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Plantar Fasciitis: Bringing Your Arch Enemy to Heel

Jonathan Vellinga, MD -

Plantar Fasciitis: Bringing Your Arch Enemy to Heel

Does walking first thing in the morning hurt your feet? That single symptom is a red flag for an extremely common foot condition called plantar fasciitis, the inflammation of the connective tissue in the sole of the foot. It often expresses itself as pain in the heel or the arch of the foot as you take your first steps in the morning. Typically this pain goes away as your feet warm up… until one day, the pain doesn’t go away. That’s usually when people will finally seek out professional help because, at this point, the ability to walk safely is threatened, and the pain can be intense! Why is plantar fasciitis so common, and what treatments are available?

What is Plantar Fasciitis?

In the condition of plantar fasciitis (pronounced “plan-tar fash-ee-EYE-tis”), the tissue that connects the heel to the toes, called fascia, develops tiny cracks that become inflamed and painful. The body attempts to heal these tiny cracks, but this makes the fascia thicker and less flexible. In the normal range of motion for walking, the tissues of the foot need the ability to flex. The damaged fascia can grow from about 3mm thick to up to 15mm (1), making it far less flexible. This lack of flexibility increases the experience of pain coming from both the fascia and the structures the fascia is attached to within the foot.

During long periods of being off your feet, such as during sleep, the fascia contracts and stiffens (1). The first steps after inactivity can then be quite painful! Walking around for a while loosens up the fascia, and the pain usually diminishes. However, if the conditions which are driving the plantar fasciitis are not addressed, eventually, the pain does not go away even after the foot gets warmed up.

Unfortunately, there’s another complicating factor. If walking is painful, people either choose to reduce their walking or, if they do walk, they’ll change the position of their feet to experience the least amount of pain. Yet both these strategies can make the condition worse.

Oh, My Aching Feet! Symptoms of Plantar Fasciitis

Since there is a lot of individuality to the biomechanics of walking (how all the muscles and bones work together), plantar fasciitis symptoms can differ from one person to the next. How advanced the condition is can also affect the frequency or severity of the symptoms. Despite that, there is agreement that sufferers may experience one or more of the following symptoms (2-4):

  • heel, arch, or sole pain, especially if: it occurs after a long period of not walking and/or first thing in the morning, the pain goes away after walking for some time, and/or the pain gets worse if you stand for a long time

  • aching or painful bones or joints in the foot

  • pain becomes worse when carrying heavy objects

  • the foot is so stiff it doesn’t “rock” from heel to toe when walking (you have to place the whole foot down flat at once)

  • a swollen heel

  • an abnormally tight Achilles tendon (connects the heel and the calf)

  • feet feel tender or ache when being rubbed

  • shooting or stabbing pain originating in the heel, arch, or sole

Why is the Risk of Plantar Fasciitis So High?

There’s a lengthy list of risk factors for plantar fasciitis, which is probably why it’s so prevalent. Close to 1 out of 10 people will experience it at some time in their lives (4). This condition is so commonplace that if you have any heel pain, it is statistically more likely to be from plantar fasciitis than anything else (5). Below is a partial list of factors that can contribute to developing plantar fasciitis or increase the risk (3, 4):

  • being a runner or athlete (overuse of the feet)

  • frequent standing or squatting (especially squatting with all weight resting on the toes and upper foot)

  • shoes that do not properly support the foot

  • the hips, knees, and/or ankles are out of alignment due to weight, injury, or genetics

  • having excess stress on the lower half of the body from being overweight

  • having weak ankles that rotate or shift away from balanced alignment

  • having flat feet or high arches

  • having a job that requires carrying heavy objects

  • scaling up athletic training too quickly

  • spending a lot of time on a hard surface (for example, cement or tile), especially with bare feet

What Are Some Possible Treatments?

Each person must be evaluated to rule out conditions with similar symptoms, such as heel spurs. Once a diagnosis of plantar fasciitis is made and the severity determined, appropriate treatment can be selected.

Note, it is helpful to pinpoint the underlying cause for the development of plantar fasciitis. The driver of the condition must be addressed in addition to healing the feet because if the underlying root cause is not addressed, the treatment benefits may not last long. Removing the cause of the condition, in addition to healing the feet, will be more likely to ensure a complete, permanent resolution.

There are some treatments such as exercises, stretches, special shoes or devices, and even cortisone or corticosteroid injections. However, there are many downsides to pursuing these approaches. Sometimes these strategies can ease the pain temporarily, but the direct healing of the underlying tissues is not achieved, and the problem returns. People may go through several cycles of the pain returning before realizing the underlying problem is not solved!