This list of frequently-asked questions (FAQ) provides information about the painful foot condition known as Plantar Fasciitis—how to identify it, treatment options, how to reduce pain and worsening of the condition, and how to choose appropriate footwear to help heal and prevent recurrences. We’ve aimed to answer some of the most-asked questions — so this Plantar Fasciitis F&Q should be a good place for you to start if you are suffering from the condition and want to find some real help.
Question: I have foot paint—how do I know it’s Plantar Fasciitis?
Answer: There are a number of conditions that cause foot pain—a stress fracture, a bruise, tarsal tunnel, heel spurs, Severs disease, arthritis—but Plantar Fasciitis has some unique markers that can help you and your doctor isolate it as the cause:
- The pain is most severe first thing when you get out of bed. It may return or worsen when climbing stairs, bending at the knees, or any other activity that stretches the bottoms of your feet.
- The pain usually originates near the front and bottom of the heel and has been described as “like walking on glass”. The pain may also occur in a different location, but always along the Plantar Fascia ligament that runs along the bottom of your foot.
- Your heel hurts when it strikes the ground.
If you have foot pain, you should see your doctor. He or she may want to take an x-ray to rule out some of the other possibilities before recommending a treatment approach.
Question: What is Plantar Fasciitis?
Answer: If you flex your foot and press with your fingers under the ball of your big toe, you will feel a large, firm ligament that stretches toward your heel. This is the inside edge of the Plantar Fascia. It is a broad band of fibrous tissue attached to the heel, which then fans out at the base of the toes. The whole assembly supports the arch of your foot.
When this tissue is strained (similar to a strained muscle), it can become inflamed and sore. Tiny tears in the ligament can also occur. This makes walking or standing painful, as the full weight of the body puts a load on the swollen, tender, ligament.This medical condition is called Plantar Fasciitis (PLAN-tar Fash-ee-EYE-tis). The name breaks down like this:
- Plantar means bottom of the foot
- Fascia is the type of connective tissue it is made of
- -itis is a suffix meaning inflammation
Question: What causes Plantar Fasciitis?
Answer: There are several factors that contribute to the development of Plantar Fasciitis. One, some or all may be involved in any particular case:
Weight: each time we take a step, the force exerted on the arch of the leading foot can be nearly two times body weight. People who are overweight—particularly women—tend to have this problem more. That includes normal-weight women who are pregnant.
Inflexible calves/Achilles’ tendon: people who have tight calf muscles or shorter, more taut Achilles’ tendons could be more at risk for this condition. This is because as they take that step described above, the moment of greatest tension increases more suddenly, causing more of a “jerk” effect on the Plantar Fascia. Due to the great number of people who live relatively inactive physical lives, these muscles and tendons are often quite inflexible and should be stretched carefully to remain as limber as possible.
Gait: some people walk and stand with excessive pronation, where the inside edges of their feet are bearing more weight than the outside edges. This puts much more strain on the Plantar Fascia and could be a cause of irritation.
Spending too much time on one’s feet: In some cases, it seems likely that Plantar Fasciitis is a repetitive stress injury, like a typist with Carpel Tunnel Syndrone. Nurses, mailmen and the like may develop this problem, as may people who simply stand all day on a hard surface at their jobs. The liklihood of injury is increased if compensating shoes are not worn.
Sports and other physical activities: the sudden, extreme forces placed on the Plantar Fascia during many sports can cause injuries mild to severe (such as tearing the fascia away completely from the heel bone). People who need to make a big step up repeatedly (such as delivery van drivers) are at risk, as are people who lift heavy weights. Pushing a car is a good example of what the foot looks like at its maximum exposure to this type of injury—fully extended, with a lot of force placed on it.
Footwear: some types of shoes do not allow the foot enough flexibility to maintain a healthy, limber Plantar Fascia. Wearing very stiff, hard, confining shoes for long periods will have a detrimental effect on the arch’s ability to absorb loads over time, as will lack of arch support.
Age: although age is not in itself a factor, some of the causes listed above tend to develop as we grow older—we gain weight, become less active, and in general become more susceptible to this type of damage. People under 25 rarely experience Plantar Fasciitis.
