Sunday, July 21, 2024
Bottom of Foot Pain FOOT PAIN

Plantar Fasciitis- The Ultimate Guide (From a Podiatrist)

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Plantar fasciitis is a common problem. This condition accounts for 11% to 15% of all foot symptoms requiring professional medical care (1)

Heel/arch pain can be frustrating and difficult to live with. Luckily, there are many things you can do to treat plantar fasciitis that can help you get back to your activities faster. 

In this article, you’ll learn how to treat plantar fasciitis and what you can do to ensure it doesn’t come back. 

Anatomy of the Plantar Fascia

The plantar fascia is a thick band of connective tissue that runs along the bottom of your foot, from the heel to the toes. The plantar fascia originates along the plantar calcaneal tubercle of the calcaneus and fans to extend into the toes. 

The plantar fascia is separated into three bands: the medial band, the central band, and the lateral band. 

The posterior tibial artery provides blood supply to the plantar fascia. The plantar fascia is innervated by the medial and lateral plantar nerves

The plantar fascia helps support the arch and also aids with shock absorption during walking and running. 

foot pain from high heels

What Is Plantar Fasciitis and What Causes It?

Plantar fasciitis is degeneration of the plantar fascia that occurs secondary to overuse and tightness of the ligament. If you spend a lot of time on your feet, you’re more likely to develop plantar fasciitis. 

Tightness of the Achilles tendon and plantar fascia can cause the ligament to become contracted and inflamed. 

Certain factors can increase the likelihood of developing plantar fasciitis. 

These risk factors include: 

1) Foot structure: If you have flat feet and overpronate as you walk, you will strain your plantar fascia in the process and develop heel/arch pain. High-arched feet can also cause plantar fasciitis due to excess pressure being placed on the heel. 

2) Shoes: Certain shoes like high heels can cause plantar fasciitis due to excess pressure being placed on the heels while standing and walking.  

To read more about high heels and their effects on the feet, check out this supplemental post “High Heels and Foot Pain (Actionable Solutions on What to Do).

Also, wearing improper shoes for your foot structure can strain the plantar fascia. 

Wearing certain shoes that don’t have arch support (like ballet flats) can strain the plantar fascia and cause plantar fasciitis. 

Read more about this in this supplemental article “A Detailed Guide on How Bad shoes Can Cause Foot Pain”. 

3) Weight gain: Gaining weight can also increase plantar fascia pain. This is because excess weight places more pressure on the heels and strains the plantar fascia while you stand and walk. 

Studies show that higher BMI can worsen plantar fasciitis symptoms. 

4) Activity change: If you have suddenly changed your activities recently, you may notice heel pain. Did you go for a hike recently? Did you walk more than usual during a vacation? Did you increase your exercise regimen too fast and too soon? 

Aggressive changes in activity that require more walking than usual can aggravate plantar fasciitis. 

5) Walking/Running on an incline: If you walk on an incline regularly while exercising (like on a treadmill), this could aggravate plantar fasciitis. 

When you are walking on an incline, the plantar fascia can become strained and inflamed. If the fascia is already weak, it may even tear. 

heel pain while sitting

What Are the Symptoms of Fasciitis Pain?

  • Dull, achy pain in the heel 
  • Dully, achy pain in the arch
  • Sharp heel pain
  • Swelling in the heel and arch
  • Pain with walking, and relieved by rest
  • Pain in the heel or arch in the morning
  • Pain in the heel or arch when standing up from a seated position
  • Bruising in the heel or arch
  • Pain when stretching the toes in an upward direction
doctor examining foot

How Is Plantar Fasciitis Diagnosed?

If you have pain secondary to plantar fasciitis that has not resolved with home therapy, it’s best to visit a local foot doctor. The doctor will perform a history and physical exam and localize the area of your pain. 

Your doctor may order one or more imaging tests to help diagnose plantar fasciitis. These tests may include a foot x-ray, Ultrasound, or MRI scan.

Although x-rays cannot directly identify plantar fasciitis, they are helpful to rule out other problems in the foot such as stress fractures and bone tumors. 

