What Is Plantar Fasciitis?
The plantar fascia is the broad band of connective tissue that runs under the skin from the back of the heel all the way to the toes on the underside of our feet. It serves to maintain the arch of the foot.
The plantar fascia is a tough bit of tissue. After all, we walk on it all day; sometimes we run, jump, stand on our tiptoes, and otherwise put a lot of stress on it. However, it may become irritated and inflamed—a condition known as plantar fasciitis.
Symptoms
Plantar fasciitis is painful, so much so that it may make walking difficult. Typically, the pain begins at the back of the heel and slowly moves forward to the underside of the heel and often further forward under the foot.
The pain tends to be most severe with the first few steps after getting out of bed in the morning or after a period of rest. The pain gets a little better once the person has been on their feet a while, but generally persists all day.
Plantar fasciitis may resolve on its own, but it often worsens and persists if untreated, and may become chronic.
Diagnosis
Plantar fasciitis is relatively simple to diagnose, and an informed individual may be able to self-diagnose. A clinical practitioner diagnoses the condition by the typical pattern of symptoms and by palpating the bony protuberance on the back of the heel and the underside of the heel. If this elicits pain, it’s suggestive of plantar fasciitis. Also, holding the big toe and flexing it upwards typically elicits pain.
Who Gets Plantar Fasciitis?
Anybody can develop plantar fasciitis; it’s a common condition. However, there are some risk factors that make us more likely to get it, such as:
- Being overweight
- High arches in the feet
- Being in poor physical condition
- Walking a lot on hard surfaces (such as concrete)
- Prolonged weight-bearing
- Walking barefoot
- High-impact activity (such as running)
- Worn-out or unsupportive footwear
Tips for Treating Plantar Fasciitis
Generally, the earlier that plantar fasciitis is recognized and treatment initiated, the easier it is to overcome. Treatment is graded, meaning that we start with simple measures, and move to increasingly more sophisticated measures if initial treatment isn’t successful.
Initial Treatment
Initial treatment is self-directed, so the person with plantar fasciitis can initiate and apply the treatment themselves without a prescription or involvement of a healthcare practitioner. These treatment measures include:
- Rest. Avoiding excessive standing, walking, or any other activity that exacerbates the pain. Complete avoidance of physical activity, however, can result in the plantar fascia stiffening
- Avoiding risk factors, when possible. For example, someone with recurrent or chronic plantar fasciitis may consider weight loss. Avoiding walking barefoot or in slippers by wearing supportive footwear around the house is helpful
- Ice. Freezing a water bottle and then rolling it along the floor under the heel and along the bottom of the foot may help settle the pain after activity or at the end of the day
- Medication. Using a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen, may help with the pain, although it is uncertain whether it helps improve the plantar fasciitis. Many NSAID medications are available without a prescription under a number of brand names, and they are available as oral medications or topical creams and gels. These medications have potential side effects and may not be appropriate for some individuals with some medical conditions. Consulting a healthcare professional is wise if there are any doubts
- Stretching. Stretches such as the calf-plantar fascia stretch, and towel-toe curls may be helpful
- Good quality footwear. Using supportive footwear, such as running shoes, and/or prefabricated silicone orthotic shoe inserts may help prevent plantar fasciitis and alleviate pain and exacerbations
Next-Level Treatment
If initial treatment measures fail to resolve the condition, it may be time to consult a health practitioner for next-level care. This may include:
- Physical therapy. Physical therapists can help treatment-resistant plantar fasciitis through a variety of techniques, such as ultrasound, low-intensity laser, electrotherapy, or dry needling
- Heel/foot taping. These are techniques for applying supportive taping to relieve pressure on the plantar fascia. They may provide short-term pain relief
- Corticosteroid injections. These are potent anti-inflammatory agents that are injected directly into the affected area
- Night-time splints. These are appliances that keep the ankle at a 90-degree angle during sleep so that the plantar fascia does not contract during the night and become irritated when bearing weight in the morning
- Custom orthotics. These are a step up from generic, over-the-counter gel orthotics;
- Walking cast. This is a boot that is worn during the day to provide additional support for the plantar fascia
- Surgery. Rarely required
Take-Home Message
Plantar fasciitis is a common cause of significant foot pain that often limits mobility. An awareness of the condition allows affected individuals to recognize the condition early and to initiate measures to treat it before it worsens and becomes difficult to treat. Of course, consulting with a qualified health practitioner to confirm the diagnosis and discuss treatment is always advisable.
