We walk, run, climb, hike, and jump. Our daily work routine involves numerous activities that use our feet. Over time, wear and tear in the bottom of the feet due to friction, overuse, and injury may cause pain and inflammation. One such cause of foot pain is plantar fasciitis—which is an inflammation of the plantar fascia ligament. This band of flexible tissue is located under the arch of the foot, which connects heel with the toe. Usually, the pain is more severe when you wake up in the morning and take your first step.
Plantar fasciitis is one of the most common causes of heel pain in people with:
- Flat feet
- Tight Achilles tendons
- High arches
Besides these, people who work in a standing position or wear defective shoes are also prone to develop plantar fasciitis. Most of the time, the pain affects one foot, but may also be in both feet—based on your specific condition.
Plantar fasciitis is also most common in people who exercise most often and run frequently. For running, workout, and exercise, make sure you wear the right kind of shoes with thick, supportive soles. With proper care and support, you can recover from plantar fasciitis within a few months. However, if the pain becomes severe with time and you don’t see any improvements, consider talking to your doctor.
What are the Symptoms of Plantar Fasciitis?
People with plantar fasciitis usually complain about a stabbing pain below the arches, and in front or in the middle of the heel. But over time, the pain may extend to one or more areas of the foot or even may limit to just one place. For some people, the pain may be dull, while for others, it’s a sharp, stabbing one. Usually, people experience pain first thing in the morning after they take their first step. Many patients also report pain right after they complete their daily strenuous activities, which involve walking or standing on feet for too long. People who hike or run a lot may also experience pain after a short or long break.
After prolonged activity, the pain can flare up due to increased inflammation. It’s not usually felt during the activity but rather just after stopping or taking a break.
Some of the main symptoms of plantar fasciitis are:
- Pain in the heel
- Stiffness in the feet
- Mid-foot area pain
Fascia ligament supports your arches and absorbs shock when you’re walking or performing an activity with heavy load on your foot. This overburdens the ligament and results in plantar fasciitis.
“Most of the time, symptoms occur where the ligament attaches to the heel,” says Paul Greenberg, DPM, and foot & ankle surgery specialist at NYU Langone in New York City.
Earlier, plantar fasciitis was associated with heel spurs, which is a condition of calcium deposit on the heel bone. However, research suggests that heel spurs might be caused by plantar fasciitis but not vice versa.
Plantar fasciitis can cause a lot of difficulties related to movement. Because of the stiffness and tenderness of your foot, you may not be able to walk or run properly. Some of the rare symptoms of plantar fasciitis include swelling and numbness in the feet.
Sometimes the symptoms associated with plantar fascia ligament may be more severe. If that’s the case, there are chances you have an actual rip of the plantar fascia, which is called plantar fascia rupture. Symptoms include severe pain in the bottom of the foot and a sensation of tearing or popping in the arch.
Are you at Risk for Plantar Fasciitis?
It depends on your daily activities and lifestyle. If you’re a hardcore runner or someone who runs and trains most often, there are chances you may develop plantar fasciitis. Some people who stand or walk on hard surfaces for too long have also reported pain and inflammation associated with plantar fasciitis. In most of these cases, high pressure or load that causes tension in the foot affects the fascia.
Risk Signs of Developing Plantar Fasciitis
Age – Most people who develop plantar fasciitis are aged between 40 to 60. There are many reasons why older people are more prone to the condition. For example: with old age, the flexibility of fascia is greatly reduced, and it becomes stiff because of degeneration. That’s why the fascia can’t support and absorb heavy loads. Even a little tension in the fascia region may cause tears and ruptures, leading to plantar fasciitis. It’s better to get support and walk carefully.
Gender – Generally, women are at greater risk of developing plantar fasciitis than men. The nature of responsibilities and burdens they carry makes them vulnerable to plantar fasciitis. For example, during pregnancy, they quickly gain weight, which puts an extra burden on their body and especially on their feet. Their fascia gives up on the load and tension, which results in plantar fasciitis. Moreover, their bodies also release a hormone called relaxin, which softens plantar fascia—resulting in damage under heavy load.
Physical activities – if you’re an athlete and run a lot, your chances of having a stabbing or sharp pain in the foot are high. Even if you exercise, jog, walk, or hike often, you may have plantar fasciitis. It’s better to take a day off to give yourself some time to recover after an intense, anaerobic exercise. Or at least do something easy and less intense to relieve the repeated strain being put on your fascia.
Obesity – It may not sound like one of the main risk factors for developing plantar fasciitis, but the opposite is true. Research suggests that people who are overweight and have higher body mass index are at risk of developing plantar fasciitis. Such people have thicker and less stiff plantar fascia, which disturbs the mechanical properties of the fascia ligament. In other words, adding more weight may result in wear and tear of the fascia ligament.
Flat feet and high arches – Biomechanical dysfunction of the foot, such as flat feet or high arches, may result in plantar fasciitis. Flat feet and high arches may be caused due to the weakness and tightness of your muscles and joints, which change the way you walk and run. This, in turn, results in extra load on the fascia tissue of your foot to cause plantar fasciitis.
