As an orthopedic surgeon who specializes in conditions of the foot and ankle, I see many patients with heel and foot pain caused by plantar fasciitis. This condition is inflammation of the plantar fascia, which is a long, thick band of tissue that runs along the sole of the foot, connecting the heel to the front of the foot.
Plantar fasciitis is very common, as our feet undergo a lot of stress, and you don’t have to be a runner or athlete to suffer from it.
What Causes Plantar Fasciitis?
The plantar fascia tissue supports the arch of the foot and acts as a shock absorber of sorts when we walk, run or move our feet. With every step, that tissue is subjected to a significant amount of tension as the heel impacts the ground, and tiny tears can occur. This may cause inflammation and irritation in the plantar fascia, accompanied by a stabbing pain and stiffness on the bottom of the heel that can interfere with daily activities.
Often it is unclear exactly how plantar fasciitis has occurred, but it can be caused by a number of factors, including inadequate footwear or an overuse injury. Other factors that can increase the risk for this condition:
- Age. As we get older, our risk of experiencing plantar fasciitis increases. It is seen most often in people over 40.
- Foot structure. Flat feet or high arches can mean a higher risk for plantar fasciitis. An unusual gait or walking pattern can cause an uneven weight distribution that is harder on the feet. Tight Achilles tendons, which attach your calf muscles to your heels, also may cause foot pain and stress for your plantar fascia.
- Being overweight or obese. Excess body weight makes it harder for your feet to support you. Pregnant women or people who experience sudden weight gain may develop plantar fasciitis.
- High-impact activities. Activities that involve your heel and its tissue can add a lot of strain to that area. Sports-related activities that involve repetitive impact are common contributors to heel and foot pain. Likewise, a sudden increase in activity, such as starting a new walking or running program, can be a jolt to the feet.
- On your feet too much. Jobs that require several hours of walking or standing on hard surfaces can cause damage to the plantar fascia.
What are the Symptoms of Plantar Fasciitis?
The primary symptom is pain on the bottom of the heel that develops over time. Some people experience pain on the bottom and at the middle of the foot. It is usually most noticeable with the first steps of the day and may return after extended periods of standing, or when standing up after sitting or lying down for a while. Navigating the stairs can also be uncomfortable.
The pain can sometimes lessen as your body warms up and you become more active during the day, but it can become worse after exercise or other vigorous activity (rather than during). Usually it affects just one foot, although it can occur in both feet. The pain can be alternately sharp or a dull ache extending outward from the heel. You may feel a higher level of discomfort when walking barefoot or in shoes with minimal support, like flip-flops.
Plantar fasciitis can often be confused with a heel spur. A heel spur is a calcium deposit that builds up and protrudes from the underside of the heel bone. Although the risk factors for a heel spur are similar to those of plantar fasciitis, heel spurs often do not cause pain or present symptoms unless they cause an injury to the soft tissue.
How Can You Treat Plantar Fasciitis?
Conservative (nonsurgical) methods usually help relieve the pain from plantar fasciitis within a few months. These are some common recommendations:
- Rest. Keep the weight and stress off the foot as much as possible. Decrease athletic activities that involve your feet pounding on hard surfaces.
- Stretching/physical therapy. Tight muscles in your feet and calves can aggravate the pain of plantar fasciitis. Stretching your Achilles tendons and plantar fascia to loosen those muscles can be very effective. This also can help strengthen your lower leg muscles and stabilize your ankles. Stretching exercises should create a feeling of “pulling” and should not be painful or uncomfortable. It may be helpful to work on a stretching and exercise program with a physical therapist, who might also recommend athletic taping.
- Ice or cold therapy. Pain and inflammation often respond to the application of an ice pack or rolling your foot over a cold water bottle for 15-20 minutes several times a day. Or try an ice massage – fill a plastic water bottle about three-quarters full, freeze for several hours, and roll your foot over the bottle for 5-7 minutes a few times daily.
- NSAIDs. Non-steroidal anti-inflammatory medications such as ibuprofen or naproxen can alleviate discomfort.
- Proper footwear. Supportive shoes with thick soles or cushioning can help with pain and reduce the stress to your plantar fascia. Silicone heel pads also provide cushioning. High heels and non-supportive footwear are best kept to a minimum. It’s a good idea to replace your athletic shoes often as well.
- Orthotics. Sufficient arch support is key. Orthotics or insoles help support the arch of your foot to help take pressure off your plantar fascia, keeping it in a neutral position.
- Avoid going barefoot. Without any support, especially on hard surfaces, this can be a serious stressor to the tissue in the bottom of the foot – including when you get up in the morning, as this is usually when the pain is worst.
- Night splints. A night splint is a brace that holds your foot in a flexed position while you sleep, stretching and lengthening the plantar fascia and Achilles tendon. Getting comfortable might be a challenge at first, but a night splint is usually very effective.
- Steroid injections. Cortisone can be injected into the plantar fascia to provide prolonged relief from pain and inflammation.
Surgery is performed only in cases in which pain is severe and conservative methods are not effective. We put our feet through a lot of pressure and stress, and it’s important to keep them healthy. If you are suffering from heel or foot pain, don’t ignore it. To get more information or expert recommendations on treatment, call us for an appointment at 913-319-7600.
About the Author
James Halloran, M.D. is a board-certified and fellowship-trained orthopedic surgeon whose primary clinical interest focuses on diagnosis and treatment of conditions involving the knee, ankle, and foot. Dr. Halloran completed fellowship training in both sports medicine and foot/ankle surgery.
The medical information contained in the Dickson-Diveley Orthopaedics website is provided to increase your knowledge and understanding of orthopedic conditions. This information should not be interpreted as a recommendation for a specific medical or surgical treatment plan. As each patient may have specific symptoms or associated problems, the treatment regimen for a specific patient may not be the proper treatment for another.
Gaining knowledge and understanding of a particular problem or condition is the first step in any medical treatment plan. I believe the information presented on our website will be helpful for those individuals experiencing ankle pain, or other related problems. However, this information is not intended to replace the advice of your family physician. You are encouraged to consult with your physician to discuss any course of treatment presented or suggested.