Plantar Fasciitis

The following information is from the National Institutes of Health's National Library of Medicine.

Plantar fasciitis is inflammation of the thick tissue on the bottom of the foot. This tissue is called the plantar fascia. It connects the heel bone to the toes and creates the arch of the foot.

Causes, incidence, and risk factors

Plantar fasciitis occurs when the thick band of tissue on the bottom of the foot is overstretched or overused. This can be painful and make walking more difficult.

The more common causes of plantar fasciitis are:

• Foot arch problems (both flat feet and high arches)

• Long-distance running, especially running downhill or on uneven surfaces

• Shoes with poor arch support or soft soles

• Sudden weight gain or obesity

• Tight Achilles tendon (the tendon connecting the calf muscles to the heel)

Plantar fasciitis is seen in both men and women. However, it most often affects active men ages 40 - 70. It is one of the most common orthopedic complaints relating to the foot.

Plantar fasciitis is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On x-ray, heel spurs are seen in people with and without plantar fasciitis.
 

Symptoms

The most common complaint is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn.

The pain is usually worse:

• In the morning when you take your first steps

• After standing or sitting for a while

• When climbing stairs

• After intense activity

The pain may develop slowly over time, or suddenly after intense activity.

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Treatment

Health care providers usually first recommend:

• Heel and foot stretching exercises. Freeze a tennis ball, golf ball, or water bottle, and roll your arch on it.

• Wearing shoes with good support and cushions

• Night splints to wear while sleeping to stretch the foot

• Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation

• Resting as much as possible for at least a week

Other steps to relieve pain include:

• Apply ice to the painful area. Do this at least twice a day for 10 - 15 minutes, more often in the first couple of days.

• Try wearing a heel cup, felt pads in the heel area, or shoe inserts.

• Use night splints to stretch the injured fascia and allow it to heal.

If these treatments do not work, your health care provider may recommend:

• Wearing a boot cast, which looks like a ski boot, for 3-6 weeks. It can be removed for bathing.

• Custom-made shoe inserts (orthotics)

• Steroid shots or injections into the heel

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Prevention

Making sure your ankle, Achilles tendon, and calf muscles are flexible can help prevent plantar fasciitis.

Shin Splints

The following information is from the National Institutes of Health's National Library of Medicine.

Shin splints refers to pain in the front of the lower legs. The pain is located along the inside edge of the tibia, the large bone in the lower part of the leg. Pain most often occurs during or right after a change in activity level, such as running more often or increasing the number of miles. Although the term shin splints is often used, it is not a defined medical diagnosis.

Causes

Tibial shin splints are very common. They can affect both recreational and trained athletes. The pain of shin splints is caused by swelling or inflammation of the muscles, tendons, and the thin layer of tissue that covers the shin bone. The common cause is overuse from too much activity or training, and then not enough time to allow the tissues to heal or recover. Often a sudden change in activity may be the cause, such as:

• Running more often, longer distances, or up hills

• Aerobic dancing

• Military training

Flat feet or a very rigid arch may place more stress on the lower leg and also cause shin splints. Other causes of pain in the shin bone:

• Chronic anterior compartment syndrome affects the outer side of the front of the leg. It can cause numbness and clumsiness of the foot while exercising.

• Stress fractures usually cause sharp pain and tenderness 1 or 2 inches below the knee.

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Home Care

Begin the healing process with 2 - 4 weeks of rest.

• Rest completely (other than walking for daily activities) for at least 2 weeks.

• Use ice or a cold pack over the area for 20 minutes, twice a day. Over-the-counter pain medications will also help.

• Talk with your health care provider or a physical therapist about wearing the proper shoes, getting orthotics for your shoes, and running on the right types of surfaces.

• Warm-up and stretch before and after any exercise.

• After 2 - 4 weeks, and when the pain is gone, you can start running again. Increase your activity level slowly. If the pain returns, stop exercising right away.

• You can try other training activities, such as swimming or biking.

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When to Contact a Medical Professional

Although shin splints are seldom serious, you may need to call your health care provider if:

• The pain continues and is persistent, even with rest

• You are not sure whether your pain is caused by shin splints

• You don't improve with home treatment after several weeks

• You have a stress fracture

Alternative Names

Lower leg pain; Pain - shins; Anterior tibial pain; Medial tibial stress syndrome; MTSS; Exercise-induced leg pain; Tibial periostitis; Posterior tibial shin splints

Achilles Tendinitis

The following information is from the National Institutes of Health's National Library of Medicine.

Achilles tendinitis is when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. This tendon is called the Achilles tendon. It is used for walking, running, and jumping.

Causes

There are two large muscles in the calf. These muscles are important for walking. They create the power needed to push off with the foot or go up on the toes. The large Achilles tendon connects these muscles to the heel. Heel pain is most often due to overuse of the foot. Rarely it is caused by an injury. Tendinitis due to overuse is most common in younger people. It can occur in walkers, runners, or other athletes.

Achilles tendinitis may be more likely to occur if:

• You run on hard surfaces such as concrete

• You run too often

• You do not have shoes with proper support

• You suddenly increase the amount or intensity of an activity

• You jump a lot (such as when playing basketball)

• Your calf muscles are very tight (not stretched out)

• Your foot suddenly turns in or out

Tendinitis from arthritis is more common in middle-aged and elderly people. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling.

Symptoms

Symptoms include pain in the heel and along the tendon when walking or running. The area may feel painful and stiff in the morning. The tendon may be painful to touch or move. The area may be swollen and warm. You may have trouble standing up on one toe.

Treatment

The main treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away. Try putting ice over the Achilles tendon for 15 to 20 minutes, two to three times per day. Remove the ice if the area gets numb. Changes in activity may help manage the symptoms:

• Decrease or stop any activity that causes you pain.

• Run or walk on smoother and softer surfaces.

• Switch to biking, swimming, or other activities that put less stress on the Achilles tendon.

Your health care provider or physical therapist can show you stretching exercises for the Achilles tendon. They may also suggest the following changes in your footwear:

• Shoes that are softer in the areas over and under the heel cushion

• A brace or boot or cast to keep the heel and tendon still and allow the swelling to go down

• Heel lifts placed in the shoe under the heel

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can help with pain or swelling. Talk with your health care provider. If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. Surgery also can be used to remove the bone spur that is irritating the tendon. Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other treatments. This treatment uses low-dose sound waves.

Prevention

Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.

Alternative Names

Tendinitis of the heel