Do you have heel pain when you wake up in the morning? Does your heel sometimes hurt for days or weeks at a time? If so, you may have plantar fasciitis.
Plantar fasciitis is caused by inflammation of the plantar fascia, a band of connective tissue that runs from the heel bone to the ball of the foot to support the longitudinal arch of the foot.
Plantar fasciitis leads to an estimated 1 million patient visits per year and is the most common type of heel pain for patients treated in an outpatient setting, according to research published in May 2022 in StatPearls. The condition accounts for approximately 11% to 15% of all foot symptoms requiring professional medical care, as well as about 10% of running-related injuries.
Plantar fasciitis can affect anyone, including men, women, athletes, weekend warriors and sedentary people.
“I’ve seen plantar fasciitis in people of all ages, all body types and all physical activity levels,” says Dr. Priya Parthasarathy, a podiatrist with Foot & Ankle Specialists of the Mid-Atlantic and physician spokesperson for the American Podiatric Medical Association.
[See: 6 Exercises Women Should Do Every Day.]
Risk Factors
While plantar fasciitis can develop in all kinds of people with different activity levels, risk factors include:
— Age: The condition is most common in people between the ages of 40 and 60.
— Certain types of exercise:Physical activities that put stress on your heels and attached tissue can cause plantar fasciitis. Such activities could include playing basketball, running long distances and dancing.
— Foot mechanics:Having flat feet, high arches or an atypical walking pattern that affects the way your weight is distributed when you are standing could add stress to your plantar fascia.
— Obesity: Being overweight can put additional pressure on your plantar fascia.
— Working on your feet: People who have jobs that require them to stand or walk on hard surfaces for a long period of time have an increased risk of developing plantar fasciitis. This can include teachers, factory workers and postal service workers.
Most cases of plantar fasciitis result from overuse stress and typically present with sharp pain in the heel. In some cases, a bone spur accompanies the condition.
Your health care provider will diagnose plantar fasciitis with a thorough review of your medical history and a physical exam, which consists of checking the bottom of your foot for tenderness and pain.
Symptoms
— Pain on the bottom of the heel when first standing after periods of rest or sleep.
— Pain after prolonged standing or after exercise.
— Pain along the arch (this is less common).
Causes
Overstretching, tension and stress can cause small tears in the fibers of the plantar fascia, leading to inflammation of the tissue. This can occur as a result of various reasons, including:
— The use of shoes that lack good support for your feet.
— Not warming up properly before sports or exercise.
— Flat feet.
— Excessive walking or running.
— Major changes in running surfaces.
— Trauma to the foot.
— Being overweight or obese.
Plantar fasciitis is yet one more foot problem that can occur if you have diabetes. Other common foot problems include diabetic neuropathy, dry skin, skin fissures and an impaired response to infections.
[READ: Creative Outdoor Exercise Ideas.]
How to Manage Plantar Fasciitis
While plantar fasciitis can be painful, there are effective ways to manage and treat the condition.
Here are 14 tips to help manage plantar fasciitis and guidance on when to see a health care professional:
Ice the affected area
Elevate and rest your aching foot when it gets aggravated. Applying ice, with an ice pack or just ice wrapped in a towel, can help lower inflammation and pain.
“Rolling the bottom of the foot on a foam roller or frozen bottle of water is also therapeutic,” says Dr. Yolanda Ragland, a podiatrist and foot surgeon in New York and suburban Maryland.
Use supportive footwear
There are many different types of footwear that can be supportive for different kinds of feet. The type of shoe that is best for you depends on your foot’s side-to-side movement, or pronation, while you’re walking. With normal pronation, your foot rolls slightly inward with every step, and the big toe and the second toe do most of the work when you’re moving, while the other toes stabilize your foot.
With overpronation, the ankle rolls inward and too far downward with every step. With this walking pattern, the big toe and the second toe do all of the push-off, which can lead to strain on those toes and foot instability. This pattern is often seen in people with flat feet.
Underpronation, also known as supination, occurs when your feet make a rolling motion to the outside edge of the foot during a step. This leads to all of the work while moving being done by the outer edge of the foot and smaller toes, which creates extra stress on the foot. This pattern often occurs in people with high, rigid arches.
You may be tempted to wear flip-flops during warm weather, but they offer no support. Some types of sandals do provide support. Ask your podiatrist to determine your movement pattern so they can recommend what footwear would be your best option.
Take over-the-counter anti-inflammatory medication
Taking OTC anti-inflammatory medications, such as ibuprofen or naproxen, should only be a short-term option to help reduce inflammation and manage pain. Before you start taking these medications for plantar fasciitis, consult with your primary health care provider to make sure these drugs won’t interact with any prescriptions you’re taking. If anti-inflammatory medications don’t resolve your symptoms within a week, see your podiatrist.
Try shoe inserts
There are widely-available commercial shoe inserts that provide support for the fascia and may lessen the impact on your plantar fascia. Commercial inserts are available online and in some shoe stores for about between $30 and $80 a pair. Your podiatrist can also make inserts customized to your feet, which usually cost $300 or more a pair. In addition to being tailored to your foot shape, custom inserts last longer than commercial options. Check with your health insurance as to whether inserts are covered. You can use a flexible spending account or health savings account funds for custom-made inserts. Because different commercial inserts are designed differently with more cushioning or arch support, it’s a good idea to ask your podiatrist which type of insert is best for you.
According to medical professionals, there’s roughly a 50% chance that inserts will improve plantar fasciitis. Generally, physicians will recommend purchasing over-the-counter inserts before turing to custom inserts because custom inserts are so expensive.
