Plantar fasciitis can be a tricky foot condition to fix. There is a lot of bad information out on the web about this topic and this article is dedicated to helping you effectively treat plantar fasciitis with real, no BS information.It’s a long article, so get some coffee — you are going to need it.
Plantar Fasciitis: Symptoms, Causes, and Ramifications
If you are experiencing heel pain, the problem might be a condition known as plantar fasciitis. In the United States and Europe, this single condition is the most frequent cause of heel pain. It is especially common among athletes, obese persons, frequent runners.
Symptoms: Do You Have Plantar Fasciitis?
Experiencing difficulty walking when first using your feet after many hours of rest is a common sign that you may have plantar fasciitis. This may include pain and stiffness in your feet when you first get out of bed in the morning and take a few steps. Other people suffering from plantar fasciitis notice that getting up after sitting for a long time poses a difficulty with their feet.
People with plantar fasciitis sometimes don’t take the condition seriously enough since pain and stiffness may lessen after they take a few steps. They may regard the initial discomfort on getting up as simply the vagaries of aging. One sign that you may indeed have plantar fasciitis is that as the day wears on, your feet begin to hurt more and more. The worst pain may occur when you attempt to climb stairs or stand for long periods of time.
The basic cause of plantar fasciitis is tendon or ligament strain. The ligament in your foot that supports the arch can become riddled with tiny tears and rips that result from repeatedly straining the ligament too much. These rips and tears in turn cause the ligament to both swell up and emit pain signals to alert you that something is wrong in the arch of your foot.
Although ligament strain is the true cause of plantar fasciitis, a fundamental question is to examine what leads to such ligament strain in the first place. Researchers have identified several different situations that can cause damage to the ligament supporting the arch of the foot. Many of these causes are inherent to an individual’s body structure rather than being based on behavioral decisions, including:
- naturally tight calf muscles
- naturally tight Achilles tendons
- a tendency to roll your feet inward when walking
- naturally high arches
- naturally flat feet
Other causes of plantar fasciitis can be linked directly to decisions or behavior undertaken by the individual suffering foot pain, including:
- obesity, which causes excessive weight to be placed on the feet
- wearing worn out shoes
- wearing shoes that do not fit well
- running on hard surfaces, which leads to impact injuries
- walking or standing for long periods of time
Whether your plantar fasciitis is due to genetic or behavioral factors makes little difference when it comes to diagnosis or treatment.
Risk Factors of Plantar Fasciitis
Some of the causes listed above, such as obesity or wearing ill-fitting shoes, can be regarded as risk factors for this painful condition. Other risk factors include age, with plantar fasciitis being most common during the years associated with middle age. Those between the ages of 40 and 60 are at highest overall risk. Gender is another risk factor. For reasons not well understood, more women than men suffer from plantar fasciitis.
One of the most common risk factors is to work in an occupation that requires a great deal of time spent on one’s feet. Standing for hours on a hard surface increases the risk of developing plantar fasciitis. For this reason, waitresses, teachers, and those who work in factories are often at high risk for the condition.
Risk factors associated with the physical condition of the feet include flat footedness and high arches. However, wearing high heels can also represent a risk factor for plantar fasciitis. When a woman wears high heels, her Achilles tendon does not have an opportunity to get stretched throughout the day. Over time, this can cause the tendon to permanently stiffen and shorten, which is equivalent to being born with naturally tight tendons. Women who wear high heels are advised to take off their shoes and stretch their feet out several times a day. Even with this precaution, plantar fasciitis can still result.
Plantar fasciitis is a serious condition that can result in complications if left untreated. Chronic foot pain is the most common result of the condition; it may become severe enough to interfere with recreational activities and even with activities associated with maintaining a normal, healthy lifestyle.
Over time, untreated plantar fasciitis can lead to chronic pain in other areas of the body, including the back, knee, and hip. This is primarily a result of sufferers adjusting their walking habits in an attempt to minimize foot pain. More than just pain, muscular and skeletal problems can develop as plantar fasciitis sufferers begin to walk awkwardly as they try to compensate.
