DEAR MAYO CLINIC: When I wake up in the morning and go to stand up, I have such excruciating pain in my heel that I have to sit back down on the edge of the bed. As the day goes on, it gets somewhat better, but my heel is still tender. What can be causing the pain?

ANSWER: "My heel is killing me!" is, without a doubt, one of the most common sentences uttered in podiatry offices worldwide. Heel pain can range from slightly uncomfortable to utterly debilitating. Most often it's caused by plantar fasciitis.

The plantar fascia is a band of tissue extending from the heel to the ball of the foot. It supports the arch of the foot and absorbs shock when walking. Although the cause of plantar fasciitis isn't well understood, typically the plantar fascia has been put under tension and stress, which can cause small tears. Repeated stretching and tearing brings on irritation, inflammation and, typically, heel pain.

Plantar fasciitis can affect anyone. However, it's most common in middle-aged adults, as well as people who take part in activities such as running, ballet and aerobic dance. Obesity also can cause this condition because extra pounds put more stress on the fascia. Other risk factors include high arches, flat feet, and occupations that require walking or standing all day on hard surfaces.

The primary sign of plantar fasciitis is excruciating heel pain when you take your first steps in the morning. It's not unusual for the pain to subside as you walk around, but it may return after you've been sitting for a while. Standing for a long time also can make it flare up.

Treatment for plantar fasciitis

The good news about plantar fasciitis is that it's highly treatable. Early detection makes the condition more manageable and prevents further complications. If left untreated, plantar fasciitis can take a toll on your enjoyment of everyday activities and make you more sedentary. The pain may cause you to change the way you walk, which in turn can lead to various problems such as knee, hip and back pain.

If you suspect you have plantar fasciitis, consult with your health care team. Although X-rays or MRIs usually aren't required, imaging may be requested to rule out a stress fracture. Nonsurgical treatment often has satisfactory results, although it may take several months to get back to normal.

Treatment typically includes:

• Rest
  Pain is the body’s way of warning you that something is wrong. Listen to your body and avoid activities that make the pain worse, such as running, hiking or dancing. So that you can keep moving while your heel improves, try bicycling, swimming, water fitness, elliptical training, strength training, yoga, and other low- or no-impact workouts.

• Stretching
  Your podiatrist or physical therapist will give you a list of stretches that reduce tension on the plantar fascia and help with healing. Tight calf muscles often play a role in heel pain. In addition to stretching, a health care professional also may show you how to apply athletic tape to support the bottom of your foot.

• Ice
  Ice therapy is a wonderful way to decrease inflammation and manage pain. Place ice on the heel for 20 minutes, three to four times a day. You also can fill a bottle with water and freeze it, then gently roll it under your heel and arch.

• Medication
  Pain relievers, such as ibuprofen and naproxen, can help decrease inflammation and speed up healing.

• Night splint
  These sock-like wraps with built-in supports help stretch the plantar fascia and Achilles tendon while you're sleeping or resting. A splint can help alleviate pain experienced with those first few steps in the morning.

• Orthotics and shoes
  Adequate arch support is essential when treating plantar fasciitis. Discuss with your podiatrist whether over-the-counter or custom orthotic inserts are right for you. In addition, avoid going barefoot and choose supportive, firm-soled shoes with good heel cushion and arch support, such as running shoes.

Surgical treatment isn't recommended often and is reserved for those not responding to conservative treatment. To prevent recurrence of plantar fasciitis, stretch properly before exercising and wear supportive shoes if you'll be on your feet for a long time. — Dr. Stephanie Kvas, Podiatric Medicine, Mayo Clinic Health System, Waseca and New Prague, Minnesota

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MANKATO, Minn. — Most runners will run into a case of plantar fasciitis occasionally, and this heel pain can range from slightly uncomfortable to utterly debilitating.

The plantar fascia is a band of tissue extending from the heel to the ball of the foot, and plantar fasciitis is caused by excessive stress, which brings on inflammation and, typically, heel pain.

