgeries reported so far have made it worse, but 40% of them are responding less than 3 months after the surgery, so many of them are likely to improve. If a surgery had made it better, they would not be visiting the web site and filling out the survey, but the same can be said for all the other treatments. About 4% of our visitors have had "devastating" cases ( here are a few examples ).

Black tennis shoes can often pass as dress shoes. New Balance is one of the few brands that often comes in extra wide sizes (2E and 4E) to accommodate high arches, inserts, and a heel lift. Shoe stores often do not have the wider sizes, but there are many places online you can find them (after first checking the styles out in local stores).

If none of the above works the best option is the newly-approved and apparently safe ESWT treatment, but insurance may not pay for it and it can cost as high as $5000.  I would not have surgery unless I was able to confirm the success rate and safety that the doctor claims. One only has to review our surgery message board to confirm that surgery should not be undertaken lightly. Depending on the patient, type of surgery, and physician, recovery from the surgery can occur in just a month or two, but it is often (if not usually) 6 months to a year.

The most frequently harmful treatments reported are the various surgeries, hard casts, deep massage, and firm heel pads. Nerve surgery ranked last out of the 46 treatments in the questionnaire because it helped only 37% and harmed 31%, but the number of responses is too small (n=16) to be sure that the results are accurate. Although having the lowest harm rate, tylenol was also the least effective (17%, n=856) presumably because it is not an anti-inflammatory like ibuprofen, Aleve, and aspirin which ranked higher at 49% helped and 3% harmed (n=1688)., LLC

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