Test and diagnosis of PF (How to Tell if you Have It)
Since plantar fasciitis has so many different contributing factors, the primary tests for the condition involve ruling out other problems that may be causing a patient to experience heel or foot pain. X-rays or MRIs are commonly employed to look for pinched nerves or stress fractures in the bones of the foot and toes.
Once other obvious causes are ruled out, a diagnosis of plantar fasciitis becomes more likely.
However, you can self diagnose the condition IF you have continuing pain in the likely areas. If it hurts a lot, for a long time, in a specific area (especially in the morning), it’s likely PF.
Plantar Fasciitis Treatments
Several treatment options exist for plantar fasciitis. Medications, both prescription and over the counter, as well as various therapies may be employed. We break the various treatments down into the following:
- Medications for Plantar Fasciitis
- Therapies to Treat Plantar Fasciitis (night splints, orthotics, shoes, stretches)
- Surgical Treatments
- Alternative Medications / Alternative Therapies
- Do It Yourself Home Remedies
For each of these ‘solutions’ we give a detailed breakdown about how these work and your options therein.
1 Medications to Treat PF
Although drugs on their own cannot cure plantar fasciitis, medications can prove useful in order to manage the condition and help patients maintain a normal lifestyle in which they can manage for themselves all the standard activities associated with daily living.
Medications are generally recommended in order to manage pain and relieve swelling and inflammation, which may in turn to serve to reduce pain and stiffness caused by plantar fasciitis. In some cases, medications are a necessary pre-requisite for other therapies, such as special exercises or stretches. Without drug treatment, these therapies may simply be too painful for patients to complete, but with medication they become possible. Drug treatment is therefore an essential component of many different therapeutic approaches to the condition of plantar fasciitis.
One caveat that exists with regard to pain relieving medications is that it must not under any circumstances be used in a way that would allow patients to continue or resume the very activities that have contributed to plantar fasciitis in the first place. For example, a woman who feels less than feminine wearing good fitting, flat heeled shoes should not use medication so that she can go back to wearing high heels that will cause her Achilles tendon to shorten and tighten. The purpose of medication is to improve ultimate patient outcomes, not worsen them.
Commonly Used Medications
Over the counter medications used to manage pain and relieve inflammation include the entire class of NSAIDs available without a prescription. This class of drugs includes
- Ibuprofen (also sold as Advil or Motrin)
- Naproxen (also sold as Aleve)
These medications all have similar properties and share many features of chemical composition. Doctors often recommend their use in cases where symptoms of plantar fasciitis have been present for only a few days or possibly weeks. In cases where patients have been experiencing pain or stiffness for a period of months, the NSAID class of drugs is less likely to be effective.
One prescription option for plantar fasciitis involves injections of corticosteroid. As steroid use carries some associated risks, this will rarely be the first medication a health care professional will recommend. However, if other therapies have been tried for sufficient time without significant improvement, corticosteroid shots may be the next treatment tried. In some cases, extenuating factors may lead a doctor to believe there is reason to try injections of corticosteroid sooner.
Corticosteroid shots provide pain relief that generally lasts from one half month to one and a half months. Doctor preferences for where to administer the injection can vary, and include
- The side of the heel or arch
- The underside of the heel
One disadvantage of corticosteroid injections is the pain associated with the shots themselves. Generally there is an anesthetic mixed into the syringe in order to deal with this issue, but even with this, these shots can still cause considerable discomfort. Because of this, many physicians will administer a topical anesthetic to the injection site before the shot.
Rare side effects can include excessive bleeding, infection of the injection site, and accidental needle damage to nerves or ligaments. Because these side effects are so rare, they are not a major factor when deciding whether to employ this treatment option.
Other side effects, however, are more common and hence are a bigger concern for medical personnel to weigh. For example, a serious consequence of corticosteroid injections can be the shrinkage of the fat pad over the heel. This is most likely to occur with repeated injections. A series of injections can also lead to the plantar fascia itself beginning to degenerate.
Because of these serious side effects, corticosteroid shots are almost never regarded as a long term solution to the condition of plantar fasciitis. When the benefits of a single shot wear off, another may be administered, but medical personnel will be reluctant to continue the series for too long. In that case, other treatment options will need to be considered.