Some medications: there is some support for the possibility that quinolone antibiotics can contribute to or even cause Plantar Fasciitis.
Question: How long will plantar fasciitis last?
Answer: There is no clear answer to this question. The pain may last a few months, or it may become permanent. It can disappear, only to reappear a few months or years later, and that cycle may continue. There are many treatments available, and often it’s a combination of several remedies that will end up relieving the pain.
Question: How Bad Can Plantar Fasciitis Get?
Answer: The pain can be mild or very severe, even to the point of debilitation for part or all of a day. Various therapies can limit the severity of pain so that you can get “back on your feet” and lead a normal life.
Question: Can Plantar Fasciitis be cured?
Answer: That’s hard to say. If a patient who successfully completes therapy can eliminate or reduce any risk factors and avoid injury to the area, there’s a good chance the pain will not return. If it does, the patient has the advantage of knowing how to treat it immediately to prevent further damage and resolve the problem quickly. So it might be safer to say it is possible in most cases to end the pain of an outbreak, and manage future occurrences (should they occur) more and more competently.
Question: What kind of doctor should I see?
Answer: Your family practice physician is your first resource, to confirm or reject a diagnosis of Plantar Fasciitis. If your pain is severe or any treatments recommended by your doctor do not seem to be helping, you may want to get a referral to a podiatrist, who will have more experience in difficult cases and has more resources relevant to your problem.
Question: How is it plantar fasciitis treated?
Answer: A conservative-progressive course of treatment is recommended. In many cases, the condition can be resolved without invasive procedures or complicated regimens. Applying ice, resting the affected foot, stretching feet and calves before walking in the morning, and changing your activities may result in a dimunition of pain. Certainly if you’re overweight, correcting that is a first step once you are mobile enough to exercise.
Further “self-treatment” can include takng ibuprofin and using pharmacy shoe inserts to provide more arch or heel support.
If the above remedies do not help, do not delay seeking medical help. The longer pain persists, the more chance that damage increases, necessitating more stringent measures. If treating the symptoms by yourself, at home, do not work, see your doctor and ask about night splints–to keep the ligament extended while you sleep—and physical therapy options.
If pain persists after these options are exhausted, or if your physican sees a need for more aggressive treatment, you may need to resort to:
- corticosteroid injections: deliver pain relief medicine directly into the injured Plantar Fascia. However, this treatment may weaken the ligament and lead to further damage.
- extracorporeal shock wave therapy (ESWT): sound waves are transmitted through damaged tissue in an attempt to stimulate them toward healing. This is a relatively new therapy.
- Surgery: direct manipulation of the ligament in an attempt to relieve the painful pressure. This would be the most extreme and expensive option, not only because of the surgery but because of the recovery period.
Question: How expensive is treatment?
Answer: The common-sense, home remedies are not expensive.
If you need to progress to physican visits, things might start to add up. Make sure that you inform your doctor about anything you’ve tried to improve your condition yourself so that efforts are not duplicated.
Physical therapy, injections, and extracorporeal shock wave therapy (ESWT) are probably going to be referrals from your primary care physician—verify that they are covered in your insurance before accepting them without looking into alternatives.
Surgery may or may not be covered under the terms of your insurance. Some occupations will specifically include or exclude surgeries of this type, so make sure you understand your financial obligation before proceeding to this step.
Question: Can I treat it myself?
Answer: In most cases, Plantar Fasciitis will respond to home remedies you can easily apply yourself. The most important consideration is to reduce current inflammation, and not damage the ligament further until it’s had a chance to heal:
- Apply ice to the affected region to reduce pain immediately.
- Before getting out of bed in the morning, gently but thoroughly stretch the feet and calves.
- Buy night splints and wear them to keep the tendons from contracting so much during the night.
- If your weight is an issue, start dieting (save exercise for after your foot pain is gone).
- Rest the painful foot whenever possible during an episode.
- If you run, jog, play sports, or engage in any othe activity that places stresses on the foot, refrain from that activity until pain is completely gone (you will probably need to apply some or all of the above measures in addition, to clear existing pain).
- Use ibuprofin in the recommended doses to relieve pain from inflammation.
- Buy drugstore orthotics (shoe inserts) that relieve pressure and let you move more comfortably.
