Plantar fasciitis involves the inflammation of plantar fascia ligament. It is a common source of pain at the bottom of your heel or foot.
Plantar Fasciitis Anatomy
The plantar fascia is a long, thick bowstring-like ligament that runs along the bottom of your foot and connects the toes to heel bone. It acts as a shock absorber that supports the arch of your foot and helps you walk.
Plantar fascia lacks blood supply and metabolic activity. As a result, overexertion or wear-and-tear of this ligament can cause microtears to form, leading to inflammation and pain in the heel – a condition termed “plantar fasciitis.”
Plantar Fasciitis Causes
There are several causes and risk factors of plantar fasciitis.
Certain types of exercise
Plantar fasciitis typically occurs in sports-related activities that involve running or jumping. Repetitive straining can cause the plantar fascia to become inflamed or irritated. If the stress on the plantar fascia becomes too intense, microtears can arise in the plantar fascia.
Runners commonly develop plantar fasciitis. While running, the runners land on the heels before shifting the weight to the heel of the other foot. This action causes the plantar fascia to strain. A sudden increase in running distance and intensity can also lead to plantar fasciitis.
Foot mechanics and footwear
Plantar fasciitis is common in people with abnormal foot mechanics – flat feet, high arches – or poor footwear choices. A tight Achilles tendon or an abnormal walking pattern may also result in plantar fascia pain.
Make sure you get proper shoes that match your actual foot and biomechanics. Avoid shoes with soft soles and poor arch support.
Age and gender
Plantar fasciitis is the most common between the ages of 30 and 70.
It is more common in women.
Excess weight can put stress on your plantar fascia. You’re at a higher risk of developing plantar fasciitis if you’re overweight. This is due to the abnormally intense pressure on your plantar fascia ligaments.
Women often experience plantar fasciitis during pregnancy, particularly in the third trimester.
Occupations that keep you on your feet
Factory workers, restaurant servers, teachers, and others who spend long work hours walking or standing on hard surfaces can damage their plantar fascia. You will be at risk if you have a job that requires you to be on your feet often.
Plantar fasciitis can also be caused by underlying conditions, including reactive arthritis and ankylosing spondylitis.
Plantar Fasciitis Symptoms
Plantar fasciitis commonly causes stabbing pain and tenderness in the bottom of your foot near the heel. Some people may feel pain at the bottom mid-foot area. It may be difficult to run or walk on hard surfaces.
The pain is usually worse after prolonged exercise or activity, not during it.
Plantar fasciitis can make the foot feel particularly stiff and tender in the morning or after a long period of rest. Climbing stairs can be challenging due to heel stiffness. As you move around, the pain usually decreases, but it might return after long periods of standing or after rising from sitting.
Plantar fasciitis takes some time to heal – anywhere from months to years. Once it’s irritated, it’s pretty stubborn. Ignoring plantar fasciitis may culminate in chronic heel pain that can change the way you walk. You may also feel pain in your foot, knee, hip, and back.
Plantar Fasciitis Diagnosis
Your doctor will diagnose according to your physical examination and medical history. After you discuss your symptoms and concerns, your doctor will examine your foot. Your doctor can generally tell if you have plantar fasciitis just by checking for tender areas in your foot. Your doctor may request you to flex your foot while they push against the plantar fascia to see if the pain worsens as you flex. They’ll also note if there are any redness or swelling.
Your doctor will look for these signs:
- A high arch
- An area of tenderness on the bottom of the foot, in front of the heel bone
- Pain that worsens as you flex the foot. The pain improves when you point the toes downwards.
- Limited “up” motion of the ankle
Your doctor will evaluate the muscles and nerves by checking your:
- Muscle tone
- Sense of touch and sight
Usually, no further testing is necessary. X-ray testing and MRI may be ordered to rule out other causes of heel pain, such as hell spurs, fractures, or tumors.