However, for some people the corticosteroid injections may allow for enough time for other therapies to be utilized, such as stretching and exercises. In many cases more invasive therapies, such as surgery, never need to be explored.
Resources for Medications Used to Treat Plantar Fasciitis
- Medical Information from Drugs.com
- Plantar Fasciitis “Treatment Pearls” from the American Academy of Podiatric Sports Medicine
2 Plantar Fasciitis Therapies
Medications are generally employed to manage pain, stiffness, and inflammation in order to buy time for other therapies to improve the underlying condition.
Common therapeutic options include:
Night splints are splints designed to be worn on the foot during long periods when the patient will not be on his feet. Wearing them nightly during sleep is therefore ideal. Night splints serve to gently stretch and flex the foot for hours at a time, gradually elongating the foot ligaments, such as the Achilles tendon, that have become tight over time. These splints are not inexpensive, ranging from $40.00 to $60.00 on average, but that price is very low compared to the cost of some other therapies that may become necessary if the condition does not improve.
The most comfortable plantar fasciitis night splint we’ve found is the Swede-O Deluxe which is around 59 dollars. If you are on a budget then you could go with the Bird & Cronin night splint which is about $24 dollars (it’s less comfortable though).
Orthotics are special devices, usually consisting of lifts and pads, that are inserted into a shoe in order to provide the foot with better support and a more optimal environment. Orthotics can both reduce the pain associated with plantar fasciitis and can help cure the condition itself. Orthotics are a good, cheaper alternative to plantar fasciitis shoes. Note that plantar fasciitis shoes offer way more arch and heel support, however.
For plantar fasciitis orthotic recommendations, there are a lot of options to choose from, ranging from no name brands, off-the-shelf Doctor Sholls inserts to expensive custom orthotics. Personally, our favorites are the Powerstep Pinnacle Orthotic Inserts which have stellar reviews online, are effective, and most importantly, won’t break the bank at about $22 bucks. Another option is the HTP Heel Seats which are also a popular orthotic used to treat plantar fasciitis. The HTP targets the heel rather then the heel + arch of the foot like the Powerstep Pinnacle Inserts.
Some people report that orthotics are more effective than night splints because they help the foot adapt to the daytime demands of walking, running, and rising from a sitting position. Every time the foot is flexed while the patient wears an orthotic, the foot is realigned into the optimal position to both accomplish the maneuver and keep tendons properly stretched and supple.
Padded shoe inserts, while less expensive than orthotics, are also less effective. They are not designed to support a damaged heel or help elongate a tight Achilles tendon. Users of orthotics report that their pain is significantly lessened while standing, walking, and running.
Orthotics are cost effective in another way since they can be removed from one pair of shoes and inserted in another, which means that athletic shoes and dress shoes, for example, can both be adapted to be more appropriate for the plantar fasciitis condition.
Plantar Fasciitis Shoes
Plantar Fasciitis Shoes are a treatment option that is similar to orthotics. In this case, however, instead of special inserts into a shoe, the entire shoe interior is designed to support the foot and heel properly for daytime activities. We recommend you check out our 2015 Guide to the Best Plantar Fasciitis Shoes if you want our recommendations for what to buy.
Special shoes for plantar fasciitis will be a more expensive treatment alternative than orthotics, particularly when more than one pair must be purchased in order to meet the demands of different social settings such as the professional work day versus an afternoon spent at the beach. On the other hand, plantar fasciitis shoes do not require insertion of special devices. There is nothing inside them to possibly slip about and become misaligned – they are literally impossible not to use correctly.
Physical Therapy Treatments
Physical Therapy for plantar fasciitis can be costly, but most major medical insurance plans will consider it a legitimate and necessary expense and reimburse it accordingly.
A disadvantage of physical therapy is that unlike orthotics and special shoes, it requires the presence of a professional physical therapist to instruct the patient in how to perform the maneuvers that will assist in healing the condition of plantar fasciitis. This by itself makes it an expensive option, but this feature also makes it far less convenient. Patients may have difficulty finding a qualified physical therapist within a reasonable distance. Even after one is located, scheduling appointments may be problematic, possibly causing the patient to lose time at work or miss other important life activities. Since physical therapists are in demand, it is unlikely that the patient will be able to schedule all appointments to suit his or her own convenience.
