Plantar fasciitis is a condition that causes pain in the bottom of the foot, mainly around the heel. It’s one of the most common orthopaedic complaints, with around one in 10 people experiencing it during their lifetime – most commonly between the ages of 40 and 60.
While plantar fasciitis can be uncomfortable, there are treatments available and exercises that can help.
Here, we’ll explain what plantar fasciitis is, what can cause it, and how to ease symptoms.
What is plantar fasciitis?
The plantar fascia is a thick, weblike ligament that connects your heel to the front of your foot. It acts as a shock absorber – supporting the arch of your foot and helping you walk.
Naturally, plantar fascia ligaments experience a lot of wear and tear in daily life. However, too much pressure on your feet can damage or tear these ligaments. In this case, the plantar fascia can become inflamed, causing heel pain and stiffness.
What are the symptoms of plantar fasciitis?
The main symptom of plantar fasciitis is pain at the bottom of the heel, or sometimes in the middle of the foot. Plantar fasciitis often affects just one foot, but it can affect both.
Pain caused by plantar fasciitis develops gradually and can be dull or sharp. Some people also experience a burning or aching sensation on the bottom of their foot that extends outwards from the heel.
If you’re unsure whether you’re experiencing plantar fasciitis, there are a few signs to look out for. This includes pain being more intense after resting or sleeping, pain improving during exercise but returning after, and having difficulty raising your toes off the floor. Climbing stairs can also be difficult due to heel stiffness.
What causes plantar fasciitis?
Plantar fasciitis is caused by straining the plantar fascia – the web-like ligament that connects the heel bone to the toes.
It’s not always clear why this happens, but there are a few reasons that can make people more likely to experience plantar fasciitis. For example…
- Active men and women between the ages of 40 and 60 have the highest risk of developing plantar fasciitis. This is largely because feet widen and flatten with age which makes it increasingly difficult for the arch of the foot to distribute weight properly.
- Plantar fasciitis is slightly more common in women than men. The reasons behind this aren’t clear, but it’s thought to be associated with factors such as pregnancy and wearing unsupportive shoes (like high heels).
- People who are overweight are at greater risk of the condition due to increased pressure on the plantar fascia ligaments. This can be especially true in cases of sudden weight gain.
- Long-distance runners, those who over-train, or who focus on speed work and hill training are more likely to develop plantar fascia problems due to excessive stress on the ligaments. Research shows that plantar fasciitis occurs in about eight to 10% of regular runners.
- If you have structural foot problems – for example, very high arches or very flat feet – you’re at higher risk.
- Tight Achilles tendons (the tendons attaching the calf muscle to the heel) can also lead to plantar fascia pain.
Other risk factors include wearing shoes with soft soles or poor arch support, exercising on hard surfaces, overstretching the sole of your foot, taking part in exercise with a tight calf or heel, and suddenly becoming more active.
The cause of plantar fasciitis discomfort itself is still unclear. However, the results of this study suggest that the condition may involve degeneration of the plantar fascia rather than inflammation. This would also help explain why mature adults are more likely to be affected.
How is plantar fasciitis diagnosed?
If you think you may be suffering from plantar fasciitis, it’s best to book an appointment with your GP.
Doctors will usually diagnose plantar fasciitis by looking at your medical history and completing a physical examination. You’ll typically be asked about the nature of your heel pain and your general physical activity levels.
As part of the physical exam, your GP should check for any tenderness in the foot to help determine the exact location of the pain. This will also help to ensure that the pain isn’t the result of a different foot problem.
They’ll examine the condition of your foot at rest, standing, and walking to look for signs of plantar fasciitis. The purpose of this is to evaluate the strength of your muscles and the health of your nerves by checking your reflexes, muscle tone, coordination, balance, and sense of touch. You may also be asked to flex your foot while they push down on the plantar fascia to see if the pain worsens.
If necessary, your GP may refer you for an X-ray or MRI scan to rule out other causes of your heel pain, such as a bone fracture.
Treatment for plantar fasciitis
Research into the treatment of plantar fasciitis has found that rest, good footwear, suitable insoles, self-monitoring of pain, and stretching are among the most effective approaches for relieving pain.
If you’d like to, have a go at practising these plantar fasciitis stretching exercises from the NHS. You can also see an example in the video below. However, experts advise doing any exercises slowly and no more than three to four times on the affected area.
Other things that you can do to improve plantar fasciitis symptoms at home include…
- Resting and raising your foot on a stool whenever you can.
