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HEALTH

What Is Plantar Fasciitis?

Plantar fasciitis occurs when the plantar fascia ligament that runs along the sole of your foot becomes inflamed, causing intense pain.1 This thin and web-like ligament, the longest in the foot, is attached to the bottom of your heel bone.2 It stretches and contracts to help maintain overall body balance, and provides the feet with support and strength for walking and other daily activities.3,4

Patients with plantar fasciitis often feel pain at the back of the arch and right in front of the heel.5,6 This condition is one of the most common complaints among runners and in the field of orthopedics.7,8

Causes of Plantar Fasciitis

Too much physical stress is never a good thing, and plantar fasciitis patients can attest to this because they feel immense pain when the plantar fascia is stretched too far and becomes inflamed. The inflammation usually occurs where this ligament fastens to the heel bone.9 Although the plantar fascia is able to absorb stress placed on the foot,10 too much pressure in the heel and other tissues may contribute to the development of plantar fasciitis.11

In some cases, your foot’s pronation, or tendency to move sideward while walking or running,12 becomes excessive to the point that it leads to pain.13 This typically occurs in your subtalar joint, found below your ankle.14

Who Is Most Prone to Having Plantar Fasciitis?

People with the highest risk for plantar fasciitis are those between 40 and 60 years old,15 and this condition is slightly more common among women compared to men.16 Plantar fasciitis not only causes crippling pain, but burdens the wallet too, since a whopping $192 to $376 million are spent annually for treatment. One million visits per year are made to medical professionals who treat plantar fasciitis, affecting approximately 10 percent of the U.S. population.17

Risk Factors for Plantar Fasciitis

These risk factors may predispose you or someone you know to plantar fasciitis:18,19

ObesitySudden weight gain can increase pressure on your plantar fascia.20

Pregnancy Plantar fasciitis may arise because of pregnancy weight gain. Women, in order to prevent thigh chafing, may walk with their feet far apart from each other, place extra strain on their feet and in effect increase their risk for plantar fasciitis.21

Foot structure These include people who have flat or high-arched feet, unusual walking patterns or a tight Achilles tendon.22

Having an occupation that keeps you on your feet Factory workers and restaurant servers, who spend long hours walking or standing on hard surfaces, can injure their plantar fascia.

Increased physical or athletic activity — While incorporating physical movement into your lifestyle is great, too much can be a bad thing. Plantar fasciitis risk is high among people who:

Run regularly or add additional minutes to their running time

Perform activities or workouts that require heavy lifting or raise stress levels

Exercise on hard or uneven surfaces

Dancers, including those who do ballet or aerobics, may be predisposed to plantar fasciitis too, since some movements may place additional stress on the foot.

Symptoms of Plantar Fasciitis

Patients affected with plantar fasciitis typically experience intense pain at the bottom of their foot, near the heel. Some patients with this condition describe it as a dull pain, while others feel a sharp twinge. In some instances, patients may experience a burning or ache at the bottom of the foot that extends outward from the heel.23 The pain may vary in different degrees and can occur:24

While performing physical activity — Even the simple act of taking a few steps upon waking up in the morning or going up or down a flight of stairs can be agonizing, because the plantar fascia band suddenly elongates, and stretches and pulls on your heel.25,26,27

After exercising or working long hours — Plantar fasciitis is not only common among runners, especially those who do long distance running, run downhill or run on uneven surfaces,28 but also in people with jobs that require them to be on their feet for most of the time, such as factory workers or restaurant servers.29

If you have been sitting or standing down for long periods of time, there could be pain once you start moving again. Fortunately, a few minutes of walking can help alleviate the pain.30

Signs Your Doctor Looks for if You Have Plantar Fasciitis

If you or someone you know is affected with crippling pain, consult a physician or a podiatrist (doctors who diagnose and address problems related to the legs, feet and ankles31) immediately. According to the American Academy of Orthopaedic Surgeons, after you describe your symptoms, your physician will examine your foot and look for these potential plantar fasciitis indicators:32

A high arch

An area of maximum tenderness at the bottom of your foot, in front of your heel bone

Pain that exacerbates when your foot is flexed and when your physician pushes on the plantar fascia, although the pain can improve when you point your toes down

A limited upward motion of the ankle

Imaging Tests That Can Help Diagnose Plantar Fasciitis

Your physician may recommend that you undergo imaging tests to ensure that the heel pain is caused by plantar fasciitis, and not another condition:33,34