Tight calf muscles – Your calf muscles may become tight because of strain or muscle cramp. As the calf muscles are attached to your heels, the lack of flexibility can overburden your fascia. And hence can cause plantar fasciitis.
Lifestyle choices – People who work in an environment where they have to either stand for a longer period of time or walk most often are vulnerable to plantar fasciitis. Make sure you don’t overburden your feet while at work and take regular breaks to relieve pain in your feet.
Shoes and insoles – Here’s a heads-up: get rid of your worn-out shoes with thinner soles. They don’t support your feet anymore and may worsen your foot pain. You can also read the American Academy of Orthopaedic Surgeons guide on choosing the right footwear.
How is Plantar Fasciitis Diagnosed?
Now that you know some of the symptoms of plantar fasciitis and the risk factors associated with it. The next step is to actually see if you really have that condition. You may need to see the doctor and tell him about your symptoms. Your doctor may thoroughly check your feet to understand the underlying cause of the problem. If he suspects the pain to be caused by plantar fasciitis, he may ask you about your medical history, fitness activities, work routine, and any risk factors.
Some of the common questions you should expect:
1. Do you exercise regularly?
If you workout most often, you may likely have plantar fasciitis because of the risks of wear and tear associated with extra pressure on your fascia.
2. Do you feel pain during the exercise?
Your fascia won’t hurt during the activity. However, the pain will likely return after you pause your workout—a typical sign of plantar fasciitis.
3. How does a typical day look like for you?
People who work jobs that require them to stand and walk most often, their bottom foot pain may be caused by plantar fasciitis.
With those questions, the doctor will also examine your calves, arches, and heel. He may also push his thumb or pointer finger on your heel to check the area where you feel the most pain. Some of the symptoms related to abnormal foot structure, such as high calves and flat feet, are also examined.
After clinical diagnosis, the doctor may prescribe medicines and offer guidelines to ensure the condition resolves. In severe cases with a long history of previous treatment, your doctor may suggest medical imaging to see if there’s anything else causing the problem, for example, bone fracture, etc.
You’ll also be subjected to imaging tests of the affected area. The three common tests are:
1. X-ray: Though it doesn’t reveal fasciitis—your doctor may still perform it to make sure you don’t have any other condition or fracture.
2. MRI: It can detect plantar fasciitis and the rupture of fascia due to tears and rips in that region.
3. Ultrasound: If needed, your doctor may perform an ultrasound to rule out soft tissue problems in the heel. If an ultrasound detects your proximal plantar fascia greater than 4mm, you may have plantar fasciitis.
X-ray and MRI may not be needed in most cases, as your doctor can tell if you’ve plantar fasciitis by looking at the affected area and physically examining it. In some rare cases, however, these tests are suggested to rule out the possibilities of any other serious condition.
What are the Treatment Options for Plantar Fasciitis?
Now that you’ve learned about how plantar fasciitis is diagnosed, let’s take a look at the various treatment options for the condition. While the inflammation caused by plantar fasciitis may go away over time, there should be some solid treatment options to reduce the pain and reverse the symptoms.
Start taking care of your ailing foot. Sometimes, the inflamed area may be swollen. In that case, apply ice three to five times for 10 to 20 minutes daily. If you’re a regular exerciser, try reducing the intensity of your workout to help reduce the pain.
Below are some of the tips and home remedies that can help reduce the inflammation and pain associated with plantar fasciitis.
Replace your worn-out shoes
For those frequent runners, worn-out shoes may contribute to plantar fasciitis. Such shoes don’t support their feet and often have thin soles, which expose their fascia to the ground. Also, make sure your insoles are comfortable and are not working against you.
Signs that show you need a new pair:
- Thinning of the outsoles
- Wear-out of the shoe’s interiors
- Blisters due to your shoes
- Insole not restricting your feet’s extra movement
- Rough shoe seams
- Tear outs on the toes
- Shoe leaning left or right
Massaging the bottom of your foot can help relieve the symptoms of plantar fasciitis. Because most people feel pain in the morning after they take their first step, it’s better to take care of your feet even before you get out of bed. Keep your feet warm with a light massage to increase the blood flow to that area.
Different types of massages for plantar fasciitis are:
Massage with Ice – In this type of massage for plantar fasciitis, you need to use a small can of frozen water. It’s better when done first thing in the morning before you take your first step. All you’ve to do is roll that ice can back and forth under your foot. Do it for 10 minutes every morning for relief.
Thumb Pushes – Push your thumb against your sole and move back and forth from each toe of your foot to the heel. Continue this practice for a few minutes and slowly increase the pressure for maximum benefits. You may need to sit in a straight way with legs over each other for this type of massage.
Massage with your hand heels – This massage uses your opposite hand’s heel to soothe the affected area of your foot by applying stroke and pressure on the sole. Start gently with light pressure and then increase the pressure with time to relax your fascia tissues.