Occasionally, one may think they have plantar fasciitis but may have a bone tumor. Heel spurs on the bottom of the foot are not generally painful.

Your doctor may order an ultrasound to identify plantar fasciitis. Ultrasound uses sound waves to create images of soft tissues like tendons and ligaments, and can help diagnose plantar fasciitis. 

Occasionally, your doctor may recommend a Magnetic Resonance Imaging Scan (MRI) to diagnose plantar fasciitis. 

MRI scans use magnetic fields and radio waves to create images of both soft tissues and bones. 

An MRI can be helpful to identify plantar fasciitis, plantar fascia tears, as well as stress fractures/bone tumors. 

stretching plantar fascia

Treatment for Fasciitis

Home Remedies for Heel and Arch Pain

If you have plantar fasciitis, there are a few things you can do to help treat it right from your home. 

Start RICE Therapy to Alleviate Pain and Swelling

You can ice the plantar fascia for 20 minutes on and off intermittently to help constrict the blood vessels and reduce throbbing pain in the heel/arch.

Resting the foot for a certain amount of time during the day can also relieve pain associated with plantar fasciitis. 

If your heel/foot is swollen, you can wrap it using an ACE bandage. Buy a 6” ACE bandage on Amazon. An alternative would be to wear compression stockings.

I recommend the Jobst Compression stockings strength 15-20mmHg. You can buy this on Amazon. Imagine squeezing a blood pressure cuff to 15-20mmHg. That’s how tight the socks will feel when you are wearing them. 

Compression stockings help immensely to reduce swelling and foot/leg pain. Do not wear compression stockings if you have peripheral vascular disease

Compression stockings should only be worn during the day and should be removed at night when your legs are elevated. 

The stockings can be hard to get on your legs, so make sure someone can help you apply them.

Stretch the Plantar Fascia

Stretching out the Achilles tendon and the plantar fascia is important in relieving pain associated with plantar fasciitis. 

Plantar fasciitis often occurs due to a tight Achilles tendon. 

The two calf muscles (gastrocnemius and soleus muscles) make up the Achilles tendon on the back of your ankle. When the Achilles tendon is tight, overpronation can occur and cause the plantar fascia on the bottom of the foot to be aggravated. 

That’s why it’s important to stretch both the Achilles tendon and the plantar fascia daily to help improve symptoms.

Plantar fasciitis stretching exercises should be performed at least three times daily for 15 to 30 minutes at a time. 

Check out this link on how to perform stretching exercises for the plantar fascia

Wear Night Splints

Many people with plantar fasciitis have foot pain when they first get out of bed. This is because when you are sleeping, your feet are in a plantarflexed (foot and toes pointing down) position. This causes your plantar fascia to stay contracted all night. 

When you get up to stand and walk, the fascia stretches out abruptly and can cause pain when you take the first few steps. 

A night splint is greatly effective in reducing pain associated with plantar fasciitis that occurs in the morning. 

A night splint is a boot that you wear that keeps your ankle at 90 degrees to prevent your foot from dropping and thus keeps your plantar fascia from becoming contracted. You can wear night splints if you sleep on your back or your side.

Get the dorsiflexion night splint from Amazon. It takes a while to get used to wearing the splint, however it is beneficial in reducing pain that occurs in the morning. Do not walk in a night splint. 

Take an Anti-inflammatory Medication

If your doctor permits it, NSAIDS can be beneficial in reducing pain associated with plantar fasciitis. 

Over-the-counter medication like Motrin can help reduce inflammation. Topical NSAID gels like Voltaren 1% gel is effective in reducing heel pain as well. You can rub the gel directly on your heel. 

Get the Right Shoes

Plantar fasciitis pain can be exacerbated by wearing the wrong shoes. Make sure you are wearing the right shoes with the appropriate amount of arch support for your foot structure. If you don’t know what shoes to buy, go to your local running shoe store to be evaluated. 

The representative at the shoe store will measure your foot size (length and width) using a Brannock Device. Many people wear the wrong size shoes. The Brannock device will give you an accurate measurement of your shoe size.

