It usually shows itself when you get out of bed. You put down a foot and ow! feel a burning pain in your heel. After walking around a little while, you notice the pain has gone away. For now.

You have become one of the millions of people suffering from plantar fasciitis (fash-e-i'-tis), an inflammation of the fibrous tissue that forms your arch.

It's the same sort of problem that people run into with tennis elbow-- except for how you recover. For while you can rest your left arm for a while, it's hard to rest your foot for long. Treating plantar fasciitis may take several months, or more.

"It's a frustrating problem for the patient, and for the physician, because everyone wants the condition to go away yesterday. But the recovery is prolonged, because you just can't completely rest your foot and remain active," says Dr Nancy Kadel, assistant professor of orthopaedics at the University of Washington School of Medicine. She practices at UW Medical Centre's Bone and Joint Centre.

The plantar fascia is tissue about the thickness of a tie, stretching between the heel and the base of your toes. It is stretched tight. By comparison, pinch the skin on the back of your hand. You can likely get it to lift. Now turn your hand over and try to get a pinchful of palm. That's more difficult. The fascia there is stretched tight.

For several reasons (ageing, stress from athletic activities, a change in shoes) the plantar fascia begins to tighten and pull at its attachment to the heel. The resulting swelling and inflammation under the skin cause muscle irritation and scarring. During sleep, while your foot droops, the fascia tries to heal itself. When you wake up and put your foot on the floor, you snap your foot and ankle to a 90-degree angle. Rip. There go the repairs. Here comes the inflammation, which makes the foot hurt. But as muscle and tissue stretch, they become more flexible. The pain will go away for a while.

"It just keeps the cycle of inflammation going. That's one reason it is hard for plantar fasciitis to get better. Every morning, you get up and undo the healing that took place that night," Kadel says.

It's a good idea to see a doctor if the pain is persistent. For one thing, your doctor will want to rule out rarer causes, such as a stress fracture or an arthritic condition. If you do have plantar fasciitis, doctors will first likely advise you to try gentle stretching, at least twice a day. If you feel a stretch on the back of your lower leg, or Achilles tendon, it means you're stretching the right line of muscles.

Here's the most popular exercise: Lean forward against a wall. Keep the knee with the foot you're exercising straight, and step forward and bend with the other knee. Keep the sore heel as flat on the ground as you can. As you lean forward, you will feel your heel and the arch of your foot stretch. Stretch and hold for 10 seconds, then relax and straighten up. Repeat 20 times.

Doctors may also suggest you take an anti-inflammatory medicine, ice the area and elevate your foot.

Then take a look at what you wear on your feet. Kadel advises patients to wear shoes with a soft cushion and rubber sole, such as some kinds of sneakers or hiking boots that don't flex much. Some patients have metal plates inserted into shoes to keep them from flexing. The idea here is that you walk as much as possible without flexing your foot, and minimise the pull on the fascia. Your heel still falls first on the ground, though, so your doctor may suggest a heel pad for your shoe.

When these approaches aren't effective enough, doctors may advise you to wear a night-time splint for as long as several months. It keeps your foot at a 90-degree angle to your leg. While you're sleeping at night, your body heals the fascia in the correct position. To protect those repairs, your doctor might provide a cast that you can wear during the day. Again, the idea is to minimise the flexing of the arch.

Doctors only rarely use surgery to treat plantar fasciitis. One myth about the condition is that heel spurs cause the pain. Heel spurs do sometimes form in the direction of the arch, toward the toes, but the spurs don't press down, don't bear weight and don't usually cause pain, Kadel says. It's the inflammation that hurts.

Health Beat, University of Washington

Date reviewed: 16 February 2000