Rethink your exercise routine
If you have plantar fasciitis, it’s still important to remain physically active, for your physical and mental health. According to federal guidelines, adults should engage in at least 150 minutes (2 hours and 30 minutes) of moderate-intensity or 75 minutes (1 hour and 15 minutes) of vigorous-intensity aerobic activity each week. Moderate-intensity activity includes activities such as brisk walking, hiking, water aerobics, yoga and dancing.
If you’re experiencing a flare-up of plantar fasciitis symptoms, avoid foot-pounding exercises, such as running or jumping, until symptoms subside. Try some lower-impact options, and avoid overdoing things. Ask a health care professional about a more suitable exercise routine while you recover.
Stretch and strengthen your feet regularly
It’s important to stretch even before you get out of bed.
“This usually involves a typical calf stretch that also stretches the plantar fascia,” says Dr. James R. Hanna, a board-certified podiatrist physician and surgeon in New York.
Another recommended method by Ragland: “While seated, take a towel or a flat-resistance band wrap under the ball of the foot, and pull the ends of the towel or band so that your toes are being pulled toward the body to keep the plantar fascia lengthened.”
Foot and calf stretches before and after physical activity are also helpful when you have plantar fasciitis.
Strengthening exercises should be done regularly for at least 6-8 weeks. In general, start with non-weight bearing, proven exercises like the towel technique or doming.
Nix barefoot walking
It may feel good, but walking barefoot provides no support.
“Walking barefoot or without supportive shoes can place added stress on your foot and aggravate conditions such as plantar fasciitis,” Parthasarathy says. “This is especially true if you are walking on hard surfaces, since there is no shock absorption. Doing this for prolonged periods of time, especially when you are used to wearing shoe gear, can make the condition worse. I definitely recommend supportive slippers for (walking) in the house to my patients with plantar fasciitis.”
It’s also not a good idea to use minimalist shoes, slippers or sandals if you’re managing plantar fasciitis.
“The lack of support places added stress on the plantar fascia and can be the missing piece as to why your plantar fasciitis is not going away,” Parthasarathy adds.
See a health care professional if you’re not finding relief
If you try OTC pain relief and stretching for six weeks and you’re not getting better, give your health care professional a call. Sometimes plantar fasciitis will get better with self-help measures, but sometimes it won’t.
“Letting the problem go on for a longer time without progress allows it to become more chronic and often more resistant to treatment,” Hanna says.
It’s especially important to see a health care professional if you have plantar fasciitis symptoms and diabetes. That’s because the symptoms could mimic complications of diabetes, such as neuropathy and Charcot neuroarthropathy.
If you are diagnosed with plantar fasciitis, your health professional may recommend options, such as:
— Complete immobilization of the foot with a cast.
— Corticosteroid injections.
— Night splints.
— Orthobiologic therapies like platelet injection.
— Percutaneous tenotomy (the Tenex procedure).
— The use of an anesthetic.
Plantar fasciectomy, a type of foot surgery, is quick and typically offers a permanent solution, Ragland says. However, surgery is usually the last option because the vast majority of patients with this condition get better with non-invasive or minimally-invasive treatments.
“Patients overwhelmingly get better with more conservative care and don’t need surgery,” Parthasarathy says.
Try extracorporeal shock wave therapy
ESWT uses shock waves that improve circulation to a healing area.
“Evidence is conflicting to date, and it is used if other treatments fail and other treatments are desired prior to pursuing surgery,” says Dr. Gina Hild, a member of the orthopedic surgery department at Cleveland Clinic in Ohio.
However, ESWT is not typically covered by insurance plans.
Consider Tenex procedure
This is a minimally invasive procedure that removes the painful scar tissue that may occur in chronic cases of plantar fasciitis or tendonitis such as Achilles, patellar or posterior tibial tendonitis. The benefits of Tenex treatment are chronic pain relief, faster recovery time, a small incision, no scarring and no risks from complications of surgery or general anesthesia. Plus, it enables patients to return to vigorous activities within weeks. Skilled physicians have very high success rates with this procedure and reoccurence of plantar fasciitis pain after the procedure is rare.
Try a night splint
A night splint stretches the plantar fascia overnight and may reduce pain when you wake up. A night splint includes straps that keep your plantar fascia at a 90-degree angle while you are sleeping or at rest. The healing process primarily occurs at night. Sleeping with your plantar fascia in the stretched position means that in the morning, you won’t be stretching and breaking through new tissue when you begin to walk.
[READ: 9 Exercises Men Should Do Every Day.]
Consider acupuncture
A review of three studies published in the Singapore Medical Journal
in February 2017 found that acupuncture significantly reduced pain levels in patients with plantar fasciitis. The benefits were observed between four and eight weeks of treatment, with no additional significant reduction in pain beyond that duration. While acupuncture may provide short-term relief of plantar fasciitis, there’s insufficient evidence to suggest it is a long-term cure, researchers wrote.
“In many cases, acupuncturists can treat the condition with little to no pain,” says Tom Ingegno, a licensed acupuncturist with Charm City Integrative Health in Baltimore. “The course of treatment varies depending on the severity and the patient’s general health, but most people may see significant improvement within the first few treatments.”
Alternative methods, like acupuncture, may help, but rather than use them as a primary treatment, experts encourage patients to try these approaches as an adjunct to proven treatments.
Be patient
It can take several months or even a year for plantar fasciitis to get better. You have to stay consistent with your self-help measures for plantar fasciitis.
Know that plantar fasciitis might recur
For some people, symptoms can abate and even disappear, but plantar fasciitis can recur. However, the odds of recurrence are lower if you adhere to the plantar fasciitis management approaches described above. Plantar fasciitis is more likely to recur if you’re still wearing improper shoes or walking barefoot too often.
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What Are the Best Ways to Treat Plantar Fasciitis? originally appeared on usnews.com
Update 06/13/23: This story was previously published at an earlier date and has been updated with new information.