“Plantar fasciitis can affect anyone,” says Stephanie Kvas, D.P.M., a Mayo Clinic Health System podiatrist. “However, it's most common in middle-aged, active adults. Other risk factors include obesity, occupations that require you to be on your feet all day and flat feet or high arches.”

The primary signs of plantar fasciitis include excruciating heel pain when you take your first steps in the morning, recurring pain when standing up from a seated position and pain associated with standing for a long time.

The great news about plantar fasciitis is that it's highly treatable. Early detection makes the condition more manageable and prevents further complications. If left untreated, plantar fasciitis can lead to various problems caused by compensating for the discomfort, including knee, hip and back pain.

Nonsurgical treatment often has satisfactory results and includes:

Rest

Pain is the body's way of warning you something is wrong. Listen to your body and avoid activities that make the pain worse, such as running, hiking or dancing.

Stretching

Your podiatrist will give you a list of stretches that reduce tension on the plantar fascia and help with healing. Tight calf muscles often play a role in heel pain.

Ice

Place ice on the heel for 20 minutes, three to four times a day. Ice therapy is a wonderful way to decrease inflammation and manage pain.

Medication

Pain relievers, such as ibuprofen and naproxen, can help decrease inflammation and speed healing.

Night splint

These sock-like wraps with built-in supports help stretch the plantar fascia while you're sleeping or resting. A splint can help alleviate pain experienced with those first few steps in the morning.

Orthotics and shoes

Adequate arch support is essential when treating plantar fasciitis. Discuss with your podiatrist whether over-the-counter or custom orthotic inserts are right for you. In addition, avoid going barefoot and choose supportive, hard-soled shoes, such as sneakers.

Surgical treatment isn't recommended often and is reserved for those not responding to conservative treatment. To prevent recurrence of plantar fasciitis, stretch properly before exercising and wear supportive shoes if you'll be on your feet for a long time.

###

About Mayo Clinic Health System

Mayo Clinic Health System has a physical presence in 44 communities and consists of 53 clinics, 16 hospitals and other facilities that serve the health care needs of people in Iowa, Minnesota and Wisconsin. The community-based providers, paired with the resources and expertise of Mayo Clinic, enable patients in the region to receive the highest-quality physical and virtual health care close to home.

Media contact:

• Amanda Dyslin, Mayo Clinic Health System Communications, 507-327 7510, dyslin.amanda@mayo.edu

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"My heel is killing me!" is without a doubt one of the most common sentences uttered in podiatry offices worldwide. Heel pain can range from slightly uncomfortable to utterly debilitating. Most often, it's caused by plantar fasciitis.

The plantar fascia is a band of tissue extending from the heel to the ball of the foot. Plantar fasciitis is caused by excessive stress, which brings on inflammation and, typically, heel pain.

Plantar fasciitis can affect anyone. However, it's most common in middle-aged, active adults. Other risk factors include obesity, occupations that require you to be on your feet all day and flat feet or high arches.

The primary signs of plantar fasciitis include excruciating heel pain when you take your first steps in the morning, recurring pain when standing up from a seated position and pain associated with standing for a long time.

The great news about plantar fasciitis is that it's highly treatable. Early detection makes the condition more manageable and prevents further complications. If left untreated, plantar fasciitis can lead to various problems caused by compensating for the discomfort, including knee, hip and back pain.

Nonsurgical treatment often has satisfactory results and includes:

Rest

Pain is the body's way of warning you something is wrong. Listen to your body and avoid activities that make the pain worse, such as running, hiking or dancing.

Stretching

Your podiatrist will give you a list of stretches that reduce tension on the plantar fascia and help with healing. Tight calf muscles often play a role in heel pain.

Ice

Place ice on the heel for 20 minutes, three to four times a day. Ice therapy is a wonderful way to decrease inflammation and manage pain.

Medication

Pain relievers, such as ibuprofen and naproxen, can help decrease inflammation and speed healing.

