It is estimated that 10 percent of the U.S. population will experience the pain of Plantar Fasciitis at some point during their lifetime. If you have foot pain, are you one of the two million people per year who’s asking: What is Plantar Fasciitis?
Your doctor may have trouble giving you a firm diagnosis; if so, cut him some slack. It’s not so easy to determine whether your pain arises from Plantar Fasciitis or some other condition. There are many causes of foot pain, and they can sometimes manifest with similar symptoms. Narrowing it down to the proper diagnosis may only be possible by a visit to a qualified podiatrist or orthopedic specialist.
But before investing money and time getting referrals and scheduling appointments, read on for some information that might help you understand why your foot hurts, what you can do to relieve the pain and prevent it from recurring, and when it’s time to start worrying about turning to professional help.
The name Plantar Fasciitis (PLAN-tur-fash-ee-EYE-tis) derives from:
- Plantar, meaningbottom of the foot;
- Fascia, whichis a type of connective tissue; and
- -itis, whichis a suffix meaning inflammation
The plantar fascia is a long, broad ligament-type band of tissue that is attached to your heel bone (calcaneus) and runs along the bottom of your foot. It branches out near the ball of your foot toward the base of each toe. If you flex your foot (as if you’re kneeling with toes on the ground) and press under the ball of the big toe, you should be able to feel the edge of it as you run your finger along your instep toward your heel. Of course, if you have Plantar Fasciitis, you’ll have no trouble finding this fibrous bunch of tissue, because it’s often tender to the touch at some portion along its run.
Why Does It Hurt?
First, understand that your feet support you AND all the forces applied to you. When you’re walking, running, climbing stairs, the forces supported by your feet can amount to up to 7 times your body weight—this is nearly 1000 tons of force per day for the moderately active person.
And by “support”, we really mean the feet must absorb force in such a way that we don’t damage anything and can move comfortably. Guess what part of the foot bears responsibility for catching, distributing and releasing this repetitive burden? The plantar fascia.
If you think of this ligament as a rubber band, it is drawn tight to capture the force of the heel striking the ground; then it is let loose as you rise up onto the ball of the foot and toes to propel yourself up and forward. And just like a rubber band, with time or excessive hard use, small tears can occur in the fibers of the band.
Fortunately, a complete break of the plantar fascia is so rare as to be almost a non-existent risk—but repeatedly stressing this band with its multitude of small tears will cause irritation, swelling, and perhaps some small separation from the heel bone. It is at this point that pain develops, most commonly at the bottom of the heel, toward the front.
It is very important to start introducing remedies and preventive techniques as soon as you notice this type of pain, because allowing further damage can quickly escalate the condition to a very painful, long-term problem.
Risk Factors: What Causes Plantar Fasciitis?
There are any number of causes for Plantar Fasciitis. It’s more accurate to call them Risk Factors, because anyone can “get” this condition. But certain people involved in certain activities are more likely to experience it. You will recognize yourself in at least one of the risk factors below, and probably in several.
The importance of the distinction between “causes” and “risk factors” is that a cause can’t be modified—it’s something in the past. But a risk factor is something you can control, both to reduce the pain of a current episode of Plantar Fasciitis AND prevent a recurrence.
This is probably the greatest single risk factor leading to Plantar Fasciitis. In some rare cases (such as pregnancy), your weight gain cannot be avoided. But in general, overweight people—particularly women—are much more likely to have persistent pain from the condition. A rapid weight gain is more likely to cause the problem, because the foot does not have adequate time to adjust to the greater and different stresses placed upon it.
In addition to the obvious fact that more weight puts more force on the foot with every step, extra weight changes the way the foot has to work. When we walk, we’re essentially “tipping over” on the leading foot, and then catching ourselves with the swinging foot. The point of highest stress on the plantar fascia comes with the effort exerted to tip over—and tipping over a heavier person is harder.
Thus, the ligament needs to work harder with more weight in this situation. The reason women are most susceptible is because their center of balance is lower than a man’s, and already puts additional strain on the plantar fascia during the act of walking.
