When you wake up in the morning, do you feel stiff and pain in one or both heels? There are a number of causes for heel pain, but plantar fasciitis is one of the most common. 10% of people experience plantar fasciitis at some point in their life and women are more likely to develop it than men. It’s most likely to show up between the ages of 40 and 60.
What is Plantar Fasciitis?
Plantar fasciitis affects the connective tissue band that runs from the heel bone, or calcaneus, to the base of the toes. A plantar fasciitis injury is not due to a sudden injury, but rather to repetitive use, such as repeatedly pounding your feet against the pavement. This explains why the condition is so common among runners, although it can affect anyone. Some people because of their occupation or the way their food is shaped are at higher risk of plantar fasciitis.
Risk Factors for Plantar Fasciitis
Certain factors increase the risk of plantar fasciitis. You may be at higher risk if you have flat feet, high arches, or tight hamstring muscles. The ligaments in your feet are also put under higher stress by being overweight or obese.
You can develop plantar fasciitis from running, jumping, or other athletic activities, especially if you do them on a hard surface or wear inappropriate shoes. But you’re also at higher risk if you spend more time standing on your feet or have a job that requires prolonged or frequent standing.
Functional and anatomical factors play a role in plantar fasciitis too. Limited ankle mobility, especially problems with ankle dorsiflexion increases the odds of developing plantar fasciitis. Ankle dorsiflexion is the act of bringing your foot upwards towards your shin. This is often caused by weak or overly tight muscles or tendons around the ankle. Your calves might be playing a role too. Weakness or tightness in the calf muscles, especially the gastrocnemius, boosts the odds of heel pain from plantar fasciitis too. People with plantar fasciitis tend to overpronate or roll their feet inward too much.
In terms of anatomy, being flat-footed or having an unusually high arch both places added stress on the ligament and hasten the development of plantar fasciitis. A discrepancy in leg length, one leg longer than the other, places added stress on the longer leg when you walk or run. Over time, this can damage the fascia. The fat pad that protects the heel also becomes thinner with age and this increases the trauma the plantar fascia sustains each time you take a step.
Why do these activities cause plantar fasciitis? An excessive amount of stress on the long ligament in the bottom of your foot can lead to micro-tears, tiny fissures in the connective tissue that makes up the ligament. While inflammation is sometimes cited as an underlying cause of plantar fasciitis, many experts believe thickening and degradation of the connective tissue are more likely culprits. For this reason, anti-inflammatory medications are not always effective for treating heel pain from plantar fasciitis.
Plantar fasciitis can become chronic unless you make lifestyle changes that reduce the stress on the plantar fascia.
How Do You Know Your Heel Pain is Plantar Fasciitis?
Plantar fasciitis produces distinctive symptoms that make it easy to diagnose. Heel pain is usually worse in the morning when you first place your feet on the ground. The pain also flairs upon taking the first few steps after sitting for a while. Once you start running or walking, the heel pain typically improves after 5 minutes or so and then shows up again after you stop running or walking. Standing for a prolonged time also makes the pain worse.
Even if you believe you have plantar fasciitis, it’s still a good idea to check with your physician, especially if you’ve had a recent injury. If you have numbness or tingling in your feet or toes, your symptoms may be due to an entrapped nerve or tarsal tunnel syndrome. Another possibility, if you do a lot of running, is a stress fracture. Foot x-rays are normal with plantar fasciitis.
Managing Plantar Fasciitis
Plantar fasciitis can hang around for a while, up to a year in some cases. Some doctors prescribe non-steroidal anti-inflammatory medications (NSAID) but, as mentioned, they may not be effective since the cause isn’t inflammation but degeneration of the fascia. Applying ice to the heel can help though.
It’s best to cut back on high-impact exercise and exercise on softer surfaces. Invest in an athletic shoe that has a thick, cushioned sole. Orthotics, inserts you place in your shoes to reduce stress on the heels, may also be helpful. Some healthcare providers also recommend wearing a splint on the affected foot at night.
Once the pain calms down, start doing dynamic Achilles stretches. One approach that works for many is to roll the bottom of your foot over a tennis ball in a slow and controlled manner. To stretch your Achilles’ tendons, place the midpoint of a towel over the bottom of your foot and hold the two ends with your hands. Then gently pull each end to stretch the tendon. Afterward, apply ice.
If the heel pain from plantar fasciitis persists after doing the above, you may need more advanced treatment. Some medical approaches to treating persistent plantar fasciitis include:
- Corticosteroid injection into the heel
- Extracorporeal shock wave therapy
- Platelet-rich plasma injection
- Surgery
The Bottom Line
Plantar fasciitis is a common cause of heel pain that can become chronic. But here’s the good news! Eight out of ten cases of this frustrating condition get better without advanced treatments. Still, a consultation with a podiatrist, sports medicine doctor, or another knowledgeable healthcare provider will help you speed up the healing process and prevent future episodes of heel pain.
References:
- “Plantar fasciitis – ncbi.nlm.nih.gov.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687890/.
- Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003 May;85(5):872-7. doi: 10.2106/00004623-200305000-00015. Erratum in: J Bone Joint Surg Am. 2003 Jul;85-A(7):1338. PMID: 12728038.
- “Plantar fasciitis: A review of treatments : Journal of the ….” https://journals.lww.com/jaapa/Fulltext/2018/01000/Plantar_fasciitis__A_review_of_treatments.4.aspx.
- “Analysis of Data on the Prevalence and Pharmacologic ….” 27 Mar. 2018, https://www.nccih.nih.gov/research/research-results/analysis-of-data-on-the-prevalence-and-pharmacologic-treatment-of-plantar-fasciitis-pain.
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