The representative at the shoe store will then give you recommendations regarding shoe gear options that would be suitable for your feet. You can also ask your foot doctor for recommendations. If you wear orthotics, make sure to take them with you when you are picking out shoes so that you can try them on in your new shoes to make sure they fit. 

Every month or so, check your shoes to make sure they are not worn. Shoe wear varies greatly depending on the type of shoe the person is wearing and their activity level.

Wear Heel Gel Cups

Although gel cups alone will not help cure plantar fasciitis, they can help provide shock absorption when walking and running. You can place them in your shoes directly on top of your shoe insoles. 

Gel cups help cushion your heels and can help reduce shock on the heels when walking/running. I recommend Tuli’s heel cups. 

They are comfortable and effective in reducing shock.

massage plantar fascia

Massage the Plantar Fascia

You can massage the plantar fascia using a golf ball, soup can, ice-cold water bottle, and even marbles. If you want, you can even obtain a manual massager on Amazon. 

Roll the arch and heel over the massager daily. This can help make the plantar fascia more supple and improve blood flow to the area, thus helping to reduce pain. Get the Foot Massager Roller Ball from Amazon.

Get the Right Orthotics

Wearing the right orthotics can be immensely helpful in alleviating pain associated with plantar fasciitis. There are so many different orthotics out there, but I recommend the Powerstep brand. They are lightweight, supportive, and have an appropriate arch to them.

These orthotics will last 6 to 12 months depending on your activity levels. You can order Powerstep inserts from Amazon based on your shoe size.

  • From mild to moderate flat feet: I would recommend the Powerstep ProTech orthotic. They have a supportive arch with a deep heel cup that will keep your heels from sliding. The center of the heel has a poron cushion that helps with shock absorption.
  • For severe flatfeet: I would recommend the Powerstep Maxx orthotic. It has the same features as the Powerstep ProTech orthotic but with an added extrinsic heel post that helps with overpronation associated with severe flat feet.
  • For high-arched feet: I would recommend the Powerstep Pinnacle High Arch orthotics. It contours the high-arched feet well and helps with shock absorption. 

Use Kinesiotape (KT Tape) For Plantar Fasciitis

Kinesio tape works by lifting the skin away from the underlying tissues. This creates a space between the skin and the tissues, which allows for better circulation and less inflammation. 

The tape also provides support to the plantar fascia, which helps to reduce stress on the tissue.

KT tape stays on for a long time and is very adhesive. You can apply the tape and continue your activities. 

Check out this video by KT tape on how to properly tape the plantar fascia. 

Wear a Cast Boot if the Pain Becomes Severe

If you have severe heel pain or arch pain, it’s best to walk in a cast boot until you can see your foot doctor. Severe pain along the plantar fascia that does not improve could be a sign that there is a tear in the fascia or even a stress fracture.

You can buy a cast boot on Amazon. You can start by obtaining a short-cast boot. This boot is essentially a walking cast that will force your foot and ankle to rest and alleviate pressure along the plantar fascia. 

Soak Your Feet in Epsom Salt in Warm Water

Epsom salt soaks in warm water can be beneficial in alleviating achy pain from plantar fasciitis. Epsom salt when added to water breaks up into magnesium and sulfate. This can help reduce the dull, achy pain in your foot. 

Make sure to soak for no more than 15-20 minutes, as soaking the foot for too long can dry out the skin.

How to perform foot soaks: 

-In a bowl, mix 1/2 cup of Epsom salt and 1/2 cup of warm water. 

-Stir until the salt is dissolved in the water.

-Fill a basin with warm water and add the Epsom salt mixture. 

-Soak your feet in the foot bath for 15-20 minutes. 

-After your feet have soaked, rinse them off with warm water and dry them with a towel. 

injection

Other Treatments for Plantar Fasciitis

If your plantar fasciitis symptoms do not get better, seek help at your foot doctor’s office. Your doctor may recommend more aggressive treatment options to alleviate pain. 

Corticosteroid Injections

Corticosteroid injections can help to temporarily reduce pain and inflammation in the plantar fascia. Your doctor will mix a local anesthetic with a steroid and inject it into the heel or arch. You may feel some discomfort with the injection, but it will be brief. 

