Plantar fasciitis is an extremely uncomfortable pain felt in the heel and along the arch of the foot when walking or standing up. The pain originates from the inflammation of very important tendons that run along the length of the soles of the feet.
Fascia is a very thin membrane that envelops our muscles. Their purpose is to innervate and prevent friction between sliding muscles. Fasciitis refers to an inflammation of this tendinous membrane and it needs to be treated as soon the first symptoms are noticed in order to prevent chronic severe pain and/or mobility problems. Those who are on their feet all day due to their occupation are also at risk. Some professions have a higher prevalence of plantar fasciitis, such as athletes, chefs, hair stylists, teachers, and factory workers.
According to very valuable information provided by ‘Board Certified and Highly Trained Plantar Fasciitis Doctors’ and published by ‘The Center for Morton’s Neuroma’:
- “Most cases of plantar fasciitis occur in middle-aged individuals (peak age of occurrence is 40 to 60 years).
- Approximately 80% of all cases of heel pain are due to Plantar Fasciitis.
- It is estimated that 1 of 10 individuals are at risk of experiencing at least one episode of disabling heel pain at some point in life.
- 8% of foot injuries in runners are related to Plantar Fasciitis.
- Some estimates report that 10-16% of the population suffer from Plantar Fasciitis.
- Approximately 1% of all visits to the orthopedists’ office are due to plantar fasciitis (this corresponds to about 2 million visits per year!)
- Plantar fasciitis involves both feet in almost ⅓ of all cases.”1
Important information published by The Plantar Fasciitis Organization explains that: “Plantar fasciitis is also influenced by the mechanics of the foot. Having conditions such as flat feet, high arches, pronation, or having an abnormal gait (the way in which the foot hits the ground), the fascia tissue can become overworked or stretched abnormally, resulting in tears and inflammation.
Age also plays a factor. As we age, tissue tends to become weaker and more prone to damage. In addition to these common risk factors, weight plays a huge role in damage to the heel. Since our heels absorb much of our body’s pressure when we walk, being overweight can easily lead to damage and plantar fasciitis.
Pregnancy can also add a few extra pounds. However, the hormonal changes in pregnant women can also cause ligaments and other tissue to relax and become more pliable, which could lead to plantar fasciitis if you are not careful. Finally, wearing high heeled shoe, boots, or other shoes that do not provide proper support around the heel and through the arch can easily lead to plantar fasciitis over time.”2
Research study results published by Science Direct and The Journal of Pain regarding ‘Plantar Fasciitis in United States adults’ obtained from the ‘National Institute of Health and Wellness survey’, reports that: “It was estimated that .85% (95% confidence interval [CI] = .77–.92) of the sample reported diagnosed plantar fasciitis with pain in the past month.
Higher prevalence of plantar fasciitis was seen in women (1.19%; referent) versus men (.47%), in those aged 45 to 64 (1.33%) versus those aged 18 to 44 (.53%; referent) years, and in the obese (1.48%) versus those with a body mass <25 (.29%; referent).
- Plantar fasciitis pain prevalence was presented for United State adults.
- Most individuals with plantar fasciitis reported at least moderate daily pain.”3
The plantar fascia has an extremely crucial biomechanical function. Along with other structures of the feet, it is responsible for absorbing and returning the energy that is produced when the feet impact the ground. It is also a vital protector of the metatarsals.
According to Certified and Highly Trained Plantar Fasciitis Doctors’ Plantar fasciitis: “is caused by degeneration of plantar fascia as a result of persistent overuse injury. Specifically, Plantar Fasciitis is a result of microtrauma leading to degeneration and small tears of the plantar fascia. Poorly managed plantar fasciitis can significantly worsen your quality of life by interfering with your ability to do day-to-day activities.”4
As the Live Science Organization explains on in their published work ‘Plantar Fasciitis: Causes, Symptoms & Treatment: “There are many reasons why one might develop plantar fasciitis, according to the American Orthopedic Foot & Ankle Society. Some of these factors include being overweight, being on your feet for extended periods and wearing shoes with inadequate support. In addition, impact exercises such as running, tight calf muscles that limit ankle mobility, flat feet or high arches, excessive pronation (when the foot rolls severely inward when walking) or wearing high heels on a regular basis can be aggravating factors.
