Plantar fasciitis foot pain is a common yet painful condition that occurs in one or both of the feet.
What Is Plantar Fasciitis?
Plantar fasciitis is a painful and sometimes debilitating condition in which the plantar fascia—the thick band of tissue running from the heel to the front of the foot—becomes inflamed. This broadband of tissue both supports the arch of the foot and absorbs the shocks that occur from the impact of the movement.
Causes of Plantar Fasciitis
Generally speaking, overweight people are at increased risk of developing plantar fasciitis due to the impact that the extra weight has on the muscles and tendons of the foot. Repeated injuries to the tissue can also cause chronic inflammation as can overuse of the plantar fascia or arch tendon of the foot.
There are, however, very specific factors that can be directly linked to an increased risk of developing this potentially debilitating condition.
You are at increased risk if any of the following criteria apply to you:
• If you partake in sports that involve running, dancing, or jumping, especially if you over-pronate (your feet roll in).
• Extremely tight calf muscles are one of the leading causes of plantar fasciitis as this usually causes inward pronation of the feet, so it’s wise to keep these muscles supple.
• Walking extensively in footwear without adequate arch support.
• If you stand most of the time.
• If you suddenly increase the amount of walking, running, or standing that you do instead of gradually acclimatizing yourself.
• Abruptly changing the surface that you usually train on, such as running on the road instead of a treadmill or track.
• Having a tight Achilles tendon will often reduce ankle flexibility and increase the strain and wear and tear on your plantar fascia.
There are many possible contributing factors to the onset of plantar fasciitis but can also sometimes occur without any apparent cause, particularly in the elderly.
Who Usually Gets Plantar Fasciitis?
Plantar fasciitis affects roughly 1 in 10 people over the course of a lifetime, which means that it’s really not that rare. It is most common in athletes and people between 40 and sixty years old, and it is more frequently seen in women than men.
Common Symptoms of Plantar Fasciitis
Feelings of pain or discomfort in the heel of the foot are usually the primary symptoms of plantar fasciitis. The sensation usually radiates from one central spot though there may be tenderness along the arch as well. There may also be a ‘hot’ or ‘burning’ sensation in the heel in particular, or the foot in general.
Sufferers often experience increased pain upon waking in the morning as the fascia may have tightened up during the night. The discomfort will likely decrease as the muscles of the foot and leg warm up with use.
Sudden stretching of the fascia may provoke bursts of pain as well; sufferers have commonly reported an increase in discomfort when standing on tippy-toe or when walking up the stairs, both of which put a strain on the arches of the foot.
It is possible to have plantar fasciitis in both feet, especially if the sufferer has unusually high arches.
Diagnosing Plantar Fasciitis
Having your doctor perform a physical exam is the best way to determine if you are suffering from plantar fasciitis. You will likely be examined while sitting, standing, and walking, and an x-ray or ultrasound may be performed to rule out other causes for your pain. It’s important to talk to your doctor about your daily routines and inform him if you stand for long periods of time or participate in high-impact sports.
The examination may also reveal the presence of a heel spur, which indicates that your plantar fascia has been under strain for a long period of time. It is not completely understood how or why these two conditions are linked but it’s possible to have a spur and still remain pain-free.
‘Conservative’ Treatments for Plantar Fasciitis
The pain of an inflamed fascia will usually heal on its own but the process usually takes time. It’s not unusual for the healing process to take several weeks or even several months, depending on the severity of the injury. There are, however, several non-invasive treatments that can be performed on their own or in combination that can alleviate pain and may help to speed up the recovery process.
Wear Supportive Shoes
Going barefoot is not recommended; shoes with cushioned heels and good arch support should be worn as much as possible. A closed-in shoe will give more support than a sandal minimally structured footwear will, and old or worn shoes should be avoided at all costs.
Use Heel Pads and Arch Supports
Heel pads and arch supports can be easily and cheaply purchased at the pharmacy or a department store. The pads are designed to cushion your heel, and supporting the arch of your foot ensures an even distribution of pressure. These tools work best when kept in the shoe at all times. If you’re still experiencing heel pain you can cut a tiny hole in the heel pad to relieve friction on the pressure point while protecting the tender spot from coming in contact with anything inside of the shoe. Both shoes should be fitted with pads and support even if you are experiencing discomfort in one foot only.
Over the counter pain killers containing ibuprofen or acetaminophen will often temporarily ease discomfort because of their anti-inflammatory properties, but they are not a good long-term solution. Self-medicating can be dangerous and instructions and warnings should be followed precisely.
Ice Pack and Elevation
An ice pack applied to the heel for 10 to 20 minutes immediately after walking will reduce both the discomfort and the subsequent inflammation that may result. Wrap the ice pack (or a bag of frozen vegetables) in a towel before applying it to the skin. When you are finished icing be sure to elevate your feet for as long as possible.