Steroid injections can reduce pain for up to 3-6 months. You can resume your normal activities after receiving a steroid injection. 

To read more about the efficacy of steroid injections for heel pain, check out this supplemental post “Do Cortisone Shots Work For Plantar Fasciitis?”

Physical Therapy

Physical therapy may be recommended to help stretch the plantar fascia and the calf muscles. Ultrasound therapy and massage therapy are beneficial in reducing pain and improving blood flow. 

Physical therapy will be needed 3 times a week for 1 month or more for acute plantar fasciitis. 

Custom Orthotics

Custom orthotics can be an effective treatment for plantar fasciitis because they redistribute weight away from the inflamed areas of your feet by lifting the arch and supporting your foot. This helps to relieve pressure on the plantar fascia and allows it to heal.

In addition, custom orthotics can also help to correct any underlying problems with your walking pattern that may be contributing to your plantar fasciitis. 

Custom orthotics are made from a variety of different materials, and are custom-made to fit your feet. Your doctor will obtain a mold of your feet and construct a custom orthotic. The orthotics can last anywhere from 5-10 years depending on the materials used.

Custom orthotics can be pricey, ranging anywhere from $300-$800 a pair. Make sure to call your insurance to see if custom orthotics would be covered by your insurance.

Surgery

If all conservative therapy options have failed, your doctor may suggest surgery for plantar fasciitis. 

Surgery for plantar fasciitis can be done arthroscopically with a small incision or an open fasciotomy. This involves releasing a portion of the plantar fascia ligament and thus relieving pain. 

Surgery would be done in the operating room under anesthesia. After surgery, you will need to stay partially weight-bearing in a cast shoe for 3-6 weeks before transitioning to athletic shoes. 

Can Plantar Fasciitis Go Away on Its Own?

In some cases, plantar fasciitis does go away without treatment. It can resolve if the symptoms are mild. However, most cases of plantar fasciitis need to be treated with at least stretching and massages. 

Plantar fasciitis pain, even when treated, can take 6-18 months to resolve.  

How Can I Prevent My Plantar Fasciitis From Getting Worse?

To prevent plantar fasciitis from becoming worse, it’s best to rest the foot and perform gentle stretching exercises. It’s also best to reevaluate your shoe gear to make sure you are wearing the right shoes and not wearing worn shoes. 

You should also avoid high-impact activities such as running/jumping if you have heel/arch pain. 

Is Plantar Fasciitis Permanent?

Plantar fasciitis is not permanent. Plantar fasciitis pain can usually be resolved with stretching, the correct shoe gear, and rest. The fascia does eventually heal and does not continue to cause pain permanently. 

running shoes

What Happens if You Leave Plantar Fasciitis Untreated?

If you leave plantar fasciitis untreated, the plantar fascia can weaken and tear. A ruptured plantar fascia can cause severe pain, swelling, and bruising in the heel/arch of the foot. Plantar fascia tears can take 3-6 months to heal.

To read more about treatment for a torn plantar fascia, check out this supplemental post “Plantar Fascia Tears- Causes, Symptoms, and Treatment”.

Another thing that can happen is that you can develop a stress fracture of the calcaneus (heel bone). This can lead to diffuse pain in the heel and may require you to stay immobilized in a cast boot for 6-8 weeks or more. 

Does Wearing Shoes in the House Help Plantar Fasciitis?

Wearing shoes with appropriate arch support can help elevate the arch and relieve strain along the plantar fascia. Aim to wear slip-on shoes that can accommodate your inserts in them. This would be ideal. 

If you prefer to wear sandals, make sure to wear sandals that have arch support in them like a Birkenstock sandal or an Oofos sandal. 

What Shoes Would a Healthcare Provider Recommend for Plantar Fasciitis?

Although there are many shoes that can improve plantar fasciitis symptoms, running shoes work well for plantar fasciitis. Ask your healthcare provider for recommendations.

Stability running shoes are designed for people who have low or medium arches and need extra support. These shoes have a medial support post, which is a piece of firm foam that runs along the inner side of the shoe from heel to toe. 

This helps prevent overpronation, which is when your foot rolls too far inward when you land on it. 