Plantar Fasciitis Treatment
Most people with plantar fasciitis recover by using conservative treatments, including rest, ice, and taking an anti-inflammatory medication along with stretching exercises. There are a few options to ease the pain and inflammation in your foot.
Pain relievers such as ibuprofen and naproxen can ease the pain and inflammation associated with plantar fasciitis. But make sure you don’t take more than recommended and be aware of how they can interact with other medications.
Injecting cortisone into the plantar fascia area can provide temporary pain relief. It may help ease your pain for approximately a month.
Your doctor may limit your injections. Multiple steroid injections aren’t recommended because they can weaken your plantar fascia and potentially cause it to rupture, which can lead to a flat foot and chronic pain.
A physical therapist can guide you in a series of exercises to strengthen the plantar fascia, Achilles tendon, and the lower leg muscles (1). They may also teach you how to apply athletic taping to support the bottom of your foot.
The physical therapy program may focus on specialized exercises, ice treatments, massage, and medication to decrease inflammation around the plantar fascia. Your physical therapist may use massage, contrast baths, or ultrasonography to help with long-term healing.
Extracorporeal shockwave therapy (ESWT)
During the ESWT procedure, high-energy sound waves are directed at the area of heel pain to stimulate the healing process. It stimulates blood flow to the foot and helps the tissue heals. It also stuns your nerves to stop the pain.
Some studies show promising results, but it isn’t consistently effective. Side effects of this procedure might cause bruising, swelling, pain, numbness, or tingling.
Transcutaneous electrical nerve stimulation (TENS) therapy relieves plantar fasciitis pain by transmitting a low-voltage electric stimulation. It’s a non-invasive treatment that can be done by a professional or on your own with a TENS unit.
Tenex minimally invasive procedure removes the scar tissue of plantar fasciitis without surgery. An ultrasound is used to target the affected area and eliminate scar tissue. The process is usually over in a few minutes. This procedure allows you to return to your routine in as little as ten days.
Few people require surgery to detach the plantar fascia from the heel bone. It’s the last resort if you have severe pain or a stubborn injury that conservative treatments fail.
Plantar Fasciitis – Lifestyle and home remedies
Home treatments may resolve plantar fasciitis, primarily if you treat it early. While it’s unlikely to heal plantar fasciitis in one week, you can improve your foot alignment sooner with lifestyle modifications.
Rest and activity modification
If overuse causes your plantar fasciitis pain, rest is one key to recovery. It’s essential to keep weight off your foot until the inflammation goes down, especially if you regularly do high-impact sports.
Avoid athletic activities where your feet pound on hard surfaces (for example, running or step aerobics). Give your feet a break to reduce inflammation and let your plantar fascia heal. While you recover, try a low-impact activity, such as swimming.
Our feet tend to point downwards as we sleep. This position relaxes and shortens the plantar fascia and Achilles tendon, which is a common reason for morning heel pain. A night splint braces the foot in a flexed position and stretches the plantar fascia while you sleep.
Although it can be bulky and difficult to sleep with, a night splint is very useful. You do not have to be used once the pain is gone.
Custom-made or over-the-counter orthotics can help alleviate pain by redistributing pressure to your feet evenly. Also called arch supports, inserts or insoles, they can give you extra cushion and added support. When you choose an orthotic, remember that firmer is better – and make sure it has excellent arch support. You should be able to stop wearing the orthotics after a few months.
A boot cast may immobilize your plantar fasciitis to reduce strain while it heals. It can also gently stretch the plantar fascia at night while you sleep. When you get up and move about in the morning, the gentle stretch overnight helps to prevent plantar fascia pain.
These heel-shaped pads raise your heel to relieve tension. They also provide extra cushion.
Kinesiology tape can support your foot and keep you from moving it in a way that makes plantar fasciitis worse.
Use your thumbs to massage your heels and arches. Work from the balls of your feet up to the heel.
Deep tissue massage is a finger-pressure technique that loosens the muscle tissues, reduces scar tissue, removes muscle toxins, and ensures proper blood circulation.
