If you haven’t experienced the pain associated with plantar fasciitis, chances are you know someone who has. Plantar fasciitis, sometimes called plantar fasciosis, is a painful foot condition that affects one in ten people during their lifetime.
Plantar fasciitis pain is constant, but it is most obvious and intense first thing in the morning. Melanie Votaw, a freelance writer in New York City, began feeling some plantar fasciitis pain in her right foot over a year ago. It seemed to ease off after a while, she said, but then it came back with a vengeance.
“I got up one morning and I almost jumped through the roof,” she recalled.
The Mechanics of the Plantar Fascia
The plantar fascia, a thick band of tissue, runs from the base of your toes, along the bottom of your foot to the heel bone. This band supports the arch in your foot, and it helps you walk by supporting the heel-to-toe movement and the push off the ball of your foot when you take a step. If you overuse your foot, or suddenly increase your activity, the stress on the band increases and the plantar fascia can become irritated, causing pain.
“Anyone can get plantar fasciitis,” said Dr. Janice Johnston, chief medical officer and co-founder of Redirect Health. “But it does seem to occur more among people over forty.”
Risk factors for developing plantar fasciitis include running, spending a lot of time on your feet, and being overweight, she added. “People with a tendency towards flat feet or high arches can also have some additional stress [on their feet].”
Jasmine Marcus, a physical therapist in New York City, frequently works with people who have problems with their feet and many have plantar fasciitis.
“It’ll happen in someone who had a big increase in activity,” Marcus said. “That could mean they didn’t do much all winter and, suddenly, they start playing golf and walking the whole course several times a week. Or they start a brisk walking exercise program or exercise with big jumps in weight-bearing activities.”
How Do You Know If You Have Plantar Fasciitis?
Plantar fasciitis symptoms are pretty typical. The pain usually starts gradually, but it can come on quickly for some people. The worst pain is felt around the heel and is most noticeable in the morning, when you first get out of bed or if you have been sitting for extended periods and you take those first steps. The pain can also worsen if you walk with bare feet or shoes that don’t have arch support.
“When I wake up in the morning, I can barely hobble until I do my stretches,” said Diane S., a retiree in Maryland who has been living with plantar fasciitis for about 10 years.
Even if you’re sure it is plantar fasciitis, it’s always good to see a doctor or podiatrist for a diagnosis because similar foot pain could be caused by nerve compression, a stress fracture, or even decreasing fatty tissue under your heel. Your doctor or podiatrist may suggest an x-ray to rule out these problems.
Managing the Condition
The longer you have plantar fasciitis, the more challenging it can be to treat. And leaving it untreated could lead to other problems as your body tries to cope with you not putting much weight on your painful foot.
“[The pain] can become so significant that it can start to affect your activities of daily living and your ability to be active,” Johnston said. “It can affect your gait, and when your gait is off-course, you can have ankle pain, knee pain, back pain — it can go up and down the line.”
Marcus adapts her patients’ treatment plan according to the cause. If the condition was the result of overuse, she advises the patients to reduce or limit the activity that triggered the pain or use orthotics to help support the foot.
“A lot of people will benefit from orthotics, which changes the way they’re hitting the ground,” she explained. In addition, there is manual therapy to help stretch the band and strengthen the foot.
Diane still does her stretches every day. One involves standing on a step with her heels over the edge. She then drops her heels and puts her weight on them, stretching out for at least 30 seconds. Good supportive footwear has also helped her.
“My podiatrist gave me a list of recommended shoes, like tennis shoes, which is what I wear ninety percent of the time now,” she said.
Diane recommended going to a specialty running shoe store where the staff can suggest different makes and models that support your own feet. Not all brands are the same and what might fit one person well might not be so comfortable for another. She also has custom orthotics, which she wears in her hiking boots.
When Votaw first started feeling the pain, she asked friends if they had plantar fasciitis and if so, what did they do? One suggested a special boot to wear at night to keep her foot in a neutral position while she slept. The day after she first used the boot, the super intense morning pain went away, she said, leaving a lingering pain.
Before getting her orthotics, Votaw also used a strap to support her arches, which she found helpful. She started seeing a physical therapist who worked on her foot and taught her some exercises, like picking up marbles with her toes. “It was a very good exercise,” she said.
It did take several months for the pain to resolve for Votaw. And she still uses her boot, even bringing it with her during a recent trip to Europe.
“Because I know what to do now, I can keep it from getting really awful again,” she said.
Using the boot, massaging her foot, and doing the stretching exercises helped, especially when she started to feel a bit of heel pain because of all the walking she did during her vacation.
Preventing Plantar Fasciitis
It may not always be possible to prevent plantar fasciitis, but you can take steps to reduce your risk, especially if you’ve already had it once.
“I always recommend that patients freeze a bottle of water. They can run their foot up and down the bottle while they’re working at their computer or watching TV, that kind of thing,” Johnston said. “And try to avoid wearing flats and walking around barefoot.”
Over-the-counter shoe inserts can help provide good support, and home stretches are also helpful. “There are some simple home stretches that people can do to stretch the bottom of the foot, the Achilles tendon, and the calf muscles,” she said.
Diane suggested doing the stretches multiple times a day. “If I’m standing around, I’ll pause and do some of my stretches,” she said.
If stretching, orthotics, braces and changing activities don’t provide good relief from the pain, it may be time for medical treatment. Shock wave therapy sends energy waves to the plantar fascia to promote healing. However, the jury is out as to how effective the treatment is.
Other treatment options include ultrasound or injecting steroid medication. But the drug only provides temporary relief and it shouldn’t be given too often as repeat steroid injections could weaken the tissue, potentially causing other problems. Surgery is a last resort treatment and is rarely done. For people who have extreme pain though, surgery to release the plantar fascia from the bone may provide pain relief.
Plantar fasciitis is common, but because of the many treatment options, it doesn’t have to limit your activities. If you think you have plantar fasciitis, make an appointment with your doctor or podiatrist. If you know you have the condition, you can see a physical therapist, who can advise you about how best to manage it.