Plantar fasciitis is a condition that causes pain in the bottom of a person’s foot, mainly around their 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, luckily there’s treatment and exercises that you can do to help.
Here, we’ll explain more about plantar fasciitis, including what it is, what it’s caused by, 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.
As a result, the plantar fascia ligaments experience a lot of wear and tear throughout daily life. Too much pressure on your feet, however, can damage or tear 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 more commonly affects just one foot, but can also affect both.
Pain caused by plantar fasciitis develops gradually over time and depending on the person, the pain 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 tell-tale signs to look out for.
For example, if the pain is a lot worse when you start walking after resting or sleeping, the pain feels better during exercise but returns after resting, or if you find it difficult to raise your toes off of the floor, you may have plantar fasciitis. Climbing stairs can also be very difficult due to heel stiffness.
What causes plantar fasciitis?
Plantar fasciitis is caused by straining of the plantar fascia – the web-like ligament that connects your heel bone to your 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 are at 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 are not exactly clear, but it’s thought to be associated with factors such as pregnancy and wearing more unsupportive shoes.
- People who are overweight or obese are at greater risk of the condition due to increased pressure on the plantar fascia ligaments. This can be especially true if you’ve experienced sudden weight gain.
- Long-distance runners, runners 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 8-10% of regular runners.
- If you have structural foot problems – for example, very high arches or very flat feet – you are at higher risk.
- Tight Achilles tendons (the tendons attaching the calf muscle to your heels) 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 – for example, doing a lot more walking, running, or just standing up in general.
The cause of plantar fasciitis discomfort itself is still unclear. However, according to this study, the condition may involve degeneration of the plantar fascia rather than inflammation. This would also help to 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.
GPs will usually be able to diagnose plantar fasciitis by using your medical history and 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 also 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 health of your nerves by checking your reflexes, muscle tone, coordination, balance, and sense of touch and sight. You may be also 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
In most cases, plantar fasciitis will improve with simple treatment like resting, stretching, foot strengthening exercises, and use of suitable footwear and insoles.
In fact, research on the treatment of plantar fasciitis found that rest, good footwear,suitable insoles, self-monitoring of pain, and stretching has the most success in 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 of a plantar fascia exercise 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 a new product, Barefoot Science insoles, which are said to have a 97.6% success rate at treating and preventing plantar fasciitis.
Wearing Barefoot insoles is designed to be an ‘in-shoe’ training system that strengthens the intrinsic muscles and activates proprioceptive nerves (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 or buy a pair using the button below.
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Physiotherapy and podiatrist for plantar fasciitis
Referral to a physiotherapist or foot specialist (podiatrist) can also be useful if you feel home remedies aren’t making enough of a difference and would 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. And physiotherapy can help to improve plantar fasciitis by reducing pain levels, reviewing and adapting your walking or running style, restoring the range of movement at your foot and ankle, and so on.
Physiotherapy is available on the NHS for free throughout the UK, but waiting times can sometimes 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 for free through the NHS – and whether you have free access will usually depend on where you live. Like physiotherapy, waiting times for podiatry can also be lengthy.
Further treatment for plantar fasciitis
If treatment such as stretching, insoles, and rest haven’t improved 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 for plantar fasciitis.
Steroid injections for plantar fasciitis
Steroid injections into the damaged section of the plantar fascia ligament can be used to offer some short-term pain relief.
While the pain relief doesn’t always last for long, some people find it worthwhile – especially if they need immediate pain relief.
These injections should be done by a specialist, who may use an ultrasound device to help determine the best place for the injection.
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 analysis of ESWT on plantar fasciitis showed 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?
- Wearing good-quality, well-fitting shoes with good cushioning and shock absorption.
- Buy your trainers from a running shop and seek advice from staff about the best shoes for your feet.
- Replace trainers and other shoes as soon as they are worn out.
- Avoid exercising on a hard surface.
- Ensure that you stretch sufficiently before and after exercise.
- Maintain a healthy weight and balanced lifestyle.
Conditions like plantar fasciitis can have an impact on our everyday lives. While plantar fasciitis can’t always be avoided, the positive news is that it’s usually easy to treat with a number of different approaches.
With a little time, patience, and perseverance, hopefully your heel will be on the mend very soon.