Night splint

These sock-like wraps with built-in supports help stretch the plantar fascia while you're sleeping or resting. A splint can help alleviate pain experienced with those first few steps in the morning.

Orthotics and shoes

Adequate arch support is essential when treating plantar fasciitis. Discuss with your podiatrist whether over-the-counter or custom orthotic inserts are right for you. In addition, avoid going barefoot and choose supportive, hard-soled shoes, such as sneakers.

Surgical treatment isn't recommended often and is reserved for those not responding to conservative treatment. To prevent recurrence of plantar fasciitis, stretch properly before exercising and wear supportive shoes if you'll be on your feet for a long time.

Stephanie Kvas, D.P.M., is a podiatrist in New Prague and Waseca, Minnesota.

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DEAR MAYO CLINIC: I am in my 60s and active. Over the years, I have had plantar fasciitis off and on, but the most recent episode has lasted longer than usual, and physical therapy hasn't helped much. What are my options for treatment at this point?

ANSWER: Most people with plantar fasciitis improve with basic care steps or physical therapy. However, healing can be slow and require perseverance. Newer, nonsurgical therapy options are helping with hard-to-treat cases.

The plantar fascia is a fibrous band of tissue on the bottom of the foot. It connects the heel to the toes and supports the arch of your foot, acting as a shock absorber when you put pressure on your foot. Plantar fasciitis discomfort occurs at the bottom of your foot, typically near the heel bone. It can range from a dull sensation to piercing pain. Often, it comes on gradually and affects only one foot, though it can start suddenly and affect both feet.

Plantar fasciitis occurs when stress and strain cause microscopic tears in the fascia. There may be a temporary inflammatory reaction to the injury, but the true problem is degeneration of the fascia — not the inflammation.

The risk of plantar fasciitis is increased by factors that put extra strain on the feet, such as obesity; high-impact activities, such as running or dance aerobics; and certain faulty foot mechanics, such as flat feet, high arches or an abnormal walking pattern. Having a tight Achilles tendon or ankle muscles is also a risk factor. Risk rises if you suddenly increase your activity level, such as walking and standing a lot while on vacation. Going barefoot or wearing shoes with minimal support, particularly on hard surfaces, or routinely wearing high-heeled shoes also increases risk of injury.

To treat plantar fasciitis, the extra stress on the plantar fascia must be relieved, so that the tears can heel. For most people, these small tears can be treated successfully with physical therapy and special equipment that gives the foot extra support. A cortisone injection also may be considered.

But for some, this isn't enough, and finding a solution to the chronic pain and loss of function due to plantar fasciitis can be frustrating. Open surgery to remove the damaged tissue is an option, but recovery often is prolonged, and recurring pain is common.

If plantar fasciitis pain is disrupting your life and a thorough plan of care isn't leading to improvement after several months, newer, minimally invasive interventions can be effective.

Ultrasonic fasciotomy and debridement, a technology developed in part by Mayo Clinic doctors, uses ultrasound imaging to identify degenerated tissues and guide the entire procedure. Through a tiny incision, a needlelike surgical probe is inserted into the degenerated tissues. When activated, the probe tip vibrates rapidly, using ultrasonic energy to break up the damaged tissues, which then are suctioned away. The procedure usually takes only a few minutes, and the incision is closed with surgical tape.

Complications are uncommon. After about 10 days of rest or restricted weight-bearing, it's usually possible to return to your regular activities. However, physical therapy still may be needed, and it usually takes longer to get back to more strenuous activities.

Another treatment is called needle fasciotomy with platelet-rich plasma (PRP) injection. Using ultrasound imaging and a thin probe, holes are poked in damaged and degenerated plantar fascia tissue. This is often followed by an injection of platelet-rich plasma into the fascia. Platelet-rich plasma is obtained from your own blood. Anti-inflammatory factors in platelet-rich plasma may help stimulate pain relief and healing in the area.

