Plantar Fasciitis Causes And Symptoms
Plantar Fasciitis is one of the most common ailments that your feet can suffer from and is more common that you might think.
On the bottom of your foot, is a fibrous band of tissue stretching from your heel to your toes called the Fascia and when this gets inflamed for any reason, you will feel pain, which can range from a stabbing acute pain to a continual dull ache.
The plantar fascia ligament is a band of tissue that stretches along the sole of your foot, from your heel bone to the area near the ball of your foot.
It's job is to be the supporting arch of your foot, bearing your weight. Without the plantar fascia you would have a flat foot and would find it very hard to run or even walk properly!
If this ligament tissue becomes damaged, suffers from micro tears or becomes inflamed, you will feel pain mainly under your heel.
Plantar fasciitis is not a sudden injury. If you are suffering from this, the pain will increase over time.
A study by the Department of Physical Therapy, Virginia Commonwealth University found that the following points are high risk factors for plantar fasciitis:
- You have a low range of ankle dorsiflexion (where your foot is not able to bend upwards at the ankle).
- You have a BMI rating that is on the "obese" scale (BMI > 30 kg/m2).
- You have a job where you spend most of your day on your feet.
The study found that the main causing factor was the reduced ankle dorsiflexion.
The most common way for the Fascia to become injured is through too much exertion, mainly from physical activities such as sports.
Running, jogging or jumping is also found to start the inflammation. This is especially if you have not exercised much before.
However, the underlying cause may be that you suffer from high arches, flat feet or overpronation, where your feet are not in line with the rest of your body.
As the fascia ligament becomes stretched, like any muscle under stress, it can tear leading to pain on the underside of the foot.
What are the symptoms of Plantar Fasciitis?
Sufferers of Plantar Fasciitis will usually get pain around the heel area, or on the sole of your foot near the heel.
It is also possible to feel the pain from this disease around the back of your ankle or Achilles tendon where there is muscle tightness and tension.
For some people, just walking across a room can be very painful, whereas others experience only temporary pain.
Foot pain first thing in the morning.
The pain associated with Plantar Fasciitis is usually felt around the inside facing part of your heel and can be very sore.
A real giveaway symptom for Plantar Fasciitis is that you feel the pain when taking the first steps out of bed in the morning.
Overnight, the Fascia contracts and tightens, making walking painful first thing.
Over the course of the next hour or so, the Fascia tissue stretches and the pain reduces as the foot and muscles begin to warm up.
A common complaint from people who suffer from this injury is that their heels hurt.
When the fascia becomes damaged, it tears near to the heel bone where it joins to form your arch.
This can be very painful and you will feel it with every step. You may even not be able to walk far due to the pain.
Plantar Fasciitis and Heel Spurs are related, but not the same thing.
When the fascia becomes damaged over time and has to repair itself over and over. However, when it is repeatedly torn, small calcaneus growths of bone can appear on the heel bone.
If these grow large enough in size, they can stick out and be painful to walk on.
If you want to read more about heel spurs, I have written an article on the subject.
Stairs are hard work.
You may also find that walking upstairs or on your toes is also quite painful if you have Plantar Fasciitis, as the tissue is being stretched the most during these types of movements.
You tend to walk upstairs using your toes, which places extra stress on your fascia ligament.
People who play sports suffer from this pain often as they are "on their toes" rather than putting their heel down first when running.
Pain after standing or walking.
Due to the way the Fascia contracts and tightens when not being fully used, suffers of this condition may also find that the pain is bad after standing for a long time, or even after resting (the same as after waking).
I find that my heel pain is worse if I sit for too long.
If you are someone who likes to exercise, the good news is that the pain from this foot problem often goes away when you start your activity, but returns soon after.
I like to run and have found that this is definitely the case.
However, you may be making the situation worse for yourself if you are not letting yourself heal.
You may also find that Plantar Fasciitis gives you pain in your lower legs too, which can lead to more discomfort.