Heel spurs are commonly thought to cause plantar fasciitis, but the opposite is more likely to be true, Greaser said. A heel spur is a bony outgrowth on the edge of the heel that’s often the result plantar fasciitis, but it’s rarely the cause of heel pain.”5
As stated by The Plantar Fasciitis Organization: “There are a number of plantar fasciitis causes. The plantar fascia ligament is like a rubber band and loosens and contracts with movement. It also absorbs significant weight and pressure. Because of this function, plantar fasciitis can easily occur from a number of reasons. Among the most common is an overload of physical activity or exercise. Athletes are particularly prone to plantar fasciitis and commonly suffer from it. Excessive running, jumping, or other activities can easily place repetitive or excessive stress on the tissue and lead to tears and inflammation, resulting in moderate to severe pain. Athletes who change or increase the difficulty of their exercise routines are also prone to overdoing it and causing damage.
Another common cause of plantar fasciitis is arthritis. Certain types of arthritis can cause inflammation to develop in tendons, resulting in plantar fasciitis. This cause is particularly common among elderly patients. Diabetes is also a factor that can contribute to further heel pain and damage, particularly among the elderly.
Among the most popular factors that contribute to plantar fasciitis is wearing incorrect shoes. In many cases, shoes either do not fit properly, or provide inadequate support or cushioning. While walking or exercising in improper shoes, weight distribution becomes impaired, and significantly stress can be added to the plantar fascia ligament.”6
- Pain in the underside of the foot arch and heel, especially in the mornings.
- A sensation of aching, burning or stabbing when walking or running.
- Difficulty supporting weight when standing.
As a common formulated question from a group of ‘Board Certified and Highly Trained Plantar Fasciitis Doctors’ says: “Have you ever felt pain along the inside heel of your foot? A throbbing searing or piercing pain that is just on the heel of your foot without any tingling or radiation? It might feel like your heel is walking on a stone or you have bruising heel pain.
Has your pain gradually worsened but now is especially bad when you take your first steps in the morning and then generally fades after about 30-45 minutes? If so, you may have Plantar Fasciitis. Sometimes it is referred to as heel-pain syndrome.7
The pain tends to subside during exercise, but then it returns once you have cooled down.
A publication by The American Orthopedic Foot & Ankle Society (AOFAS) in cooperation with the Choosing Wisely Organization and ABIM Foundation (Advancing Medical Professionalism) regarding the work ‘Treating Plantar Fasciitis’ indicates that: “Plantar fasciitis is a common condition. It is also called jogger’s heel. The main symptom is a pain in the heel when you stand up after sleeping or resting. The pain usually gets better when you walk around.”8
Treating plantar fasciitis requires a combination of rest, physical therapy, and medication to ease the pain and prevent further progression of damage to the structures of the feet. Many doctors would say that the best treatment for plantar fasciitis is the RICE method:
- Rest the affected foot for at least 4 to 8 days for faster healing.
- Ice down your feet to provide relief and reduce the inflammation. Place an ice pack under your foot, immerse it in cold water, or rock your foot back and forth over a frozen bottle of water.
- Cold compression. Wrap ice in a towel and place it under the heel or foot arch for 15 or 20 minutes, three times a day.
- Elevation. Lift your foot and place it on a chair or over some cushions to elevate your feet above your chest level. This will promote better circulation and help relieve inflammation and pain.
- Practice strengthening exercises, it will increase the stability and support of your feet.
- Take anti-inflammatory medication to ease the swelling.
The American Orthopedic Foot & Ankle Society (AOFAS) in cooperation with the Choosing Wisely Organization and ABIM Foundation (Advancing Medical Professionalism) on their work ‘Treating Plantar Fasciitis’ manifest that: “This condition takes time to heal. It usually goes away on its own in less than six months.
Your health care provider can usually diagnose it with a physical exam of the foot. You don’t need X-rays unless you have symptoms for longer than six months.”9
As a publication by ‘Sports Health‘ based on Plantar Fasciitis ‘Non-medical Treatments’ recommends: “Patients can initiate some treatments, such as rest and stretch, on their own, while others should be done under a doctor’s supervision.
Patients are advised to cut back on jogging or other activities that keep them on their feet for an extended period of time. This decrease in activity usually only needs to last a week or two for plantar fascia to heal.
Comfortable shoes with soft soles and arch supports will place less strain on the plantar fascia. For some athletes, just changing running shoes can significantly ease plantar fascia pain.
A physical therapist can employ a number of different taping techniques to support the plantar fascia, giving it a chance to heal.
Some shoes can be fitted with inserts. One example is an orthotic, which spans the length of the shoe. It can provide support and put less strain on the plantar fascia. Another option is a heel cup. This insert is designed to support and cushion the heel.