Physical therapy carries with it another limitation in that patients must be very careful to perform the stretches or other activities they have been taught with utmost precision when they are not in the presence of the therapist. Doing the therapy in an incorrect manner may retard or delay healing effects and in some cases it can even lead to the plantar fasciitis condition worsening.
There are three major types of physical therapy treatments for plantar fasciitis: stretches, exercises, and taping. Let’s go over each type
Physical Therapy: Stretches
Stretches are the most basic form of physical therapy and have as their goal the simple objective of making tightened tendons long and supple once again. A related result of these stretches is a gradual reduction in pain as the condition itself improves. There are a number of different stretches commonly employed to treat plantar fasciitis.
All stretches should be learned and practiced under the guidance and supervision of a properly licensed physical therapist and done without supervision only when the therapist has approved such activity.
The most basic stretch used in treatment is usually the “seated foot stretch,” which requires the patient to sit on the floor with both legs stretched in front, held together. A strap is slung around the balls of the feet and this strap is gently pulled toward the torso in order to flex the feet and provide slow, gradual tension that will elongate the Achilles tendon. This stretch, like all stretching exercises, should be done in a slow, gradual manner. Over-stretching should be at all times avoided since it can cause tears in the muscle tissue that will actually cause the plantar fasciitis condition to worsen.
Another useful stretch is the “calf wall stretch,” which requires the patient to stand on a slanted board. With hands leaning against a wall, the patient gradually leans toward the wall, allowing the knee to bend so that the calf muscle is stretched out. This stretch will be painful and possibly impossible to do if the seated foot stretch has not been employed for several weeks beforehand in order to prepare the muscles for more advanced stretching.
As the patient’s flexibility increases, the angle of the slant board can be adjusted in order to continue stretching the muscles and tendons in an effective manner.
These and other recommended stretches are generally repeated once or twice daily, with three to five stretching cycles included in each session. As such, they do not take a great deal of time to accomplish. The key is consistency and regularity so muscles and tendons will gradually elongate and become looser.
There is one little device you should buy if you have plantar fasciitis. It’s the Medi-Dyne ProStretch Unilateral System. The device helps to stretch out your plantar fascia and your calf which, if done, can prevent those terrible morning spikes you get if you suffer from plantar fasciitis. It works great with a night splint or possible even as a replacement (as some readers have said).
Physical Therapy: Exercises
One effective exercise regimen is toe stretching, which can assist with lengthening the plantar fascia itself. Since the plantar fascia extends from the ball to the heel of the foot, bending your toes backwards toward the top of the foot will cause the entire ligament to be placed under a gentle stretching stress. Use your fingertips to make your toes perform this maneuver, but be gentle and slow for best results. Toe stretching is most effective when you are already in a seated position with your legs in front of you.
You can increase the value of toe stretching exercises by also bending your toes the usual way, then stretching them backwards once again. Five to ten slow repetitions on each foot can be effective.
Some people find that toe stretching is best performed one toe at a time while others prefer to stretch and flex all toes at once. Which method is effective depends on the individual’s level and location of damage to the plantar fascia, so it is best to try it both ways and see which feels best and serves to relieve the most pain.
Toe stretching can be performed without any additional equipment, but another useful exercise for plantar fasciitis uses a small ball such as a tennis ball. While in a standing position, hold onto a chair or other sturdy object to keep your balance while you perform this exercise. You will need to place the ball on the floor and place your foot atop it. Roll the ball around on the floor, controlling it with the bottom of your foot. Try to move the ball from the heel of your foot to the toes, placing gentle pressure downward the entire time. This will have the effect of massaging the bottom of your foot and gently stretching the planter fascia.
There are a number of plantar fasciitis exercise devices on the market. Some people report them surprisingly effective at treating the condition. One device is the Elgin Archxerciser which is a little device that you slip your your big toe into and pull downwards. It helps to build up your foot muscles and may help fix plantar fasciitis. We’ve had a number of people say it’s helped to cure plantar fasciitis over time.
