Plantar fasciitis is such a common foot condition – affecting about 10 percent of people during their lifetime – that I see several patients every day with this foot problem. Characterized by sharp, severe heel pain that eventually becomes dull and achy, plantar fasciitis can be very uncomfortable for patients, making it difficult to do high-impact exercises, stand for a long time or even walk.
Feeling better takes time, but fortunately treatments, including those that can be done at home, can help.
What is Plantar Fasciitis?
The plantar fascia is the thick ligament – or band of tissue – that connects the heel bone to the toes. It, in combination with the bone structure, acts like the truss, or support, on a bridge, preventing the foot bones from splaying.
Plantar fasciitis occurs when the plantar fascia is strained and damaged faster than it can heal.
Why might this happen?
For one, people with a body mass index (BMI) above 30 are at high risk of plantar developing plantar fasciitis. The extra weight puts pressure on the foot, causing extra stress through the fascia, which can lead to inflammation of the plantar fascia.
Many patients who wear what I describe as “poor footwear” can develop plantar fasciitis. Poor footwear includes shoes that are very flexible without much structure. Poor shoes have thin soles and lack support. Military personnel and first responders sometimes have less-than-ideal footwear that can lead to plantar fasciitis. I encourage everyone to opt for footwear with thick, stiff soles, and supportive insoles.
Plantar fasciitis is most prevalent in people ages 40-60, and it can affect people with flat feet or with high arches. And it often affects people who engage in a lot of activity, such as long-distance runners or people who stand all day as part of their jobs, such as teachers, nurses, postal workers and warehouse workers. People who spend a lot of time standing on hard surfaces, such as concrete or hardwood floors, are more at risk for developing plantar fasciitis than those who spend more time on cushioned, padded surfaces.
Military personnel and first responders, who carry extra loads and equipment, are at high risk of developing plantar fasciitis.
Symptoms of Plantar Fasciitis
Heel pain is the most common symptom of plantar fasciitis. Most people experience the worst of the pain first thing in the morning, when they step out of bed, of after periods of inactivity, such as a 30-minute drive or sitting for a few hours. The pain then transitions from a stabbing pain to a dull, achy pain as the day progresses.
Treating Plantar Fasciitis
When patients with heel pain see me in the office, I do an exam to rule out stress fractures in the heel or problems with adjacent tendons. I may recommend a foot X-ray to rule out fractures and other uncommon reasons for heel pain.
Recovering from plantar fasciitis takes time and patience. There are many steps patients can take a home to treat plantar fasciitis, including:
- Resting. Staying off your feet can help the plantar fascia recover.
- Icing the foot. Ice for 15-20 minutes at a time to reduce inflammation. Be sure to protect your skin by placing a towel between the ice and the skin’s surface. An ice pack works well as does rolling the foot on a frozen water bottle.
- Elevating the affected foot or feet.
- Stretching or massaging the foot and leg, including the heel, toes and calf. (Exercises to relieve pain)
- Wearing stiff shoes. Supportive footwear is vital to improving plantar fasciitis. Shoes that are considered “forefoot rocker” are a good place to start.
- Taking over-the-counter pain relievers, such as ibuprofen.
- Wearing a walking boot, which reduces stresses through the foot.
- Sleeping with a night splint, which allows the fascia to heal under some tension.
If at-home treatments don’t help, corticosteroid injections may reduce the inflammation. Podiatrists can also recommend and prescribe shoe inserts, or orthotics, which may help.
In some cases, such in instances of chronic plantar fasciitis, we may recommend surgery, such as an endoscopic plantar fasciotomy, or EPF. During this minimally invasive procedure, with a small camera as a guide, we cut the plantar fascia to release the tension. Recovery is usually quick, and patients generally are able to stand and walk in the first few days. They wear a walking boot for two to six weeks after the procedure to immobilize the foot.
Though common and treatable, plantar fasciitis can be very painful and inconvenient for the roughly 2 million people in the United States who experience this condition. Healing from plantar fasciitis can take months to a year. Maintaining a healthy weight, wearing supportive footwear and stretching before and after exercising can go a long way toward preventing plantar fasciitis from developing.