Talk with your health care provider to see if either of these treatments would be a good option for your situation. (adapted from Mayo Clinic Health Letter) — Dr. Arthur De Luigi, Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, Arizona

The post Mayo Clinic Q and A: Treating plantar fasciitis appeared first on Mayo Clinic News Network.

March is National Nutrition Month, an education and information campaign created by the Academy of Nutrition and Dietetics to help you make informed food choices and develop sound eating and physical activity habits. The theme of the campaign this year is Put Your Best Fork Forward. On the Mayo Clinic Radio podcast, dietitian Kate Zeratsky covers the five key messages of the campaign. Also on the program, oncologist Dr. Kathryn Ruddy discusses the importance of cancer survivorship programs for people who live with the disease. And physical medicine and rehabilitation specialist Dr. Jay Smith shares the latest treatment options for plantar fasciitis.

The post #MayoClinicRadio Podcast: 3/11/17 appeared first on Mayo Clinic News Network.

Here's your Mayo Clinic Radio podcast.

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Listen to the program on Saturday, March 11, at 9:05 a.m. CST, and follow #MayoClinicRadio.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

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Listen to the program on Saturday, March 11, at 9:05 a.m. CST.

Miss the show?  Here's the Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

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DEAR MAYO CLINIC: Is it true that plantar fasciitis sometimes can be treated with ultrasonic energy? How does that work?

ANSWER: Yes. The treatment you are referring to is called percutaneous ultrasonic fasciotomy, which uses ultrasound technology to treat plantar fasciitis and other soft tissue problems. The treatment is showing promising results in patients who have not gotten relief from standard therapies for persistent plantar fasciitis.

Plantar fasciitis is a common foot problem that involves the thick band of tissue (plantar fascia) connecting the heel bone to the toes. The purpose of the plantar fascia is to support the arch of the foot and act as a shock absorber when you walk, run, jump or otherwise use your feet. If the strain on the plantar fascia becomes too great, small tears can develop in the tissue. Those tears can lead to inflammation and pain. In some cases, these microtears fail to heal properly, leading to degenerative changes, scarring and abnormal blood vessel growth within the tissue.

Plantar fasciitis has many possible causes, including certain types of exercise that put a lot of stress on the feet, such as jogging. Excess weight also can contribute to plantar fasciitis, particularly in overweight people who have been sedentary and then begin an exercise program. In addition, thin-soled or loose shoes, high-heeled shoes, and shoes without enough arch support or flexible padding to absorb shock can increase strain on the plantar fascia, leading to plantar fasciitis. Age also is a factor. As you age, tendons and fascia lose some flexibility and are less able to absorb impact.

To treat plantar fasciitis effectively, the extra stress on the plantar fascia must be relieved, so the tears can heal. For most people, these small tears can be treated successfully with physical therapy and special equipment that gives the foot extra support. A cortisone or other injection also may be considered.

But, for some, this isn’t enough, and finding a solution to the chronic pain and loss of function due to plantar fasciitis can be frustrating. Open surgery to remove the damaged tissue is an option, but recovery often is prolonged, and recurring pain is common.

Fortunately, a minimally invasive treatment is available for patients with plantar fasciitis who otherwise have not found relief. Percutaneous ultrasonic fasciotomy uses the Tenex Health TX tissue removal (debridement) system, which Mayo Clinic doctors helped develop. The procedure, which can be done in a doctor’s office, can be used on elbows, shoulders or other places where tendinopathy (irritation in the tendons) may develop, as well.

Here’s how it works. Before the procedure, imaging tests — such as ultrasound or MRI — are done to determine the location and extent of the degenerated tissue. Once the specially trained physician has a clear picture of what’s going on, her or she numbs the skin over the area and makes a small incision ─ just large enough to insert a needle-like probe.

The physician then inserts the probe into the opening, guided by ultrasound imaging. The probe’s oscillating tip produces ultrasonic energy, which breaks down the damaged tissue directly ahead of it. At the same time, a built-in inflow-outflow fluid system simultaneously irrigates and sucks up the broken down, or emulsified, tissue. Once all of the degenerated tissue is cleared away, the probe is removed, and the incision is closed with adhesive skin tape and a pressure bandage. The whole procedure takes only a few minutes, and complications are few.