You may also add a few drops of essential oil to a warm foot bath.
Cannabidiol (CBD) may have analgesic effects that can ease plantar fasciitis pain and inflammation.
The best CBD products for plantar fasciitis include:
- CBD capsules. A convenient way to take regular doses of CBD, pills are effective but take slightly longer to affect due to the digestive and metabolic processes that are involved.
- CBD oil tinctures. CBD can be given sublingually in the form of oil tinctures. It has a faster absorption rate because it bypasses the digestive system and goes into the blood directly. Effects can be seen within minutes.
- CBD edibles. Edibles, such as gummy bears, is a tasty alternative to capsules and oil form. They do, however, require a longer time to be absorbed into the bloodstream because of the digestive and metabolic processes involved.
- CBD vaporizers. Vaping CBD is the fastest way to obtain its therapeutic effects. Your lungs can quickly absorb the CBD that you inhale. It is preferable for individuals who want prompt results.
Plantar Fasciitis Prevention
Once your foot is less painful, you can make a few lifestyle changes to help keep plantar fasciitis from coming back.
Maintain ideal weight
Lose weight to minimize stress on the plantar fascia. Work with your clinician to come up with a long-term plan that focuses on a balanced diet and regular exercise.
Choose supportive shoes
Don’t go barefoot, especially on hard surfaces. Keep some supportive footwear by your bedside. Shoes with thick soles and extra cushion can reduce strain on the plantar fascia. Avoid high heels or flat shoes. Find proper shoes that fit your actual foot biomechanics.
Don’t wear worn-out athletic shoes. Replace your athletic shoes often. If you’re a runner, you should replace running shoes every 400 to 500 miles of use. Non-runners should replace athletic shoes every six months or son, depending on how often you wear them. Signs that you need a new pair:
- Wear on the outsoles
- Stretching of the heels
- Molding of the insoles to the shape of your feet
- Breakdown of shoe interior
- New blisters forming on your feet
- New pain in your feet, legs, or back
Sports shoes with soft, cushioned soles can help reduce irritation or inflamed tissues from plantar fasciitis.
The compression from plantar fasciitis socks can be very beneficial and decrease pain in the short term. Plantar fasciitis socks are often used to reduce inflammation and to decrease swelling in the arch of the foot.
Change your sport
Avoid high-impact activities, including jumping and running, which put undue stress on your feet and can tighten your plantar fascia. Opt for a low-impact sport, such as swimming or bicycling instead.
After you’re done with the workout, stretch out your calves and feet. Curl and relax your toes and make circles with your feet and ankles.
Tight muscles aggravate plantar fasciitis in your feet and calves. Stretching your calves and plantar fasciitis is the most effective way to relieve the pain that comes with this condition. Simple home stretches can help ease pain, stabilize your ankle, and prevent plantar fasciitis from recurring.
Plantar fascia stretch. While seated, cross your affected foot over your other leg. Grasp your toes with the hand on your affected side and slowly pull the toes toward your shin until a stretch is felt; hold for a count of 10. Repeat it 20 times for each foot. This exercise is best performed in the morning before standing or walking.
Calf stretch. Lean towards a wall with one knee straight. Place the other leg in front, with bent knees. Push your hips toward the wall slowly. Hold the position for 10 seconds. Repeat 20 times for each foot.
Achilles tendon stretch. Stand with your affected foot behind your normal one. Point the toes of the back foot toward the heel of the other foot while leaning into a wall. Bend the front knee and keep while keeping the back knee straight with your heel firmly planted on the floor. Hold for a count of 10.
Swimming and other water sports. These low-impact exercises exert no direct pressure on your feet, and water therapy can help reduce the inflammation caused by plantar fasciitis.
The Bottom Line
Plantar fasciitis tends to improve through physical therapy, self-treatments, and medication.
If treatment isn’t working, get help. Your doctor will make sure the pain you’re feeling is from plantar fasciitis – and not due to other factors that are causing pain in the bottom of your feet.