X-rays — Although I don’t recommend these unless absolutely necessary, by providing clear images of bones, X-rays may be helpful in making sure that the heel pain is not caused by fractures, a pinched nerve or arthritis. Plus, if you have heel spurs that were undetected, an X-ray can spot them.35

Other imaging tests such as magnetic resonance imaging (MRI), ultrasounds,36 blood tests or bone scans37Again, I don’t ordinarily recommend MRIs unless no other diagnostic tool is available, but an MRI scan could be ordered by your physician if your heel pain has not been addressed by initial treatment methods. Take note, however, that these other types of imaging tests are rarely ordered and not frequently used to diagnose plantar fasciitis.

Plantar Fasciitis Could Progress Into Worse Complications

If left untreated, plantar fasciitis can lead to chronic heel pain, change the way you walk, and result in further injuries to your legs, knees, hips and back.38 The plantar fascia can also rupture and trigger heel hypoesthesia and flattening of the foot’s arch.39 Certain treatments such as steroid injections can weaken and rupture your plantar fascia as well.40,41

If you ignore chronic plantar fasciitis pain for a year or more, it can develop into plantar fasciosis because avascular scarring may develop in the plantar fascia. Plantar fasciosis is painful, since the scarred tissues run low in blood supply and the pain is resistant to anti-inflammatory treatments.42

How to Treat Plantar Fasciitis

If you or someone you know is struggling with plantar fasciitis, don’t fret — there are multiple, non-surgical home treatments for pain caused by this condition:43,44

Getting adequate rest — An important step in eliminating plantar fasciitis-related pain is to lessen or stop activities that cause it, such as athletic activities wherein your feet pound on hard surfaces, heel-stressing activities, or standing or running for long periods of time.45

Placing ice on the affected area Applying a cloth-covered ice pack on your foot for 15 to 20 minutes, three to four times a day, can be effective.

However, if the pain has not subsided after two to three days, adding heat to the area using a hot compress or hot packs may help.

Taping the foot — This stabilizes the affected ligament and limits its movement. Taping may help the plantar fascia avoid abnormal movement or excess strain, preventing tears from developing.

Consult a physician to learn the proper way of taping the foot and the schedule you should follow when applying and removing the tape.46

Stretching and strengthening exercises — These exercises may promote flexibility and strength in muscles supporting your foot, and hopefully lower your plantar fasciitis risk.47

Extracorporeal shockwave therapy (ESWT) — Often utilized when conventional treatments fail to work, ESWT entails directing sound waves toward the affected area to hopefully address the pain and promote healing.

However, there are no consistent findings on ESWT’s effectivity, so it’s not commonly performed. It has also been said to trigger bruising, swelling, pain, numbness or tingling.

Physical therapy — Consult with a physical therapist who can work with you on an exercise program that concentrates on stretching and strengthening your lower leg muscles and plantar fascia.

Use the Right Type of Footwear

The next time you purchase a pair of shoes, don’t just think about how good they look; rather, take the time to examine how comfortable they are, and how they are made and structured, since these factors could affect your plantar fasciitis risk.

According to the Occupational Health Clinics for Ontario Workers Inc., shoes with high heels, hard soles, poor support, and inadequate sizing and width often have poor cushioning. These types of shoes call for more flexibility in your calf muscles by increasing foot length and requiring the foot to bend further back while walking.48

However, if your foot isn’t able to bend back any further, it causes increased tension on your plantar fascia.49 Tighter calf muscles, meanwhile, make it hard for you to flex your foot and bring your toes upward toward your shin.50

It is recommended that plantar fasciitis patients wear an insole that can be bought over-the-counter or online to help relieve the pain.51 You can also use or purchase orthotic shoes52 that may aid in supporting your feet and arch, addressing foot problems and decreasing rotational movements.53

Shoes that provide ample support to your feet are valuable as well, especially if they have firm soles and extra cushioning, as they lessen pain when you are performing activities such as running or walking.54

When you take a step and your heel strikes the ground, tension is placed on your plantar fascia, leading to the formation of microtrauma or tiny tears in the tissue. Cushioned shoes or inserts work by decreasing tension and microtrauma formation.55 Another option for potentially lessening foot pain is to put soft silicone heel pads in your shoes. They work by cushioning your heel and potentially reducing pain.56