So if you have developed Plantar Fasciitis and are overweight, you will go a long way toward licking this condition by losing weight.
Inflexible Calf Muscles
This probably ranks equal with weight as a risk factor, but overweight people tend to be inactive physically. And an inactive lifestyle is likely to contribute to calf muscles that are tight or too short. There are also some people who simply have short calves.
The consequence is that their feet are not allowed to work as efficiently as they were designed to, forcing the toes into the ground too soon and rarely allowing the plantar fascia to extend to its full capability.
There are various stretching exercises that will be very effective for limbering up your calves and ankles. If you have a biomechanical problem (such as short calf muscles that will not respond to simple at-home stretches), then other remedies can be suggested by a podiatrist. But for most of us, gently stretching the calves and ankles—every day, and always before any physical activity—will work wonders for preventing a recurrence of Plantar Fasciitis.
Sudden Change In Activity
This risk factor can apply both to inactive people and active people. If you’re inactive, your calf muscles and plantar fascia are probably not conditioned for the additional stretching that occurs when you suddenly begin to perform activities, even relatively mild ones like walking.
But it’s also true that people considered active can put sudden stresses on their feet that the plantar fascia is not prepared for. For instance, somebody who’s been walking several miles a day for years would not necessarily be prepared to play basketball or soccer without a very thorough and complete program of warm-up exercises.
This risk factor takes on more prominence as we age. When we’re young, we can spend weeks or months fairly inactive, and then suddenly “jump into” something more jarring without experiencing any pain at all.
But with age comes less ability to indulge in that kind of spontaneity without bad effects. It’s always a good idea to stretch well before playing any kind of running or jumping game; but when you’re over 25 years or so, it’s almost a requirement, if you don’t want to get hurt.
Sports and Hard Activity
Sports that require lunging, jumping, or repetitive hard steps are particularly hard on the plantar fascia, especially when they take place on hard surfaces. Tennis, basketball, running, step aerobics, and volleyball are all examples. There is a real possibility of tearing the fascia away from the heel in activities like this, especially in competitive situations.
But beyond the world of sports, some everyday “extreme” activities can cause problems as well. pulling the fascia to its limit for an extended period. Pushing a heavy cart or rolling something uphill has a similar effect, except that it happens repeatedly.
There is really no amount of warming up that can prevent injury to the plantar fascia in these situations. Your best bet is to stay limber and eat well for bones, muscles and tendons that respond as well as possible in diverse situations. And never exert yourself beyond a point where it feels like something might “snap”.
People in some occupations are more likely to develop Plantar Fasciitis. Waitresses, nurses, mail carriers, and teachers are all people who spend too much time on their feet each day. Anybody who needs to stand or walk most of the day on hard surfaces should wear shoes with a lot of cushioning, and take time out to stretch. If possible, mats or carpeting should be used in areas where you stand for long periods.
What makes a “bad shoe”? One that is stiff, inflexible, and with too little arch support. Look for shoes where the toe bends back easily, and with plenty of cushioning inside.
High heels are not necessarily bad, but wearing them too much will get the calf muscles “used” to being foreshortened, and suddenly switching to flat shoes can create a painful shock for the plantar fascia.
Long-term use of flip-flops is particularly hard on the feet because they have zero arch support, and your toes are scrunched together trying to hold them on. This does not put the plantar fascia in the best position to handle stress.
Some people are subject to overpronation, where the ankle rolls inward slightly when walking or standing. This puts more weight on the insides of the feet, and may contribute to the development of Plantar Fasciitis. People with flat feet may experience overpronation more often.
The opposite is underpronation, and can also cause problems by rolling the feet outward. This occurs more often in people with high arches.
Having one leg shorter than the other is likely to cause foot problems, including Plantar Fasciitis.
All the above can be corrected with orthotics (shoe inserts), whether mass-produced or custom made. However, be careful to break in any rigid orthotics as directed, since they can actually make the problem worse if they don’t fit perfectly. If you experience more pain with any orthotic device, stop using it immediately and switch to another or get a doctor’s advice.