Question: Will my insurance cover treatment?
Answer: Custom orthotics may or may not be covered. If you have a cafeteria-style medical reimbursement program, over-the-counter medications (such as Ibuprofin) and shoe inserts/splints probably are covered. Visits to your doctor for diagnosis, and referrals for more invasive treatment are variable. Check with your insurance plan about coverage for injections, ESWT (extracorporeal shock wave therapy), and surgery.
Remember that treatment should start with the most simple at-home remedies, and progress to the point of contacting your doctor only if you notice no relief after a week or so. Similarly, your doctor should explore non-invasive, inexpensive options before resorting to a referral for a more expensive option.
Question: Will I need to wear special shoes?
Answer: Plantar fasciitis shoes are the best way to go about treating this condition — most people find wearing the right sort of shoes will help heal the condition, over time. It’s possible that custom orthotics will be required in severe cases where relief cannot be obtained through shoes or therapies alone. It may be that your feet, legs, hips or other muscular-skeletal feature presdisposes you to irritation of the Plantar Fascia, and your pain is bound to return due to these features.
Question: How can I prevent developing Plantar Fasciitis?
Answer: Maintain a healthy weight and diet, stay active, stretch thorougly before exercise, and wear footwear appropriate to your daily activity. Unless you’re wearing fancy shoes for an occasional night out, try to always keep arch support and flexibility in mind when choosing your footwear.
Question: If I have delayed treatment, have I made it worse?
Answer: Possibly. If you have “put up with” severe pain for a period of weeks to months, it’s likely you have allowed further damage to your feet that might necessitate more intensive solutions. As soon as you feel the pain of Plantar Fasciitis, you should begin common-sense home treatments and then, if pain does not lessen over a week or two, seek medical advice.
Question: How long will it take to feel better?
Answer: Most people start to feel relief after a couple of weeks or a month of low-tech treatment at home. If your case is more severe, your doctor may be able to help you manage the pain with stronger medications until a solution is found. Remember you should not endure severe pain for longer than a week or so, because you might be making the condition worse.
“Severe pain” can include intermittent pain. If you have severe pain only in the morning, but it happens every morning for more than a week or two while you are taking measures to reduce it, you should still see your doctor. Severe pain, even if brief, means that damage is still being done to the ligaments of your foot.
Question: Can I work when I have Plantar Fasciitis?
Answer: You may need to make some modifications in your work life when you have Plantar Fasciitis. If your work contributes to the condition (such as if you’re on your feet all day, either moving or stationary), you will definitely need to change your footwear and incorporate exercises that help your calf muscles and ankle tendons stay flexible and not contract too much. Whether you can use drugstore orthotics, or need to visit a podiatrist for specialty shoes, is up to you and your doctor.
If your work is very physically active, you will need to stretch more often and more thoroughly before engaging in the activity. You should also be sure that your Plantar Fasciitis is completely healed before subjecting your feet and legs to acute, sudden stress again.
If your lifestyle is more sedentary and you believe your Plantar Fasciitis occurred because of an unusual event (such as picking up a heavy load, or pushing something), then it would still be a good idea to stretch your legs more often, even at work. Keeping the tendons and ligaments in your legs and feet in good working order is a great idea for everybody.
Question: Can I exercise when I have Plantar Fasciitis?
Answer: Limit any exercise that stresses your foot until the condition is completely healed. Instead of placing stress on the foot, switch to exercise that stretches and tones the foot and leg instead, such as step-climbing.
Question: Is there other special footwear that will help?
Answer: Night splints are designed to keep the foot, ankle and calves in a slightly extended state while you sleep or are inactive, thus preventing the affected muscles and tendons from contracting to the point where there will be pain when they are stretched.
Question: Will I have more problems as I get older?
Answer: Older people are more likely to have problems with Plantar Fasciitis, both due to the degeneration of body tissues, and to the fact that weight tends to increase and we tend to become less active as we age.
However, Plantar Fasciitis is not a necessary adjunct to aging. Maintaining a healthy weight and diet, and keeping reasonably active and limber throughout life will decrease the chances that you will be affected by Plantar Fasciitis as you get older.