Physical Therapy: Taping
Another treatment option is taping, in which athletic tape is used to provide support for the foot. When properly done, taping will ease pain by confining the foot in ways that prevent improper movements that might tear the plantar fascia further.
Taping presents some risks if it is not properly performed. Feet should be kept dry to prevent the onset of fungus or athlete’s foot conditions. Nor should tape be left on day and night — as skin is an organic substance, it must be allowed exposure to air.
People who wash with a moisturizing soap will find that the residues and oils in the soap cause athletic tape not to stick to skin. Therefore, patients using taping therapies must switch to a simple soap formulation while taping is in use.
Taping techniques are somewhat simple and most patients are able to learn them with relative ease. However, the success of this therapy varies quite a lot depending on factors such as the extent of existing damage to the plantar fascia and the individual’s pain tolerance. When effective, taping therapy can be of great use, but it is not effective for all patients.
Taping is usually used in combination with other therapies that can actually reverse the condition; taping itself is more of a pain and movement control mechanism than a cure per se.
You can look at the PediFix Arch Bandage which is a sort of elastic “tape” you put around your arch to provide more support. If you want to do the full taping method, any sports tape (for example Johnson & Johnson Coach Sports tape) will do the job fine.
Resources for Further Research into Plantar Fasciitis Therapies
- Four Ways to Fight Plantar Fasciitis from Active.com
- Plantar Fasciitis Treatments from Aetna Insurance Resources
- Plantar Fasciitis Treatments summarized by the Mayo Clinic
3 Surgical and Other Procedures to Treat Plantar Fasciitis
For some patients, the plantar fasciitis condition cannot be adequately treated using medication in combination with shoe supports and physical therapies. In cases where the condition has progressed to an advanced degree, or where for other reasons simple treatments are ineffective, more invasive procedures may be called for. Extracorporeal shock wave therapy and surgery are two of the more dramatic options sometimes needed to treat plantar fasciitis.
Extracorporeal Shock Wave Therapy
Technically classed as a non-invasive procedure, extracorporeal shock wave therapy delivers shock waves into a damaged area of the body in order to encourage the body’s own healing mechanisms to do their job. The shock waves used in this procedure are similar to the ones employed for breaking up kidney stones, a therapy that has been in use for many years. However, in the case of plantar fasciitis therapy, the shock waves employed are ten times less strong than the ones used in kidney stone treatments.
Extracorporeal shock wave therapy is often used as an alternative to surgery. If it is effective, the more drastic step of surgery can be avoided.
Surgery for Plantar Fasciitis
Most patients with the conditions will not require surgery. If the above treatments, however, are not effective even after a year of efforts, your care provide may decide that surgery is an appropriate treatment option for you. Most doctors will insist that before plantar fasciitis surgery is considered, all other treatment options must be exhausted; the doctor must be convinced that the patient has fully participated in prescribed physical therapies and has dutifully worn his or her orthotics or special shoes. Surgery is not a quick fix, but remains something as a last resort.
Surgery involves cutting into the plantar fascia to release tension. It is important that a surgeon release only one third to one half of the tension as proper walking does require some tension present in the plantar fascia. One major complication of plantar fascia surgery is an over release of the plantar fascia. This will result in a fallen arch and will require surgery to correct it; otherwise a foot deformity can develop. Combining plantar fascia surgery with flat foot surgery is not advisable, but sometimes becomes necessary if the surgeon over releases the plantar fascia during the initial surgical procedure.
Another unwanted side effect of plantar fascia surgery is nerve damage to the foot, which can result in pain, numbness, or both in various areas of the foot. This does not occur in all cases but poses a significant risk that must be weighed against the benefit to be gained from the surgery.
As with all surgical procedures, there is also a risk of infection and excessive bleeding.
Resources about Plantar Fasciitis Surgery:
- Diagnostic Information about the Surgical Option
- Plantar Fasciitis Surgery Success and Failures: Anecdotal Evidence
- Surgery Information from Podiatry Today
- Plantar Fasciitis Treatment Summaries from Cigna Insurance
4 Alternative Medicine for Plantar Fasciitis
Natural treatments for plantar fasciitis includes such alternative medicine therapies as the use of magnets.