Night splints are also helpful for plantar fasciitis patients, since most people sleep with their feet pointed down. This prompts your plantar fascia and Achilles tendon to shorten, and may increase your risk for heel pain. By using these, you can stretch your plantar fascia while sleeping.57

Stay Away From These ‘Ideal’ Treatment Methods

Nonsteroidal anti-inflammatory drugs (NSAIDS), despite their “ability” to eliminate inflammation, aren’t the best choice for addressing plantar fasciitis. Different studies have shown that NSAIDs can cause side effects such as an upset stomach, nausea and vomiting, heart problems, GI bleeding, kidney problems, hypertension and even death.58

Avoid steroid injections for plantar fasciitis as well.59 The use of steroids even for a short period of time may increase your risk for broken bones, blood clots or life-threatening sepsis.60 In some cases, people may develop more adverse effects such as fluid retention and swelling of the lower legs, high blood pressure or blood sugar levels, oral thrush or fungal infection in the mouth, and weight gain.61

Is Surgery Advisable for Plantar Fasciitis?

Surgery may be recommended for some plantar fasciitis patients, but remember it is not the be-all or end-all of plantar fasciitis treatment, especially since effective nonsurgical methods are available. In fact, around 95 percent of people with plantar fasciitis can opt for pain relief sans the surgery. If you or someone you know has plantar fasciitis, take note that a surgical procedure should only be considered if:62,63

Conventional nonsurgical treatments don’t work

Other treatment methods you’ve been using for at least six months have been ineffective in treating your pain

Your ability to do work or moderate exercise has been affected because of heel pain

Surgical Procedures for Plantar Fasciitis

Two types of surgery can be performed on plantar fasciitis patients:64

Gastrocnemius recession — This procedure aims to add to the motion of your ankle. A gastrocnemius recession involves a surgical lengthening of calf muscles, especially if they are tight, since they may increase stress on your plantar fascia. This is done via a traditional, open incision or by making a smaller incision and looking inside the area using an endoscope, a device that has a small camera.

Plantar fascia release — Patients who complain of continuous heel pain but have a normal range of motion in their ankle are usually recommended by their physicians to undergo this type of surgery. In this procedure, the plantar fascia ligament is partially cut to decrease tension in the tissue.

A plantar fascia release can be performed via an endoscopy, wherein the endoscope is inserted into the area. However, it’s arguably easier to do a plantar fascia release with an open incision since it also has a lower risk for nerve damage.

Potential Risks for Plantar Fasciitis Surgery

Because it’s an invasive procedure, you must be aware that there are potential complications linked to plantar fasciitis surgery. Take note of the following risks associated with these surgical procedures:65

A pinched nerve or tarsal tunnel syndrome or posterior tibial neuralgia, wherein the tibial nerve in your tarsal becomes compressed66

Recurring heel pain

Neuroma, a benign yet painful tumor comprising nerve tissues felt between your third and fourth toes, and can lead to a burning sensation, and tingling or numbness between the toes and in the ball of the foot67

Wounds that take a long time to heal

Delays in performing normal activities

Infection

Worsened symptoms post-surgery (although rare, it is a possibility)

Nerve injury and long-term muscle weakness68

Risks caused by anesthesia

Exercises for Plantar Fasciitis

Just because you have plantar fasciitis does not mean that you should stop making an effort to work out. Exercises that stretch both your plantar fascia and calves are helpful in relieving pain caused by the condition.69,70 Here are five plantar fasciitis exercises recommended by Lulu Peelle, a yoga therapist and Ayurvedic counselor.71

Wall Stretch

Stretching and elongating your calf muscles are the primary objectives of this move:

1. Stand about an arm’s length from the wall.

2. Step forward with your left leg, while moving backward with your right.

3. Bend your left knee and press down with your right heel.

4. Hold this position for 20 to 30 seconds and then switch legs.

Tennis Ball Massage

The rolling motion in this tennis ball massage helps loosen up your plantar fascia,72 potentially reducing pain. Peelle suggests doing this exercise on a soft surface such as a yoga mat, carpet or rug, as hardwood surfaces will make the ball slide:73,74,75,76

1. While sitting down, place a tennis, lacrosse or golf ball underneath the big toe of your left foot.

2. In a backward and forward motion, gently roll the ball beneath your foot. Once you locate a tender spot, stop and flex your toes upward and downward.