Other foot problems might also be to blame and you may experience pain all over your feet if you are not treated.
How can you treat plantar fasciitis?
There are many different treatment options available if you have heel pain.
Some are free and just involve rest, stretching and applying ice.
Other treatments involve using gadgets or orthotics or even surgery! Let's look at the options available to you.
Rest and use medication.
The best treatment for this problem is to rest your feet as much as possible and also use medicines such as Ibuprofen, which will help reduce any inflammation and stop it from hurting quite so much.
However, there is an underlying problem there that needs to be addressed, so simply popping pills is not the answer for long term treatment.
Do some stretches and exercises.
Your doctor or podiatrist will most likely give you a set of exercises to follow that will involve simple stretches. For example, you may be asked to stand flat on the floor with your back to the wall and do several rises on your toes, moving slowly upwards and downwards.
You should seek to get a set of exercises that are designed for your needs. As you might expect, not all patients are the same.
This great video from The Proactive Athlete shows some good exercises to do first thing in the morning:
Ice your heel.
Another great way to treat this condition is to use ice to help reduce the swelling or pain. There are many ice pack products available and putting these on the bottom of your foot will help.
If you do not have a product like this, take a plastic water bottle, fill it up and put it in the freezer. Once it is frozen, you can put it on the floor and roll your foot backwards and forwards over it, giving great relief to your Fascia pain.
Foot massage products also work well.
Professional products such as Pedi Rollers can also be used in this way.
Although they are designed to massage the sole of your foot more than anything, look out for the ones you can place in the freezer to add that extra level of pain relief.
If you want to go the whole-hog - get a product like the CloudMassage and have your own personal foot-heaven massager 🙂
Night splints help stop morning heel pain.
Due to the way that the Fascia tissue contracts overnight, when the foot is not being used, it is possible to use a strapped on night splint that pulls the foot straight.
This will mean that the tissue is constantly pulled out, which may allow the problem to subside over time.
The downside to this is that you have to wear something similar to a moon boot to bed every night.
You can wear special Plantar Fasciitis shoes.
Wearing the right shoes can make all the difference with foot problems.
There are shoes and footwear available that can help you reduce the flexing and pressure on your Fascia tissue, therefore making your feet less painful and better supported.
Common questions about Plantar Fasciitis.
How did I get Plantar Fasciitis?
The most common reason is through exercise, where you may have torn or inflamed the tissue, which makes it painful to walk or stand for long periods of time.
Old age is another common cause, as is being overweight.
However, one of the main reasons I have come across is that Plantar Fasciitis can be caused or made worse by not wearing the right types of shoes.
High heels are the worst culprit here and wearing shoes that do not give your feet adequate support can cause lots of different types of heel and foot pain.
What causes plantar fasciitis to flare up?
There are several main triggers for heel pain from Plantar Fasciitis, the most common of which is over-exercising. This could be because you have started a new sport that requires you to move in different ways to normal, or that you have run faster or further than ever before.
The pain comes from the torn fibres in the fascia ligament, which do heal themselves over time, but can easily be damaged again, especially if you have had that injury before.
Your heel pain can also be impacted by your weight too. If you have gained a few pounds, this will add to the pressure on your feet, making damage to the fascia ligament more likely.
In my experience, my problems come and go and despite me stretching, resting and icing my feet after every run, I can find that just sitting for too long can cause my plantar fasciitis to flare up again. I then have to pay extra attention to ensuring that I stretch and wear arch supporting shoes more than I would do normally (at home for example).
What causes heel pain in the morning?
Because the fascia ligament that spans the arch of your foot (from ball to heel) gets over-stretched and tears, when you rest at night and it is not under pressure or stress, it begins to retract and shrink slightly (this is normal for people who do not have plantar fasciitis too).
When you then get our of bed for the first time, the damaged parts of the ligament (usually around the heel bone) start to become stretched again and the tears re-open, causing immediate pain.
This is one of the most common symptoms that sufferers report.
However, these products can be uncomfortable and bulky - so try some stretching first before you resort to using these.
