plantar fasciitis
/ PLAN-tar fash-ee-EYE-tis /
Plantar fasciitis is the classic story of stabbing heel pain that is worst with the very first steps out of bed in the morning, eases as you walk around, and returns after sitting or at the end of a long day on your feet. It is the most common cause of heel pain in adults and a frequent visitor to running and standing-occupation clinics.
The plantar fascia is a thick, tough band of tissue that runs along the sole from the heel bone to the toes, working like a bowstring or shock-absorbing arch support for the foot. Overload — a lot of standing or running, tight calf muscles, unsupportive shoes, a sudden change in activity, or extra body weight — irritates and degenerates the band where it anchors at the heel. Despite the '-itis', the chronic problem is again largely degeneration rather than inflammation, so the more accurate term is 'plantar fasciopathy'. A heel bone spur is often seen on X-ray but is usually a bystander, not the pain source.
The encouraging news is that plantar fasciitis is generally self-limiting, with the great majority resolving over months to about a year, and rehabilitation is conservative and effective. The mainstays are calf and plantar-fascia stretching, progressive loading exercises for the fascia and calf, supportive footwear or arch supports, and load management; injections and other procedures are second-line. As with other overuse soft-tissue problems, patience and graded loading matter more than aggressive intervention, and corticosteroid injection into the heel is used cautiously because it can risk fascia rupture or fat-pad damage.
A nurse who works long shifts on hard floors gets stabbing heel pain on her first morning steps. The X-ray shows a heel spur, but the real problem is an overloaded plantar fascia; calf stretching, supportive shoes, and graded loading settle it over several months.
The heel spur on the X-ray is usually a bystander; the overloaded fascia is the problem.
A heel spur seen on X-ray is usually not the cause of the pain. And like other chronic soft-tissue overuse, this is largely degeneration, not inflammation, so loading and stretching outperform rest and outlast quick fixes.