3. Continuously roll the ball for about a minute or two, then repeat on the other foot.

4. You can also do this tennis ball massage while standing up, but make sure you can fully support yourself first.

Picking Up a Sock or Towel Using Your Toes

Tone your plantar fascia and develop arch strength by doing this simple exercise any time of the day. Simply curl your toes around a washcloth, towel or sock, pick it up and then release the item.

Seated Calf Stretch

Peelle’s version of a Seated Calf Stretch involves lifting and straightening your leg, pointing your toes forward just like a ballerina, flexing and keeping them as wide apart as possible. Repeat this step for a couple more times. After this, move your ankle in circles and point and flex your toes while doing a circular motion. This allows the ankles to remain strong and provides support for your feet.77

However, if you want to take it up a notch, you can do this ankle flexion exercise from ACE Fitness. Although the movement comes from your ankle, this exercise targets your calves and shins. It’s similar to the seated calf stretch, although it uses resistance bands or cables:

1. Start by sitting with one leg stretched in front of you. Wrap a cable or resistance band around the ball of the outstretched foot, in order to pull the bottom of your foot away from you.

2. With your toes pointed away from your body, slowly pull them toward your shin. Go back to the starting position slowly and, with control, repeat the first step.

Avoid bending or fully extending your knee during this exercise, and make sure to align your foot and ensure it faces forward. Sit up as straight as you can, and avoid arching or slouching on your lower back.78

Belt Stretch

You can do this stretch while sitting or lying down:79,80

1. Take a belt, towel or yoga strap and place it under the ball of your foot. Slowly pull the belt toward you and allow the toes to come toward your body.

2. Try to continuously release and stretch your foot, especially your plantar fascia. Hold this position for around 15 to 30 seconds to feel the stretch in your calf, while relaxing your shoulders, neck and jaw.

3. Release the foot back to the starting position, repeat the move two to four times and then change sides.

Preventing Plantar Fasciitis

While a one-size-fits-all solution to completely eliminate plantar fasciitis does not exist, there are techniques you can follow if you want to help prevent this condition.

These Food Items Are a Must in Your Diet

If you want to avoid plantar fasciitis, begin with your diet. Given that this condition is characterized by the inflammation of the plantar fascia,81 a diet composed of potent anti-inflammatory and low-sugar foods, and non-vegetable carbohydrates is highly recommended. These include:

Herbs and spices that include ginger, cloves, rosemary and turmeric

Fermented and traditionally cultured foods that are able to control inflammation by “reseeding” your gut with beneficial bacteria, resulting in improved immune function

Shiitake mushrooms, as they have strong compounds that have the natural ability to impede inflammation. One example is ergothioneine, which could prevent oxidative stress

Don’t forget to increase your intake of healthy saturated fats. Various studies have shown that saturated fats are NOT linked to heart disease and that they actually offer these health benefits:

Helping with mineral absorption

Acting as carriers for fat-soluble vitamins (A, D, E and K)

Delivering building blocks for cell membranes, hormones and hormone-like substances

Converting carotene into vitamin A

Serving as optimal “clean” fuel for your brain and mitochondria

Helping in providing satiety

Your best sources for healthy fats include:

Animal-based omega-3 fats, such as krill oil

Coconuts and coconut oil

Grass fed butter

Organic pastured egg yolks

Avocados

Black sesame, cumin, pumpkin and hemp seeds

Raw nuts, such as macadamia nuts and pecans

Third party-certified, high-quality olive oil and olives

Complement all of these healthy dietary changes by incorporating as much real food into your meals as possible — this means unlimited amounts of fresh and organic vegetables and moderate portions of high-quality grass fed meats.

You Can Exercise, but Not Intensely

If you regularly set aside time to exercise, follow these tips from Runner’s World Magazine, which not only will help you make the most out of your workout, but also evade plantar fasciitis:82

Slip on well-cushioned shoes and see to it that the heels don’t become significantly worn.

Run on soft surfaces such as grass, trails or a good track, and avoid asphalt and concrete.

Maintain your mileage to a constant level. Raise your total weekly miles by no more than 10 percent a week, especially if your training remains relatively the same.

When beginning speedwork, ensure that you ease into it gradually via a several-week buildup.

Regularly perform exercises that stretch your Achilles tendon.

Frequently Asked Questions About Plantar Fasciitis

Q: Where does plantar fasciitis most often hurt?