After the procedure, patients must rest the area for several days and may need crutches or a walking boot to relieve pressure on the foot. But, they usually can get back to their regular routine within a week to 10 days, although it might take several months before returning to the activity that prompted the plantar fasciitis. Improvement continues as the tissue heals. Some people may benefit from additional physical therapy.

The procedure may not be appropriate for patients who have a complete tear in the fascia, but those with plantar fasciitis that hasn’t responded to initial treatment should talk to their doctor about all of their treatment options, including ultrasonic fasciotomy. — Jay Smith, M.D., Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota

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October 14, 2011

Dear Mayo Clinic:

Are there any tried-and-true treatments for plantar fasciitis?

Answer:
Plantar fasciitis is a common foot problem that involves tiny tears in the thick band of tissue (plantar fascia) that connects the heel bone to the toes. Although there's no one-size-fits-all approach, the heel pain that results from plantar fasciitis usually can be successfully treated with physical therapy and special equipment that gives the foot extra support.

The purpose of the plantar fascia is to support the arch of the foot and to act as a shock absorber when you are walking, running, jumping or otherwise using your feet. If the strain on the plantar fascia becomes too great, small tears can develop in the tissue. Those tears can lead to inflammation and pain.

Plantar fasciitis has many possible causes. Certain types of exercise that put a lot of stress on the feet can lead to this disorder. For example, it's often seen in long-distance runners or ballet dancers. Excess weight can be a factor, particularly in overweight people who have been sedentary and then begin an exercise program.

Shoes can be part of the problem, too. Loose, thin-soled shoes, and shoes without enough arch support or flexible padding to absorb shock can increase strain on the plantar fascia. Regularly wearing shoes with high heels can also cause strain on the tissue around the heel and lead to plantar fasciitis.

To effectively treat plantar fasciitis, the extra stress on the plantar fascia must be relieved so the tears can heel. That can be accomplished in several ways. First, and probably most important, is to meet with a physical therapist who can show you a series of exercises to stretch the plantar fascia and strengthen your lower leg muscles, which stabilize your ankle and heel. Doing these stretching exercises regularly and consistently is critical to successful long-term treatment of plantar fasciitis.

Second, a variety of equipment is available that can help provide extra support the foot needs as it heals. In some cases, wearing athletic tape to support the bottom of your foot during the day may be useful. At night while sleeping, you may need to wear a splint that stretches your calf and the arch of your foot. Regularly using arch supports that fit into your shoes or wearing shoes with built-in extra support may also be helpful.

Although it may take several months or more, in many cases these approaches are enough to relieve the symptoms of plantar fasciitis. Depending upon what caused your plantar fasciitis, you may need to continue wearing arch supports or special footwear long term to help ensure that the condition doesn't return.

A cortisone injection may also be considered in chronic or acute cases with associated bursitis. An ultrasound guided technique can be considered to ensure accurate placement of the medicine in the area of the tear.

Rarely, in severe cases of plantar fasciitis or in chronic cases that aren't helped with more conservative treatment, surgery may be an option. One procedure involves detaching the plantar fascia from the heel bone. But surgery is typically only used when the pain is severe and all other treatments have failed. Extracorporeal shock wave therapy, which uses sound waves directed at the area of heel pain to stimulate healing,may also be used to treat chronic plantar fasciitis. But research clinical trials have not found this procedure to be consistently effective.

Once plantar fasciitis has been effectively treated, follow a few self-care tips to help keep it from coming back. Consistently wear shoes that have good arch supports. Avoid high heels and don't go barefoot, especially on hard surfaces. Replace athletic shoes regularly; don't wait until they lose their foot support and cushioning. Finally, maintain a healthy weight. All of these steps will minimize the stress and strain on your plantar fascia and help keep it healthy.

— Steven Kavros, D.P.M., Podiatric Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minn.

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