Magnets have frequently been recommended as an alternative therapy for many kinds of pain inducing conditions, such as arthritis. Plantar fasciitis is no exception. Since plantar fasciitis pain is centered in the foot region, practitioners of alternative medicine recommend that magnets be placed in close proximity this region of the body.
The most common delivery method is to insert magnets into foam insoles which are then inserted into the patient’s shoes. If the foam insoles are well constructed and made of dense enough foam to provide support, they may have the same effects as orthotics. Should the magnets also prove effective, it would mean the magnetic foam insoles provide two different therapeutic therapies simultaneously.
Magnetic treatment is not presented, even by advocates, as a cure for the underlying condition, but rather as a pain management strategy. Research indicates that magnets have been used to treat pain for centuries. Although some doubts exist as to the true effectiveness of such treatments, advocates point to double blind studies in which patients in pain reported a reduction in discomfort after nearly an hour’s exposure to magnetic fields. Since the patients in question did not know if they were exposed to real magnets or not, and only the ones exposed to real magnets reported significant pain loss, there may be something to the idea of magnetic therapy for pain.
In any case, it doesn’t cost very much money to give this strategy a try. Magnetic foam insoles are not, in general, an expensive treatment option. They are available online at a cost that varies between $5.00 and $10.00 per pair.
Most people who employ magnetic therapy will also be engaged in physical therapy or other treatment options designed to cure the underlying condition of plantar fasciitis.
If you want to try magnetic therapy (some people swear by this type of treatment, though as we note, it’s still controversial as to whether it’s effective at treating plantar fasciitis or not), you could try Magnetic Foam Inserts which have magnets inserted into shoe inserts.
Resources for Alternative Medicine Therapies
5 DIY Home Remedies for Plantar Fasciitis
Most home remedies for foot pain, plantar fasciitis included, are aimed at managing the condition so that normal life activities can be continued or resumed.
The most common home remedies include the following:
- advising the patient to put his or her feet up
- applying ice or cold packs to the sole of the feet
- decreasing physical activities that cause pain, such as running, walking, and standing for long periods of time
- switching from vigorous exercise to low impact exercises which are more gentle on the joints and feet
- wearing shoes with arch supports
- exercises to stretch the arch of the foot
These home remedies are similar in many respects to the treatments that physicians will offer. Arch support shoes, for example, operate on the same principle as orthotics or special shoes for plantar fasciitis in particular.
Prevention of Plantar Fasciitis
As the old saying goes, an ounce of prevention is worth a pound of cure. This is nowhere more true than in the case of plantar fasciitis. The condition can be debilitating and cause sufferers a terrible level of pain, so it would be best for all concerned to avoid the condition in the first place.
Some risk factors, such as age and gender, cannot be avoided, but many decisions can be undertaken than will serve to prevent the onset of plantar fasciitis. Women who wear high heels on a daily basis are greatly increasing their likelihood of developing the condition. Excessive exercises on hard surfaces, especially while wearing shoes that provide insufficient support and cushioning, are another activity to be avoided at all costs.
Well-fitting shoes appropriate to the sports activity being practiced are a must for those who would keep their feet in top condition and avoid the pain and disability that comes hand in hand with plantar fasciitis. Proper stretching both before and after sporting activities can help make sure that tendons and ligaments remain in good shape, unlikely to tighten in later life.
Resources About Prevention and Home Remedies for Plantar Fasciitis
- Plantar Fasciitis Prevention
- Summary of Prevention Methods from Web M.D.
- Injury Prevention: Plantar Fasciitis
- Recommendations for Home Treatment and Prevention of Plantar Fasciitis from the Mayo Clini
Final Word on Treating Plantar Fasciitis
We hope you’ve found this comprehensive plantar fasciitis article helpful. It can feel overwhelming when you suffer from this debilitating condition, but rest assured that you can cure the condition if you are proactive about it (and indeed you must, because plantar fasciitis can severely limit your life). It can take anywhere from 4 months to several years to effectively get rid of the condition, so it’s important to be patient when trying to cure the problem!
Best of luck with your treatment!