Plantar Fasciitis, Your Questions Answered

What is Plantar Fasciitis?

The term plantar fasciitis means inflammation of your plantar fascia. The plantar fascia runs along the bottom of your foot from your heel to your toes. It’s a very strong ligament, so problems usually occur at the attachment to the heel bone. That’s why people with plantar fasciitis complain of heel pain, and it’s usually worse in the morning or after resting for a while.

You can easily feel your own plantar fascia. Just run your finger along the arch of your foot. You’ll feel that rope-like connective tissue that pops out when you pull your toes back? That’s your plantar fascia… and it’s really important.

When you’re walking, your plantar fascia stabilises your arch to enable you to push off properly. It’s the longest ligament in the body – and the strongest as well, able to withstand up to 30 times your body weight.

Technically, the chronic heel pain problem is actually more often to do with degeneration of the plantar fascia. That’s why podiatrists can refer to it as plantar fasciosis. However, I’ll use the more popular term, plantar fasciitis here.

Plantar Fasciitis is a common diagnosis for anything heel pain-related, but can be mis-diagnosed in up to 80% of cases. It’s important to get the right diagnosis to ensure you receive the most effective heel pain treatment.

What are the symptoms?

You can feel a sharp pain when you are on your feet, and a dull ache when you’re resting, but usually it is worse in the morning when you are hobbling, or after you’ve been sitting down for a while.

Usually it will hurt mostly directly underneath the heel bone right in the centre of the pad of your heel.

What causes plantar fasciitis?

Sudden overuse injuries, new shoes, doing more activity than normal, or perhaps just standing for longer periods of time can cause micro-tearing of the plantar fascia. The extra load pulls the plantar fascia from the heel bone and causes inflammation.

Usually this damage will heal if you are off your feet for a while, for example, while sleeping overnight. The body heals the painful area with fibrosis or scar tissue formation. However if your foot isn’t getting a chance to rest properly, the new tissue can be damaged again as soon as you stand on the feet after rest. This starts the injury cycle of pain and micro-tearing again. That’s why plantar fasciitis often hurts most after you’ve been resting for a while.

Over time the tissue starts to thicken and if inflammation continues, standing can be painful. The body is clever, though, and if you let it go too long it will grow extra bone. This is the beginning of a heel spur.

Are some people more likely to get Plantar Fasciitis?

People who have recently changed jobs or started on a health kick can be more likely to get plantar fasciitis, and it’s not limited by age. More often, though, it’s middle-aged women and men that get it.

Some people who have injured themselves in the past can be more likely to get plantar fasciitis as the body tries to compensate for the injury.

It’s actually amazing how our feet put up with what we put them through. In a lifetime we will walk the equivalent distance to walking around the earth 3 times. There will be natural degeneration and weakening depending on your activity levels and injury history that might also contribute to getting plantar fasciitis.

If you have plantar fasciitis, are there forms of exercise you should avoid?

If you have plantar fasciitis, make sure you are giving it a chance to heal. Long runs on hard ground, beach sprints that require bursts of power, jumping and lunging can all make it worse. You want to give it a chance to heal without damaging things further.

You need to find a balance between giving it enough rest to heal, and enough work to stay strong. That’s the tricky part, but if you get it right you can recover well.

You’ll feel better with cushioning or padding under your heels. But again you need to have a balance between something soft, and having enough support. So, wear comfortable, supportive shoes, and make sure you stretch every day. 

It can also help to massage the area by rolling your foot over a tennis ball or golf ball.

What is the best treatment for plantar fasciitis?

Podiatrists are the health professionals dedicated to problems involving the feet, and have expert knowledge and training for helping people with plantar fasciitis. Plantar fasciitis treatment and management usually includes a combination of the following. Your podiatrist can:

• Order an X-ray and ultrasound to find out exactly what’s wrong
• Help you find the right shoes to wear
• Advise on appropriate plantar fasciitis socks
• Help you with specific plantar fasciitis exercises for your feet
• Help your muscles and joints work together with foot mobilisation to encourage healing
• Make specific orthotics for your shoes to offload the painful area and promote healing of the injured plantar fascia
• Assist with taping and plantar fasciitis strapping techniques to support the injured area
• Advise on night bracing if needed
• Help with shock wave therapy (ESWT) in chronic heel pain cases
• Advise on activity or training modification
• Work with you to make sure the problem doesn’t return

Everything is focused on treating the cause of the problem, and reducing the load on the plantar fascia. That’s how you can speed up healing and prevent the problem returning.

Once your pain has resolved, progressive loading can commence with a major focus on specific strengthening exercises, support and prevention of injury recurrence.

What other heel pain treatments are available?

Podiatrists can also help you by checking your posture or walking style. They will also ask lots of questions about your injuries, and also check every muscle and joint in the area. This gives clues about other treatments that can help.

Massage, stretching, strapping, mobilisation, footwear advice and orthotic support are often sufficient but occasionally we may need to look at other treatment options. These may include:

• Extracorporeal Shock Wave Therapy (ESWT)
• Ultrasound-guided Cortisone injection
• Platelet-rich plasma injections (PRP)
• Surgery is always a last resort

Posture Podiatry uses Shockwave Therapy for heel pain relief. Image © Posture Podiatry

Some football players have gone to drastic measures, with stories of jumping off tables to tear the fascia completely so they can get back out and play with less pain.

It’s important to find the true cause of your plantar fasciitis, otherwise the problem will return later.

How long does it last?

Left untreated, plantar fasciitis can take from 12 months to many years in order to develop the right amount of spurring and thickening to be pain free. However, this isn’t the best outcome because the extra thickening can lead to further problems later.

You can reduce pain in much less time with the right treatment.

Conclusion

People with plantar fasciitis experience heel pain in the morning or after rest. It’s common, and podiatrists are the experts dedicated to helping people with plantar fasciitis. 

There are many things you can do to help, so have it checked properly by an experienced podiatrist.

Where Can I Get Help for Plantar Fasciitis?