A: The plantar fascia ligament, found across the bottom of the foot, bears the biggest brunt of the pain. It’s considered the largest ligament in the human body and connects the heel bone to your toes.83 One of the many symptoms of plantar fasciitis is intense pain that gradually develops near the heel of your foot.84

Q: How long does plantar fasciitis pain last?

A: According to the University of Pittsburgh Medical Center, plantar fasciitis symptoms may go away on their own. If they don’t, plantar fasciitis recovery time may last between six and 18 months, if the condition is untreated. However, the more you prolong a checkup despite immense pain, the more devastating the condition can be, and it may take longer to heal from plantar fasciitis. If symptoms arise, make sure to have yourself checked immediately.85

Q: Is a massage ideal for plantar fasciitis?

A: Having a massage or performing exercises involving a massaging motion on your foot can be beneficial. Massages release endorphins or hormones that help induce relaxation, relieve pain, and lessen levels of stress chemicals like cortisol and noradrenaline. The tennis ball massage is an exercise you should perform the rolling motion enables the plantar fascia to loosen up, helping lessen irritation in the foot.86,87

Q: Is acupuncture effective for plantar fasciitis treatment?

A: Yes. Some studies have shown that acupuncture can be effective in treating plantar fasciitis and other forms of heel pain.88,89,90 Evidence presented in a 2012 Acupuncture in Medicine study highlighted that this form of treatment may be effective for people with plantar heel pain (PHP).91

Q: Is a brace ideal to treat plantar fasciitis?

A: Plantar fasciitis patients can wear a night splint, which is a brace92 that provides enough support to your calf and foot.93 a common scenario among plantar fasciitis patients is morning heel pain caused by sleeping with the feet pointed down. By wearing a night splint, the plantar fascia is stretched during sleeping hours, potentially reducing pain.94

Q: Can socks work for plantar fasciitis relief?

A: Plantar fasciitis socks and compression sleeves may be effective. These aim to increase pressure to the plantar fascia, while stabilizing the foot and stretching the ligament. These socks can be worn during the day or night, under regular socks, or even while you sleep.95

Q: How do you tape your foot for plantar fasciitis recovery?

A: Two types of athletic tapes can be used: kinesiology or kinesio tape and regular athletic or medical tape.96 Runner’s World suggests the following steps when taping a foot affected by plantar fasciitis. To do these, you’ll need tape measuring 1, 1.5 or 2 inches, and pretape spray (if possible):97

“You may [pre-measure] and cut the tape before you start. Measure using the nonadhesive side. You will need [two 1-]inch strips and [four] to [six] wider strips. The 1[-inch] strips will measure along the outside border of the foot starting behind the small toe, around the back of the heel and ending behind the big toe.

Take your first [1-]inch strip and begin behind your small toe, running along the outside of your foot, behind the heel and finish just behind your big toe joint. This is your base strip.

Next take your wider tape and apply beginning at the heel. Attach the tape even with the top of the base strip on the outside of your foot and pull up snugly across the bottom ending even with the top of the base strip on the inside of the foot. Overlap by one-half all the way up the foot ending behind the ball of the foot.

Try to make sure there are no wrinkles in your skin or the tape. Finish the tape job with a [1-]inch strip the same way you started, covering all the ends of your wider tape starting behind the small toe, running around the back of the heel and ending behind the big toe again. It should make the foot feel better, if it doesn’t then take it off and start again.”

Q: Is surgery needed for plantar fasciitis?

A: Patients with plantar fasciitis may undergo surgery, provided that:98

Conventional treatments did not work99

Treatment protocols utilized for at least six months were ineffective

Your ability to do work or moderate exercise has been severely impacted due to heel pain

Surgical procedures that are typically performed for plantar fasciitis patients are the gastrocnemius recession or the plantar fascia release.100

Q: How long is the recovery time from the surgery?

A: Those who undergo a gastrocnemius recession often make a full recovery in around three to four months.101 Meanwhile, patients who undergo a plantar fascia release may experience a complete recovery in around six months or more (depending on the condition of the patient), although your doctor may allow you to return to your normal routines six to 12 weeks after the operation.102

Remember to always discuss both the risks and benefits of the surgery with your physician before undergoing an operation for plantar fasciitis, as there are potential risks that may affect you, such as infections, recurring heel pain and slower recovery time for wounds.103

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