Plantar Fasciitis is a painful inflammation of the plantar fascia, which is a band of fibrous connective tissue that runs from the heel bone to the toes, just below the skin on the bottom of the foot. The main function of the plantar fascia is to support the arch of the foot and to help support the weight of our body. The plantar fascia undergoes significant tension when the foot is bearing weight. It has been estimated that the plantar fascia alone may carry up to 14% of the total load of the foot.

Plantar Fasciitis usually develops due to overuse of the plantar fascia. Excessive strain can be placed on the plantar fascia when you stand or walk for long periods of time, or when you run or practice high-impact physical activities. The risk of overloading the plantar fascia also increases if you’re overweight or if you commonly wear poorly supportive footwear, for example.

These contexts of overload on the plantar fascia create significant strain on the tissue, which may cause small tears. When these small tears occur, an inflammatory reaction is triggered in an attempt to repair the injury, which leads to pain and tenderness. But these attempts to self-heal may not be successful and the inflammatory reaction may persist; it may even worsen. With a continued overuse of the plantar fascia, these small injuries and inflammatory reactions will accumulate and the plantar fascia will slowly and progressively degenerate.

What are the symptoms of Plantar Fasciitis?

Plantar Fasciitis Symptoms

Plantar Fasciitis Symptoms

The small tears of the plantar fascia occur most often at the attachment of the plantar fascia to the heel bone. Therefore, the bottom of the foot, near the heel, is the area where Plantar Fasciitis pain is usually felt most severely — this is its main symptom. In fact, Plantar Fasciitis is the most frequent cause of heel pain. Although the bottom of the heel is the most commonly painful area, Plantar Fasciitis pain and tenderness may extend along the plantar fascia into the arch of the foot.

The severity of pain can differ significantly depending on several factors, particularly on the severity of the injury. A common sign of early Plantar Fasciitis is an area of tenderness and slight irritation on the bottom of your foot, just in front of the heel bone. That tenderness is an indication that an inflammatory reaction is taking place as an attempt to repair an injury. At this point, your injury is likely to spontaneously heal if you rest, massage, and carefully stretch your foot.

When Plantar Fasciitis sets in pain becomes more intense. Pain is usually more severe with the first few steps after getting out of bed in the morning, when it can be felt as flares of stabbing pain on the bottom of your heel. Pain is also intense when you get up after a long period of sitting, such as after a long car ride, for example.

As you get up and start moving, you start warming your plantar fascia and pain normally decreases and main ever subside. But after a long day on your feet, pain will likely get worse again. Pain is also usually worse after you exercise. During exercise, you may not feel pain because the plantar fascia is warmed, but as it cools down, pain will be more intense. If you have been feeling pain in the bottom of your heel, remember that even though you’re not feeling it while you run, the injury in your plantar fascia may be worsening.

Pain caused by Plantar Fasciitis gets worse when you flex your foot or push on the plantar fascia; it improves when you point your toes down. Pain associated with Plantar Fasciitis may limit movements of your ankle, particularly the up motion.

If you recognize these Plantar Fasciitis symptoms, you are likely to have Plantar Fasciitis and you should see a doctor right away to confirm the plantar fasciitis diagnosis. The earlier you start treating Plantar Fasciitis, the better — with an early intervention, your plantar fascia may actually repair itself naturally with the help of simple conservative treatments you can do yourself.

How severe can the symptoms get?

Plantar Fasciitis can be resolved in just a few months if you seek timely treatment. But if you ignore those early signs described above, it is likely that the injury and its symptoms will intensify. Even when you don’t exercise, you still place load on your feet while you stand or walk. With repeated stress to the untreated plantar fascia, the small tears will accumulate and affect its strength and stability, making it more vulnerable to additional damage and degeneration. It may even lead to plantar fascia tears.

Since the early symptoms of Plantar Fasciitis are not very intense, many people ignore them. But as it progresses, it begins to noticeably affect daily activities and quality of life. At this point, Plantar Fasciitis may already be severe and harder to treat.

As Plantar Fasciitis worsens, heel pain in the morning becomes more intense and lasts longer. You may feel flares of stabbing pain even after just sitting for short periods of time. You may even feel throbbing or stabbing pain during periods of rest. You may reach a point of constant severe heel pain that restricts with your routine.

Pain in your heel and plantar fascia, even if mild, will increase the effort of walking and weight bearing. Even though you may not realize it, you will probably change your posture and gait pattern to minimize pain. This will have an impact on the biomechanical properties of your feet, knees, hip, and even your back. This may cause additional musculoskeletal problems such as ligament tears, tendonitis, heel spurs, pain and osteoarthritis of the ankle, knee, or hip, back pain, etc.

How can these symptoms be treated?

Plantar Fasciitis can easily be resolved within a few months with an early intervention with conservative treatments. The initial treatments will aim at managing the inflammatory process and pain, prevent additional damage, increase the support to the plantar fascia, and promote healing.

Simple conservative treatments options for Plantar Fasciitis include rest, stretching exercises, ice massage, and over-the-counter pain medication. Together, these approaches — which are simple and can easily be done at home — are very effective in the majority of Plantar Fasciitis cases.

When these are not sufficient, which may happen in more advanced cases of Plantar Fasciitis, you can also consider deep tissue massage to the heel and to the back of the calf muscles to help stretch and release tension in these tissues. This should be performed by an expert.

You can also improve your footwear to decrease any stress to the plantar fascia. You can buy good supportive shoes or upgrade your footwear with specialized devices that you insert in your shoes, such as cups, cushions and insoles. These devises are called orthotics; they can be generic or custom-made.

If you are a good sleeper, you may also use anterior night splints to help support the arch of your foot and stretch the plantar fascia, the Achilles tendon, and your calf muscles while you sleep (if you are a poor sleeper, night splints may disrupt your sleep).

There are a few more sophisticated therapeutic options you may also consider. These include Extracorporeal Shock Wave Therapy, Ultrasound-Guided Corticosteroid Injections, Platelet-Rich Plasma Injections, and Ultrasound-Guided Radiofrequency Ablation. These have all shown good results in safely treating Plantar Fasciitis and providing long-term pain relief.

Surgery to treat Plantar Fasciitis can also be performed, but it is rarely recommended. Around 95% of plantar fasciitis cases recover without the need for surgery. Only when all conservative measures have been exhausted should surgery be considered as an option.

 

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Janet Pearl MD

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