Examples of stability athletic shoes are:

-New Balance 860v13

-ASICS GEL-Kayano 29

-Brooks Adrenaline GTS 22

-Saucony Guide 15

Motion-control running shoes are for people who have high arches or flat feet. These shoes have a rigid heel counter (the part that cups the back of your heel) and a dual-density midsole (the part between the outsole and insole). 

The extra support helps prevent overpronation and encourages proper alignment. Motion-control shoes are generally a bit heavier.

Examples of motion-control shoes are:

-Hoka Gaviota 3

-Brooks Beast ’20 review

-Brooks Adrenaline GTS 18

-Mizuno Wave Alchemy 12

Can Socks Affect Plantar Fasciitis?

Certain socks can make plantar fasciitis symptoms worse. For instance, if your socks are too tight and don’t fit well, they can place excessive pressure on the arch and the heels and cause pain.

Also, some socks like cotton and nylon socks can cause your feet to stay sweaty. This can cause your feet to slip around in your shoes and cause pain. 

If your feet tend to sweat, get Merino wool socks. These socks can help wick away moisture and keep your feet comfortable.

If you have a lot of swelling in your foot, compression stockings (as mentioned previously) can help to reduce swelling and pain.

stationary bike

Is Riding a Stationary Bike Good for Plantar Fasciitis?

Riding a stationary bike is good for plantar fasciitis because it helps stretch the plantar fascia and the Achilles tendon, and thus helps prevent inflammation. 

Also, riding a stationary bike is a low-impact activity that doesn’t put too much stress on your feet and ankles. 

This is important because when you have plantar fasciitis, you want to avoid activities that put undue strain on the affected area. Working out on a stationary bike is a great way to stay active without exacerbating your symptoms. 

Why Do I Have Plantar Fasciitis on Only One Foot?

Plantar fasciitis is often seen in one foot but can occur in both feet. This is due to biomechanical abnormalities that may be present in one foot and not the other. 

For instance, one foot may be more flat-footed than the other. Or you may have ankle equinus (reduced range of motion in the ankle) on one side more than the other.

Also, some people are born with limb length discrepancies, with one limb being longer than the other. 

These factors can cause the plantar fascia to become more strained on one side, resulting in plantar fasciitis. 

Conclusion

Dealing with pain from plantar fasciitis can be incredibly frustrating. It’s best to address your symptoms early and start treating them right away to ensure the best results possible. If your plantar fasciitis symptoms don’t improve with self-treatment, make sure you contact your local foot doctor to be evaluated. 

Related articles: 

7 Tell-tale Signs That Your Planar Fasciitis is Healing

The Top 5 Reasons Your Heel Hurts From Walking

Ruptured Plantar Fascia – Causes, Symptoms & Treatment of a Tear

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References

  1. Buchanan BK, Kushner D. Plantar Fasciitis. [Updated 2022 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431073/
  2. Taş S, Bek N, Ruhi Onur M, Korkusuz F. Effects of Body Mass Index on Mechanical Properties of the Plantar Fascia and Heel Pad in Asymptomatic Participants. Foot Ankle Int. 2017 Jul;38(7):779-784.https://pubmed.ncbi.nlm.nih.gov/28535692/
  3. Tahririan MA, Motififard M, Tahmasebi MN, Siavashi B. Plantar fasciitis. J Res Med Sci. 2012 Aug;17(8):799-804. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687890/
  4. Latt LD, Jaffe DE, Tang Y, Taljanovic MS. Evaluation and Treatment of Chronic Plantar Fasciitis. Foot & Ankle Orthopaedics. 2020;5(1).https://journals.sagepub.com/doi/full/10.1177/2473011419896763
  5. Trojian T, Tucker AK. Plantar Fasciitis. Am Fam Physician. 2019 Jun 15;99(12):744-750. https://pubmed.ncbi.nlm.nih.gov/31194492/
  6. Barrett SJ, O’Malley R. Plantar fasciitis and other causes of heel pain. Am Fam Physician. 1999 Apr 15;59(8):2200-6.https://pubmed.ncbi.nlm.nih.gov/10221305/

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Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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