Which shoes are good for Plantar Fasciitis?
As a rule, any shoes that meet the following criteria are good for helping to relieve your foot and heel pains:
How does a night splint help heel pain?
One of the common products you can use to treat your heel pain is called a "Night Splint" - something that looks like a ski-boot and is worn overnight.
Because the ligament that runs along the sole of your foot contracts overnight, stepping out of bed for sufferers of plantar fasciitis can be agony. Wearing a night splint (or dorsiflexion splint) forces your foot to be pulled up at such an angle that the fascia never gets to contract.
Read my article where I review the best plantar fasciitis night splints.
This means that there is less pain first thing in the mornings and the fascia is kept supple and stretched, which will help reduce heel pain overall.
I have used a night splint before, as well as a plantar fasciitis sock. The splints are bulky and uncomfortable to use but are effective. However, I tend to only wear one when my PF is severe as they don't let me sleep very well.
Should I wear special socks for plantar fasciitis?
I am not sure that wearing special socks will help much, but you could wear socks that provide you with additional support or compression, which might help with your circulation.
There are socks that can be worn overnight that have a velco strap that attaches from the toes to the shin area. This is supposed to pull the foot up and back, which will stretch out the fascia whilst you are asleep, preventing it from becoming sore in the morning.
If you are interested in trying some socks, look at some ankle-high running socks as these have extra padding and fabrics that are tighter in certain areas, which might help support your arch and heel.
When does Plantar Fasciitis go away?
Without treatment Plantar Fasciitis should go away within 8-12 months.
Despite wearing the right shoes, stretching and icing my feet as often as I can, I still have heel pain.
However, I am still running though - so I am blaming that too.
With the right treatment, there is no reason why your heel pain should not be healed. It will take time to do this treatment, so don't expect an overnight miracle cure - even getting used to wearing a pair of properly supportive shoes can take several months.
You may not be able to rest as much as you want either, especially if you have a job where you are on your feet all day. This will increase your recovery time.
Make sure you see a podiatrist as soon as possible so they can work out a recovery schedule for you. Without this and without regular monitoring by them, you might not be able to get your plantar fasciitis to go away for a long time.
How Long Is The Typical Plantar Fasciitis Recovery Time?
The longest time that it may take you to recover from Plantar Fasciitis is up to 4 years. However, there are many factors that can reduce this time.
This is because there can be different causes of your injury, other factors that might be affecting your gait, posture or foot mechanics.
Add to that the issues surrounding weight being a common factor in the onset of foot pains, and you could have lots of things to address before you start to get better.
It is important that you do everything that the doctor tells you, since those are the best chances for a speedy and complete recovery, particularly so if the approach is a holistic and therapeutic one which places great responsibility on you to do everything you are instructed.
Can plantar fasciitis be cured?
Yes - Plantar Fasciits can be cured, providing you are prepared to seek proper medical advice from a Podiatrist and also commit to the regime of wearing proper shoes, resting, massaging and treating the pain.
It may take some time for the pain to go away, but the number one way to be cured is to not ignore the issue and get an appointment booked as soon as possible. It could be the difference between a few weeks pain or a few years, or the difference between having discomfort or surgery!
I won't say it's easy.
I have struggled to manage my PF for years now, but seeking proper diagnosis was the first step. I don't think I will ever be cured, unless they invent a flying chair so I never have to walk again (although that might introduce other problems!). For me, it is more about management of the condition, knowing my limits and triggers and being sensible about caring for my feet.
What is the best treatment for Plantar Fasciitis?
The best treatment is to get yourself to a podiatrist who can take a good look at your feet, how you walk, stand and what problems might be causing your heel pain.
If this is not an option, make sure you rest your feet as much as you can, learn to do some stretches (as tight calf muscles can cause PF too), ice or massage your feet whenever possible and get yourself some properly fitting shoes, with or without orthotic insoles.
The worst thing you can do is to ignore it - it could end up with you needing surgery if left untreated!
