Plantar fasciitis – Symptoms and causes
Your plantar fascia is a tight, thick tissue that connects your heel bone to your toes. Plantar fasciitis occurs when the plantar fascia becomes inflamed or irritated, resulting in a sharp or dull pain felt at the bottom of the heel. This can be caused by several things, from carrying extra weight to wearing unsupportive footwear. Though treatments are usually quite simple, the pain of plantar fasciitis can be fairly severe.
The most common symptoms of plantar fasciitis are:
- Sharp or dull pain felt at the bottom of the foot directly on or near the heel
- Pain that is most severe in the morning, especially when first standing
- Pain that worsens after prolonged weightbearing
- Pain that is relieved with rest
- Heel swelling and/or stiffness
When a person has plantar fasciitis, the connective tissue that forms the arch of the foot becomes inflamed. As the stress placed on the inflamed plantar fascia continues, microtears develop, which may eventually lead to the development of a bony growth called a heel spur.While it’s not uncommon for people with plantar fasciitis to have a heel spur (seen on an X-ray), keep in mind that the heel spur is not the source of the pain. In fact, many people with heel spurs have no pain at all.There are a number of factors believed to increase a person’s risk for developing plantar fasciitis. Some of these factors include:
- Excessive training or exercise, especially long-distance walking or running
- Rapid weight gain
- Prolonged standing
- Recent change in activity
- Tight calf muscles or a tight Achilles tendon
- Improper footwear
- Flat feet
- Very high foot arches
The diagnosis of plantar fasciitis requires a medical history and physical examination. During the medical history, your doctor will ask you where your pain is located, and whether it’s worse in the morning and/or with prolonged standing.Next, your doctor will look for plantar fascia tenderness. While holding your foot, he will bend your toes toward your shin and then press along your plantar fascia from your heel to forefoot.Blood and imaging tests are not used to diagnose plantar fasciitis, though they may be helpful for ruling out other potential heel pain diagnoses, such as:
- Tarsal tunnel syndrome
- Rheumatologic conditions, like reactive arthritis or ankylosing spondylitis
- Calcaneal (heel bone) stress fracture
The treatment of plantar fasciitis begins with the following simple, self-care steps:
Resting your foot is perhaps the most important step you can take to ease your plantar fasciitis-related pain. This means avoiding irritating activities, like those that place unnecessary strain on your foot (e.g., running, jumping, dancing, or walking barefoot).
Applying a cold compress or ice pack to the back of your foot for 15-minute sessions, several times a day, can ease pain and swelling. Be sure to wrap the ice pack in a thin towel, so it is not in direct contact with your skin.
You may also consider using an ice bottle massage, which is a way of applying ice to your foot while simultaneously massaging the plantar fascia.
Gently stretching your plantar fascia, as well as the muscles around your foot and ankle, can improve foot flexibility and mobility, and promote healing of the irritated fascia.
Muscle Strengthening Exercises
Since the weak muscles in your foot and ankle may be contributing to your plantar fasciitis, strengthening these muscles can be beneficial. The classic strengthening exercise for plantar fasciitis is called the toe towel grab, in which you use your toes to grasp and drag a small towel across the floor.
Be sure to check in with your physical therapist or doctor to see which strengthening exercises are right for you.
Kinesiology tape is a flexible, cotton tape that can help support your foot’s arch, while still allowing your foot and ankle to move well. Before applying kinesiology tape to your foot, be sure to speak to your physical therapist or doctor to ensure you are applying it properly.Kinesiology Taping for Plantar Fasciitis and Foot Pain
You doctor may recommend a short course (two to three weeks) of a nonsteroidal anti-inflammatory drug (NSAID) to ease your plantar fascia pain and inflammation. Talk with your doctor, though, before taking an NSAID, to make certain it is safe and right for you.If your pain persists, your doctor may inject a steroid (cortisone) into the tender area of your foot.
Your physical therapist or doctor may recommend a cushioned-soled shoe with an orthotic support, like a heel cup or gel-pad insert, for your plantar fasciitis. The main purpose of this orthotic support is to support both the arch and heel of your foot to take pressure and strain off of the plantar fascia.
Options for Persistent Pain
If the above measures do not provide adequate foot and heel pain relief, your doctor may consider one of the following options:
- Night splint: Although the scientific evidence is limited, a night splint, which gently stretches your plantar fascia overnight by keeping your foot at a 90-degree angle, may be of some benefit.
- Immobilization: Your doctor may recommend complete foot rest by temporarily immobilizing your foot with a cast or cushioned walking boot.
- Extracorporeal shock wave therapy (ESWT) and Botulinim toxin (Botox) injection:ESWT and Botox are two examples of alternative therapies your doctor may recommend for chronic plantar fasciitis.
- Surgery: Rarely, surgery to release part of the plantar fascia from its attachment to the heel bone is used to treat plantar fasciitis.
It’s not unusual for people to manage their plantar fasciitis effectively, only to have their symptoms come back when they stop treatment. For this reason, it’s important to develop strategies to help prevent a recurrence of symptoms.
These strategies may include the following:
- Losing weight if overweight or obese
- Regularly performing plantar fascia stretching exercises
- Wearing supportive, well-cushioned footwear and avoiding very flat shoes or high heels
- Placing a supportive shoe or sandal (not a slipper) on your foot right after waking up each morning (even if your floor is carpeted)
- Switching to low-impact forms of exercise, like swimming or stationary cycling
A Word From Verywell
No doubt, plantar fasciitis can be a frustrating and painful problem to manage. The upside is that there are steps you can take to help alleviate your symptoms and prevent them from returning.It may be a trial-and-error process and take a little patience and persistence on your part, but you can obtain relief.