Plantar fasciitis happens when the foot tissue used for walking and moving your foot, called the plantar fascia, becomes inflamed. It typically causes a stabbing pain in the bottom of your foot near your heel which is often worst when you wake and take your first few steps.
The cause of plantar fasciitis can be anything that irritates or damages your plantar fascia. This includes your shoe type, overuse, lack of warm-up and stretching, and the sort of surface you move on. Also, your foot structure can cause plantar fasciitis.
Plantar fasciitis treatment usually involves conservative treatments, such as icing the painful area, stretching, adapting or pausing activities, and over-the-counter medicine. Most people with plantar fasciitis recover within several months without the need for surgery.
What is plantar fasciitis?
Plantar fasciitis is a common cause of heel pain. It happens when your plantar fascia, a strong band of tissue that runs along the bottom of your foot, becomes inflamed. This tissue connects your heel bone to the base of your toes and supports the arch of your foot. It absorbs shock and plays an important role in how your foot moves when you walk.
When you stand or put weight on your foot, the plantar fascia stretches and tightens. This tension increases more when you push off on the ball of your foot or toes, such as when walking or running. Over time, or with too much use, the plantar fascia can become irritated and inflamed, leading to pain even during everyday activities.
Plantar fasciitis symptoms
Plantar fasciitis typically causes pain in the bottom of your foot near the heel. This plantar fasciitis heel pain often starts gradually but can sometimes come on suddenly if for example you miss a step or jump from a height. It is usually worst in the morning when you take your first steps after waking up, often being referred to as "first-step pain".
Your plantar fasciitis pain may improve a little as you move around during the day or after warming up, but it can return and feel worse after standing for long periods or doing vigorous activities. The pain is often sharper when walking barefoot or wearing shoes with little support.
What causes plantar fasciitis?
Stress to your plantar fascia can cause small tears and repeated tears may lead to irritation, inflammation, and heel pain. The exact cause of plantar fasciitis is often unclear.
Common plantar fasciitis causes include:
- Increased activity levels, such as starting a walking or running program.
- The shape or structure of your foot.
- The surface where you stand, walk, or run.
- Wearing shoes with poor support.
- Carrying excess weight.
Less common causes:
Risk factors
Factors that can increase your risk of developing this condition include:
- Age – being most common in 40- to 60-year-olds.
- Activities that place a lot of stress on and around your heel – including long-distance running and aerobic and ballet dancing.
- Foot mechanics - Flat feet, high arches and atypical walking can affect weight distribution when standing putting added stress on your plantar fascia.
- Obesity - Excess weight places extra stress on your plantar fascia.
- Heavy on your feet work – spending most of your work hours standing on hard surfaces such as teachers and factory workers.
Plantar fasciitis diagnosis
A plantar fasciitis diagnosis is usually made based on your medical history, pain location, and a physical exam to check tender areas in your foot.
Diagnositc tests such as an X-ray or MRI are not usually needed. They may be used to rule out other problems such as a stress fracture. An X-ray may show a piece of bone sticking out from your heel bone, called a bone spur, but it is rare that these are problematic and need surgically removing.
Treatment at home
Plantar fasciitis treatments at home aim to reduce your plantar fasciitis pain and inflammation. They include:
Icing and medications
- Apply ice to the painful area several times a day to reduce pain and inflammation.
- Over-the-counter pain relievers like ibuprofen can help manage discomfort.
Activity modification and orthotics
- Avoid activities that stress your foot, such as prolonged walking or running and try low-impact activities like swimming or cycling.
- Choose supportive shoes with thick soles, good arch support, a low to moderate heel and extra cushioning. Don't wear worn-out athletic shoes, flats or walk barefoot.
- Switch to more shock-absorbing surfaces for exercise such as grass, rubberised tracks, and treadmills.
- Use orthotics including arch supports, heel cups, or custom orthotics to cushion your foot and distribute pressure evenly.
- Wear night splints to stretch your plantar fascia and Achilles tendon while sleeping.
- Apply athletic tape for additional support to muscles and ligaments.
- Walking aids such as a walking boot, cane, or crutches to reduce weight-bearing stress on your foot temporarily.
Therapy
- Physical therapy including exercises to stretch your plantar fascia and Achilles tendon and strength your lower leg muscles.
- Shock wave therapy where high- or low-energy shock waves stimulate healing by creating microscopic trauma in your plantar fascia. This treatment is used for chronic cases that don’t respond to other therapies.
- Ultrasonic tissue repair uses minimally invasive ultrasound imaging probe guidance into the damaged plantar fascia tissue. The tip rapidly vibrates and breaks up the damaged tissue, which is then suctioned out.
Steroid injections
Steroid injections temporarily reduce inflammation and pain. They are often used if symptoms persist after more conservative treatments. However multiple injections are not recommended due to the risk of weakening the plantar fascia.
Most people recover with conservative at-home treatments, but severe cases or high-demand athletes may require longer treatment courses or additional interventions.
Plantar fasciitis surgery
Surgery tends to be the last resort for plantar fasciitis treatment, for severe, persistent cases. Options include:
- Plantar fascia release: Detaching the plantar fascia from your heel bone.
- Gastrocnemius recession: Lengthening your Achilles tendon to reduce tension on your plantar fascia, particularly if you have tight calf muscles.
Plantar fasciitis treatment at Ramsay
At Ramsay Health Care, we offer fast and convenient appointments with our expert consultants who will listen to your symptoms of plantar fasciitis and recommend treatments.
We have a multi-disciplinary team including physiotherapists, podiatrists, consultant orthotists, consultant orthopaedic surgeons, consultant neurosurgeons and consultant rheumatologists who understand the pain of plantar fasciitis and provide the best treatment options.
