Plantar fasciitis is perhaps the most common cause of foot pain we see in our clinic. If you have not suffered from it yourself, you probably know someone who has suffered debilitating plantar fasciitis pain, occurring in the heel and/or through the arch of the foot.
What is plantar fasciitis?
The plantar fascia is a thick, fibrous band or ligament that runs along the plantar (bottom) surface of the foot. It is important in helping to support the arch and joints while we stand, walk and run. Plantar fasciitis is inflammation of the plantar fascia. This most commonly occurs where the plantar fascia attaches into the heel bone but can occur anywhere along the length. It is the leading cause of heel pain.
How does it occur?
As we established above, the plantar fascia is important in supporting the arch of the foot. Every time we stand the plantar fascia is loaded with forces stretching it end to end. When we walk or run, this loading (and unloading) occurs repeatedly, stretching then contracting every time we take a step. It can handle a heck of a lot but if it becomes too much, micro tears begin to form in the tissue that makes up the plantar fascia. This leads to inflammation, pain, swelling and heel pain.
But what about a heel spur?
The terms ‘heel spur’ and plantar fasciitis are often incorrectly used interchangeably.
A heel spur, while it is often a by-product and related to plantar fasciitis, is a separate and distinct condition. Heel spurs are a bony outgrowth from the heel bone that grows to even out the increased pressure applied to that part of the heel. Heel spurs are generally not painful unless there is plantar fasciitis accompanying it.
What causes plantar fasciitis?
Frustratingly, plantar fasciitis can often feel like it has sprung up out of nowhere with no obvious cause. This is because it is very much an overuse injury, meaning that more is being asked of the tissue than it is able to cope with. The injury itself may be occuring well before symptoms arise.
A few common causes / contributing factors all of which may increase load on the plantar fascia and lead to injury:
- Footwear that does not adequately support the foot, particularly the arch of the foot
- Poor foot function leading to overpronation (flat feet)
- Tight calves, leading to altered biomechanics
- Increasing walking or running time/distance too quickly and without giving the body time to adjust and strengthen
- Weak foot and lower leg muscles leading to poor foot function
- Pregnancy. Weight gain and hormonal changes can lead to ligament laxity and altered biomechanics
Plantar fasciitis symptoms
‘It feels like someone is stabbing me in the heel with a knife!’
Indeed, plantar fasciitis can present as a very painful condition. Pain is usually felt in the heel or the arch of the foot and is at its worst when getting out of bed in the morning or standing after sitting for a time. This is because while not weight bearing, the plantar fascia has a chance to tighten up… only to be stretched again once it’s owner stands and starts moving around. Generally pain reduces or subsides after a few minutes of weight bearing, once it has warmed up.
Plantar fasciitis treatment
Here’s the good news: plantar fasciitis is very treatable and shouldn’t be something you need to put up with. The bad news? It usually takes a few months to resolve and there are no quick tricks unfortunately!
Treatment at our Alexandria Podiatry clinic will involve a combination of interventions all aimed at reducing the load and forces going through your plantar fascia.
This may include temporary reduction in exercise or activity, footwear change, calf stretching, home exercise regime, plantar fasciitis taping, anti-inflammatories, ice application, orthotics / custom insoles and shockwave therapy.
In severe cases that are not resolving with more conservative treatments, a corticosteroid injection into the plantar fascia can be considered.
Plantar fasciitis exercises
If you are suffering plantar fasciitis there are a few easy exercises you can get started on right away:
Seated calf stretch
The seated calf stretch can be effective at reducing pain, especially if done before getting out of bed or before standing after sitting for a while.
- Sit with your leg straight out in front of you. Place a towel around your foot and gently pull toward you, feeling a stretch in your calf muscle.
- Hold for 1 minute and repeat 2-3 times.
This is a great exercise to help strengthen the small muscles in your foot. By making these muscles stronger, you can reduce the stretch and load on the plantar fascia.
- Using your toes, pick up a small towel on the floor and move it to your right. Drop it and then pick it up again and move it to your left.
- Repeat 10 times, 1-2 times per day.
Arch roll, plantar fascia release with ball
This exercise can help reduce tightness in the plantar fascia itself
- Rest your foot on a spiky ball, golf or tennis ball and roll your foot back and forth over it.
- Repeat for 3-5 minutes, 2 times per day.
The take-home message
Plantar fasciitis is a condition much easier to treat if it is caught early. The take-home message is to offload as best you can and if that doesn’t do the trick, seek help. Ignoring it will only result in a longer journey back to health.