Resting the foot should be a priority. This means no running, jumping, or excessive standing and walking during the recovery period. You should also avoid any sudden or unnecessary stretching of the sole during this time. The only exception is performing the recommended exercises below.
Perform Specific Exercises
Gently stretching your Achilles tendon may help ease your discomfort by releasing the tightness in the tendons, which are likely pulling at the back of your heel and keeping your plantar fascia tight. Also, the plantar fascia tends to tighten up overnight, so a gentle stretch will help the fascia to warm up and therefore loosen up. Your doctor may give you a referral to a physiotherapist if your case is severe, otherwise, try the following exercises and see if they help to ease the pain:
• Stand on the bottom step of a staircase with your feet shoulder-width apart and hold the railing for support. Let your heels dangle off the edge of the step. Gently lower your heels while keeping the knees straight. You should feel a stretch in your calves but you should not feel any pain. Hold the stretch for 15-20 seconds, and then relax. Repeat 6 to 8 times. If you can, perform this exercise twice daily.
• Sit on a towel or rug on the floor and stretch out your legs. Take another towel and loop it around the balls of your feet. Keep your knees straight as you gently pull your toes back toward you. Hold the stretch for 10-20 seconds. Repeat 6 to 8 times once daily.
• Sit on a chair with your feet flat on the floor. Lift your toes and the front of your foot upwards but keep your heels on the floor. Hold the stretch for 10-20 seconds and then relax. Repeat about 10 times 4-5 times daily if possible (at least try to get in a few stretches whenever you’re sitting down.)
• Sit in a chair and place a rolling pin, soda can, or small rubber ball beneath the arch of your foot. Roll your arch over the object in all directions, giving it a good massage. Try to do this exercise on each foot for a few minutes 2 or 3 times daily.
Note: Some suffer find relief in wearing a special overnight splint that keeps their Achilles tendon and plantar fascia slightly stretched to prevent the plantar fascia from tightening up overnight. In extreme cases a plaster cast or temporary brace is used on the lower leg to provide protection, cushioning, and stretching of the fascia and tendon, however, the benefits of this type of treatment have never been conclusively proven and they can be quite inconvenient to wear.
Medical Treatments for Plantar Fasciitis
If conservative treatments do not help to relieve symptoms or advanced treatment is needed for a quick recovery more invasive methods may be proscribed by your doctor. Here is a list of possible treatment options, in no particular order:
Steroid injections are used in an attempt to reduce severe pain, however, success is not guaranteed and the shot itself can be quite painful. Although a cortisone shot may temporarily reduce inflammation it is not a permanent solution and it carries the very rare risk of rupturing the plantar fascia. Several shots may be administered over a period of weeks if the initial treatment does not work.
Extracorporeal Shock-Wave Therapy
In this type of therapy, the ESWT unit is used to deliver a very intense, very brief wave of energy through the skin to the affected area. The scientific process behind the therapy is quite complex and is not yet fully understood, but doctors suspect the energy wave is able to deliver enough force to break down calcified deposits found in soft tissues.
Many recipients of this type of treatment reported a reduction in pain several days after treatment; however, some clients also experienced discomfort such as reddening or bruising of the skin and swelling of the feet. This is a very new treatment that needs to be refined and studied more carefully although it seems very promising.
Surgery is usually only considered for advanced or difficult cases where the pain is still present one year into treatment and when all other options have been exhausted. Surgery carries several risks and a successful outcome is not guaranteed. When surgery is performed the affected tissue is removed from the plantar fascia by creating an incision in the heel. Complications such as infection, injury to adjacent nerves, or a shortening of the plantar fascia can occur. Surgery truly is the last resort treatment for plantar fasciitis foot pain.
Current studies and trials are underway to try and find better and more effective solutions to treat plantar fasciitis, including experiments with injections of the botulinum toxin and the use of radiotherapy. These treatments are not widely available as they are still in the research and trial stage.
Prevention Methods for Plantar Fasciitis
There are several steps that can be taken to prevent the onset and/or reoccurrence, of plantar fasciitis. These steps include, but are not limited to, the following suggestions:
• Make sure you are not wearing old sneakers when running or exercising. Shoes should be changed every 3 to 5 months depending on your level of activity.
• Wear shoes with good cushioning in the heels.
• Try to purchase shoes with good arch support, otherwise, invest in removable inserts.
• Maintain a healthy weight.
• Stretch your plantar fascia and Achilles tendon regularly by using the exercises above, especially if you are active.
• Do not run or exercise on hard surfaces.
• Increase your level and intensity of exercise gradually; do not shock your body with new and unexpected pressures.
With proper care and attention, most cases of plantar fasciitis will heal within a year using non-invasive treatments. Difficult cases, however, may require medical intervention. Preventing plantar fasciitis foot pain is crucial, and if you suspect that you are suffering from this affliction the best thing to do is get it checked by your doctor and begin experimenting with conservative treatments.