Apply essential oil
Studies suggest that essential oils such as that of lavender have anti-inflammatory properties that help reduce inflammatory pain. Other essential oils such as peppermint, grapeseed, and lemongrass oils also help in reducing the pain caused by plantar fasciitis. For a long-lasting and maximum benefit, apply a diluted solution of lavender directly under the bottom of your foot.
If you’re overweight and it’s contributing to the pain in your foot, try losing a couple of pounds to relieve that extra burden on your fascia. Research shows that people with higher BMI are more prone to developing the pain associated with plantar fasciitis.
Sometimes the best way to cope with foot pain is to slow down and take a few days or even a week off. Your fascia needs repair, which is not possible if you still hit the trail and run that daily mile. Take a little rest from working long hours and frequent walks to ease your pain.
Usually, plantar fasciitis goes away within 6 to 12 months—given that you take care of your foot and don’t burden it beyond its capacity. But the condition may not always resolve even after trying massages and home remedies.
Some of the medical treatments that can help if you don’t see any improvement:
Medication: Take oral nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve the inflammation. Common NSAIDs prescribed are:
- Ibuprofen – such as Advil and Motrin
- Aspirin – such as Bayer and Ecotrin
- Naproxen – such as Aleve
Steroid Injection: NSAIDs should relieve the pain and ease the symptoms. However, if they are not helping, then you may get a steroid injection for quick pain relief. They may keep the pain off for a month or more. Steroid injections are directly applied to the affected area. An ultrasound device is also used to determine the ideal spot for injection. Your doctor will apply a small, painless electric current to ensure the steroids reach the inflamed muscle.
Physical therapy is one of the safest and most effective ways to help reduce the pain and inflammation caused by plantar fasciitis. A physical therapist can show you specific exercises and stretches that would help you stretch your plantar fascia, strengthen the leg muscles, and stabilize your walk.
Exercise and Stretches for Plantar Fasciitis
One of the most important physical therapy treatment methods for plantar fasciitis is exercise. There are specific exercises and stretches that can greatly improve your symptoms and even completely eliminate the pain in your fascia ligament. Main exercises and stretches are given below:
1. Calf Stretch
As the name suggests, calf stretch is the loosening of your calf muscles. When your calf muscles become tight, it shifts the load onto your fascia ligament—resulting in pain and inflammation.
You can follow these stretches below:
- Put your hands on the wall
- Position your legs in such a way that your affected leg is behind the other leg
- Keep the knee of the affected leg as straight, while the other’s knee bent.
- Your affected leg should have its heel on the ground.
- Now you should feel a stretch in your back leg.
- Hold for 20 seconds
- Repeat two to three times a day
2. Strap Stretch
Strap stretch is another way of loosening your calf muscles – as they may cause plantar fasciitis.
The stretch using a strap performed below:
- Sit in a resting position with your inflamed leg extended in front of you
- Place a strap around the bottom middle of your foot and tug it towards your body.
- You can feel your calf being stretched – which makes it work back again.
- Hold for half a minute and repeat a few times daily
3. Fascia Stretch
A stretch of the fascia ligament may restore its normal function. Below is the procedure to do the stretch correctly:
- Sit on a chair with your affected leg crossed over the other.
- While in that position, grasp the inflamed foot toes and bend them upward.
- Move them toward your shin as far as possible until you feel a stretch in your fascia
- With your other hand, massage the arch of your foot
- Hold for 15 seconds. Repeat a few times a day.
Supports and Braces for Plantar Fasciitis
Specialized devices, supports, and braces may provide symptom relief.
Night splints – Night splints help reduce the pain caused by plantar fasciitis. It actually holds your toe and foot in such a position so that your fascia becomes lengthened. Wear it overnight for several weeks to see improvement.
Ankle Brace – Ankle braces are typically worn around your ankle and midfoot. They support your arches by suspending it from above. Your fascia is relieved from the pressure that you may feel first thing in the morning—if you’re suffering from plantar fasciitis.
Athletic tape – Athletic tape is used to keep your foot from moving in a direction that may cause the fascia to inflame.
Heel pads – Heel pads give your heels an extra ground to relieve the tension during intense exercise, frequent walking, or fitness activity. They may also help with your heel pain.
Foot rollers – Foot rollers can give the bottom of your feet a gentle massage. When performed daily, it may be helpful as it stretches your fascia and alleviates any pain and swelling.
Walker boot – Walker boot forces your foot in a resting position. Also called controlled ankle motion (CAM) walker, they relieve your pain. However, it may not provide permanent relief, as the pain may continue after you remove the walking cast.
Surgery may be your last resort if the severe pain doesn’t go away. Your fascia may be partially detached from your heel bone, which may limit its function. If it’s not an option, your calf muscle may be lengthened to help perform its normal function.
Plantar fasciitis becomes painful after you wake up in the morning or take a break from a sports or fitness activity. To effectively reduce the pain associated with plantar fasciitis, consider some home remedies and physical therapy. If you still have the problem, you may consult with your doctor for prescription medication and further help.