Plantar fasciitis is associated with less flexibility in the ankle, Achilles tendon, and calf muscles. Gentle stretching to improve flexibility can make the biomechanics of standing, walking, and jogging less stressful for the plantar fascia.”10
Many people who have experienced plantar fasciitis have found great relief with a combination of the above treatments.
According to survey results from the National Institute of Health and Wellness survey ‘Prevalence and Pharmaceutical Treatment of Plantar Fasciitis in United States Adults’ published in Science Direct ‘The Journal of Pain’:
“Prescription medications for pain were used by 41.04% of plantar fasciitis respondents, but only 6.31% attributed this use specifically to plantar fasciitis pain. Nonsteroidal anti-inflammatory drugs (4.01%) and opioids (2.21%) were the most prevalent prescription drugs used specifically for plantar fasciitis pain. Almost 70% of individuals with plantar fasciitis used over the counter (OTC) analgesics for general pain management, with OTC nonsteroidal anti-inflammatory drugs being used by 49.47% and acetaminophen by 26.93% of respondents. Individuals diagnosed by medical specialists had twice the odds of using prescription drugs as those diagnosed by other providers (odds ratio = 2.12; 95% CI = 1.01–4.46). Non-Hispanic black individuals were more likely to use prescription pain medications specifically for plantar fasciitis pain than non-Hispanic white individuals (odds ratio = 3.02; 95% CI = 1.05–8.70).”11
According to The Plantar Fasciitis Organization: “Taking over the counter medications such as ibuprofen or acetaminophen can help reduce pain and inflammation that may have developed. An orthotic device placed in your shoes can also significantly help to reduce pain. In addition, orthotics can also help promote healing to reverse plantar fasciitis.
Prolonging treatment for plantar fasciitis will cause the condition to become worse. In some cases, a mild aching can evolve into a chronic problem. Another common problem is a change in your gait in order to counteract pain during movement. As a result of these involuntary changes in the foot’s mechanics, knee, hip, or back pain can also develop. 12
Plantar Fasciitis Prevention
- Use shoes with excellent arch support and shock absorption soles.
The PFO clearly states that: “Shoes are very important and should fit well and provide ample cushioning and support throughout the heel, arch, and ball of the foot so that weight is distributed evenly throughout the foot”
- Keep an ideal weight. Being overweight can increase compression and inflammation of the plantar fascia.
- Avoid standing or practicing sports for too long. Take between 15 to 30 minutes to rest every two hours.
- Stretch and warm up before any physical activity.
- If you have high arches or flat feet, an orthotic shoe insert should be considered to counteract the stress caused by the abnormal mechanics of the foot.
As explained by certified specialists from The Plantar Fasciitis Organization: “In most cases, plantar fasciitis does not require surgery or invasive procedures to stop pain and reverse the damage. Conservative treatments are usually all that is required. However, every person’s body responds to plantar fasciitis treatment differently and recovery times may vary.” 13
(1, 4, 7) Board Certified and Highly Trained Plantar Fasciitis Doctors. The Center for Morton’s Neuroma. Fasciitis specialists. https://www.fasciitis.com/what-is-plantar-fasciitis/
(2, 6, 12, 13) Plantar Fasciitis Organization. http://www.plantar-fasciitis.org/
(3, 11) Science Direct. The Journal of Pain. Volume 19, Issue 8, August 2018. Prevalence and Pharmaceutical Treatment of Plantar Fasciitis in United States Adults. National Institutes of Health. National Center for Complementary and Integrative Health. 2013 https://www.sciencedirect.com/science/article/pii/S1526590018301123
(5) Live Science Organization. Plantar Fasciitis: Causes, Symptoms & Treatment https://www.livescience.com/63816-plantar-fasciitis-causes-symptoms-treatment.html
(8, 9) The American Orthopaedic Foot & Ankle Society (AOFAS). Choosing Wisely Organization. ABIM Foundation | Advancing Medical Professionalism. Treating Plantar Fasciitis. http://www.choosingwisely.org/patient-resources/treating-plantar-fasciitis/ http://www.choosingwisely.org/wp-content/uploads/2018/02/Treating-Plantar-Fasciitis-AOFAS.pdf
(10) Sports Health. Plantar Fasciitis. Initial Treatment Options. Non-medical Treatments. 2017. https://www.sports-health.com/sports-injuries/ankle-and-foot-injuries/plantar-fasciitis-initial-treatment-options