What can I do to reduce my heel pain?
Although it is VERY important to go and see a doctor or podiatrist as soon as you suspect that you have painful feet that are more than just normal aches and pains, there are quite a few things you can do at home to help with heel pain.
- Resting is important - try to keep your feet above your heart level to help with circulation.
- Massage helps - You can do this at any time such as when watching the TV. Use your thumb to work around the sore areas. You can also use products such as foot rollers or massage balls which are very effective. Tip: Look for a foot roller you can keep in the freezer for an icy boost for your massage!
- Ice - If your feet are really sore, or you have walked or run a long way, you can use ice to treat sore heels. Remember to put any ice packs inside a piece of material though, otherwise you might get a bad reaction.
- Wear supporting slippers at home - if you have already got a pair of supportive shoes or are using some orthotic insoles, remember that when you are at home, your feet also need support. Not all people take off their shoes when they go inside their home, but if you do, look into using some slippers with arch support.
How do I tape my foot to help with plantar fasciitis?
This is one treatment that I have not tried yet, but the use of taping or wrapping the heel to add some additional support using PT, athletic or kinesiology tape is recommended.
The idea is that the taping will pull the foot, muscles and tendons into such a way that it will prevent the fascia from stretching too much, therefore avoiding damaging it any further. This reduction in movement can also help recovery too.
I am not sure if taping your foot to prevent heel pain is something that you will be able to do well on your own, but this video from John Gibbons shows the process to follow.
Can I run with plantar fasciitis?
Heel pain can be a real problem for joggers and runners and can put stop to your exercise program if not treated.
Luckily, the solution might be easier than you think and best of all, it's free too.
I have just started running and doing more workouts at the gym recently and my heel pain has come back to haunt me, along with tight hamstrings and calf muscles too.
However, there is some good news for us runners who want to fix their Fascia pains. All you need to do is to reduce the amount of running you do and introduce some other activities to make up for it.
However, some runners (me included) actually feel less pain when they are running, because the Fascia tissue becomes stretched. But the pain will come after you have stopped.
If you are able to, reduce the running and start to do other activities such as swimming, which is low intensity on your feet and will provide support for your body.
Relative rest training works well for fixing Plantar Fasciitis in runners.
As Paul Ingraham says at PainScience.com:
"The art of rest is mostly the art of “relative” rest: finding a way to stay active and fit without placing stress on injured or severely fatigued tissues. Like rest in general, it is a neglected concept in rehabilitation."
This training plan is called "relative rest" and is recommended for people with sports related injuries. Perhaps riding a mountain bike can be another option rather than running. Perhaps if you were running in a group, they will let you tag along on a bike instead.
If these other sports sound like a really terrible idea to you and running is the only option, try introducing some periods of rest to your workout plan.
Walking for around 50% of the distance will help reduce the stress on your feet. Once you become more accustomed to the pain and changes in your workout, you can increase the speed and distance, always keeping your focus on your Plantar Fasciitis pain so you can cut back when needed.
Using the relative rest training will definitely help you continue to work out, whilst helping your foot pain problems heal at the same time. You need to make sure you are taking the right steps towards fixing the problem, otherwise you will be in pain for much longer.
It has been reported in the medical press that symptoms of Plantar Fasciitis will be resolved in more that 80% of people within a year if they take proper steps to remedy the problem.
You don't need to spend lots of money on getting it fixed too - simple stretches or wearing supports in your shoes might be enough to sort it out for you.
Simple, regular calf stretches can help runners.
Treating Plantar Fasciitis will also need to involve treating the underlying causes, such as tight calf muscles.
James Amis, an Orthopaedic surgeon who has over 20 years experience in dealing with this problem suggests that this is the most common cause and solution for Plantar Fasciitis.
Stretching the calf muscle for 3 minutes, 3 times a day by balancing on the edge of a stair and rising up and down on your toes, can be enough to fix the problem for most people.
However, this will take time and should be approached as a long term solution, rather than a quick fix.