- Placing an ice pack (or bag of frozen peas) wrapped in a towel on the painful area of your foot for up to 20 minutes every two to three hours.
- Taking part in low-impact exercise that doesn’t put pressure on your feet – for example, swimming.
- Strengthening the intrinsic muscles of your feet (there are 20 muscles in the sole of each foot that support the arch). This can be done through exercises like gentle heel raises and picking up marbles or pencils with your toes.
- Avoiding walking or standing for long periods of time, wearing high heels or tight pointy shoes, and walking barefoot on hard surfaces.
After conducting new research, health and fitness company All About Balance have created Barefoot Science insoles, which are said to have a 97.6% success rate at treating and preventing plantar fasciitis.
Barefoot insoles are designed to be an ‘in-shoe’ training system that strengthens the intrinsic muscles and activates proprioceptive nerves (which send information to your brain about your body’s position and actions) to improve balance. You can read more about the science behind Barefoot Science insoles here.
Physiotherapy and podiatry for plantar fasciitis
Referral to a physiotherapist or podiatrist (foot specialist) can be useful if you feel home remedies aren’t making enough of a difference and you’d like some expert treatment and advice.
Podiatrists will be able to advise you on suitable treatment such as wearing ankle braces for support or using night splints to help stretch the plantar fascia.
Physiotherapy can help to improve plantar fasciitis by reducing pain levels, reviewing and adapting your walking or running style, restoring the range of movement of your foot and ankle, and so on. Physiotherapy is available on the NHS throughout the UK, but waiting times can be long. Depending on where you live, you’ll either be able to self-refer or will have to see your GP or consultant first.
Unfortunately, podiatry isn’t always available through the NHS – and whether or not you have free access will usually depend on where you live. Like physiotherapy, waiting times for podiatry can also be lengthy.
For this reason, some people prefer to pay to see a podiatrist or physiotherapist privately. You can search for registered physiotherapists and registered podiatrists on the NHS website.
Further treatment for plantar fasciitis
If you find that treatments such as stretching, insoles, and rest don’t improve your symptoms after a few months, or your condition is having a significant impact on your life, your podiatrist, physiotherapist, or GP may suggest further treatment.
Below are a few examples of further treatment options for plantar fasciitis…
Steroid injections for plantar fasciitis
Steroid injections into the damaged section of the plantar fascia ligament can be used to offer short-term pain relief.
While the effects don’t always last for long, some people find it worthwhile – especially if they need immediate pain relief.
Steroid injections bring a small risk of complications and side-effects, including skin thinning and plantar fascia rupture. Therefore, it’s important to weigh up the pros and cons with your doctor or specialist before you decide whether they’re right for you.
Shock wave therapy for plantar fasciitis
Extracorporeal shockwave therapy (ESWT) is a non-surgical treatment that involves passing shockwaves through the affected area of your foot. This increases blood flow and stimulates cell regeneration and healing.
ESWT is thought to be a safer alternative to steroid injections and some people find it useful for relieving plantar fasciitis pain. For example, this study found that ESWT for plantar fasciitis had an 80-88% success rate in substantially reducing heel pain.
Surgery for plantar fasciitis
Plantar fasciitis surgery typically involves the partial or full release of the plantar fascia from the heel.
It’s generally the last resort if other treatments aren’t successful and, according to the NHS, less than 5% of patients undergo surgery for heel pain.
It’s important to remember that most cases of heel pain can take up to 12 months to improve. Usually, it’s only if the pain is still unbearable after this time and other treatments haven’t worked that surgery should be considered.
Can plantar fasciitis be prevented?
While it can’t always be avoided, there are a few measures that you can take to reduce your risk of developing plantar fasciitis. These include…
- Wearing high-quality, well-fitting shoes with good cushioning and shock absorption
- Buying trainers from a running shop and seeking advice from staff about the best shoes for your feet
- Replacing trainers and other shoes as soon as they’re worn out
- Avoiding exercise on hard surfaces
- Stretching before and after exercise
- Maintaining a healthy weight and balanced lifestyle
Final thoughts…
Conditions like plantar fasciitis can significantly impact daily life. While plantar fasciitis can’t always be avoided, the good news is that it’s usually straightforward to treat.
For further reading, check out the general health section of our website. There’s information on everything from important health checks to how to stay healthy throughout the winter months.
Have you struggled with plantar fasciitis before? What helped improve your symptoms the most? We’d love to hear from you in the comments below.
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