Some medications have a side effect or risk of weakening ligamentous tissue. Whether or not these medications actually cause Plantar Fasciitis is not proven, but there is some support for the possibility that quinolone antibiotics are a contributing factor. If your medicine chest includes antibiotics with names ending in “oxacin”, consult your doctor for futher information.
This is a risk factor that obviously can’t be controlled, but if you simply can’t think of how you might have injured your foot, realize that older tendons and tissues are more susceptible to rips and tears. It might not take much to do damage if you’re over 50. In addition, the padding of the foot thins as we age, providing less protection from the shock of all the forces we subject the feet to each day.
How Can I Stop The Pain?
If you have been suffering pain for some time—months—and it’s getting worse, you might want to see your doctor. At-home treatments should begin immediately when the pain starts. Gritting your teeth through the pain and continuing normal activities may have caused enough damage that you require a more thorough examination.
It’s also important to recognize that other conditions can cause the same kind of pain as Plantar Fasciitis. In many cases, though, the less aggressive remedies that you can administer yourself will certainly do no harm, and they might help you avoid a visit to the doctor by reducing pain to the point where you’ve essentially “healed yourself”. Some of these conditions are:
- stress fracture
- tarsal tunnel syndrome
- heel bursitis
But if you’ve just started experiencing the heel pain, and the information above leads you to believe you have Plantar Fasciitis or one of the similar conditions, a basic regimen of conservative treatments is the recommended first step. Try each one, or a combination of all, to see if you can relieve the pain quickly and prevent it from recurring. Also remember to monitor your risk factors both while recovering and post-recovery, so you do not injure the foot again. Here are the remedies that will help 90% of sufferers find relief from pain and promote healing:
Rest and Ice
These two are the most effective treatments for most people. If you can actually stop using the foot for weight-bearing, all the better. But definitely don’t partake in activities that put undue stress on it. If you’re a jogger, take a week or two off. If you’re a waitress, see if you can take over hostessing duties until your pain is gone. It’s inconvenient to be off your feet or to reduce your duties temporarily at work; but it’s much better than undergoing surgery at some point and being unable to walk for several weeks.
Applying ice to the foot is important to reduce microbleeding and scar tissue. It also helps to reduce inflammation. If you can do this 5 times per day, you should see great results. If that’s impractical due to your type of work or schedule, then try it each night after your day’s activities are finished and there’s little chance of stressing your foot again until morning. You should also apply ice immediately if you re-injure your foot.
Since treating the foot with ice is a pretty boring task, try to make it as easy as possible so it’s hard to skip a treatment. Many people use a frozen can of vegetables with the label removed—it’s not so cold that they need a protective layer between it and their skin, it’s easy to roll under the foot to make sure all injured areas are treated, and you can just throw it back in your freezer (or cooler, at work) so it’s ready for next time. Five minutes per treatment should be fine—you don’t want to freeze your foot, just cool it.
Use anti-inflammatory medications like Ibuprofen, Aleve, and aspirin. Don’t use Tylenol.
It might seem counter-intuitive to stretch a ligament that was damaged by stretching, but we’re talking here about simply stretching it to the point where it’s “warmed-up”. Even a very gentle massage with the fingertips will succeed in stretching the plantar fascia enough so that pain while walking is reduced. At the same time, be sure to stretch your calf muscles and ankles to give your foot the best chance of remaining flexible while going about your daily activities. It’s very important that your leg and ankle are not so tight that they are reducing the free movement of your foot.
Some people find success by adding a night splint, which keeps your leg and foot slightly extended while you sleep. The goal is to prevent the plantar fascia from tightening up at night, so that heel pain is reduced in the morning.
Athletic tape can isolate and immobilize the plantar fascia enough to relieve pain for many people. You can find detailed instructions online for a variety of taping schemes that will help heel pain.
More Serious Cases
If you have tried the remedies above for a couple of weeks with no success—and assuming you have ceased any activities that might be preventing your foot from healing—then you should see your doctor. It’s important to resolve Plantar Fasciitis before damage progresses to the point where invasive treatments are needed, because these have a less-than-certain outcome. However, a certain percentage of people with the condition will have chronic cases that cannot be treated any other way.