Plantar Fasciitis: Causes Symptoms & Treatment

What is Plantar Fasciitis?

Waking up in the morning with fear of standing up and walking around for the first few minutes, knowing it will be painful, could be plantar fasciitis, and is not something you want to endure.  Sometimes this pain can occur during or after you’ve been out for a nice walk, a run or after an exercise group. It impacts on your physical and mental health and stops you from having your ‘me time’ as well as spending time with your family and friends.

Quite often, this pain is sharp and located at the bottom of your heel and can spread into the arch of your foot. It often improves after a few minutes of walking around but then comes back if you have been active or get up from having a rest.

Sometimes the remedies found online, such as resting, or the basic information from your GP doesn’t improve your heel pain.

If you or someone you know are experiencing some of the symptoms mentioned above, you most likely have plantar fasciitis. The plantar fascia is a fascial band that starts at the bottom of the heel bone and fans out into the balls of the foot (known as metatarsal heads).

When things go wrong, see ‘The Cause’ below, it can result in the plantar fascia becoming thicker, can be swollen, inflamed and in some extreme cases may also have a small tear.

The Cause

Heel pain, or what is commonly diagnosed and known as Plantar Fasciitis, affects the bottom of one or both heels.

Plantar heel pain can be caused by many different things such as:

• Sudden increase in level of exercise / activity – If you are not an active person and suddenly increase your walking, start to run, or start going to a lot of fitness classes in a short period of time, your muscles and tendons are not able to cope with this big increase and this can often lead to the development of heel pain like plantar fasciitis.
• Footwear which doesn’t provide you with enough support – Wearing footwear which is not suitable to your feet, i.e. thin midsole, flexible shoe or slip-on, can result in more pressure being put through your feet, after wearing them for a long time, the material of the shoes will wear down causing you to change how you walk which increase the pressure on your feet.
• Being overweight – This causes more pressure to be applied through the sole of your foot, more so the heel as this is the first part of your foot to contact the ground when walking and most of the time when you run (some people contact the ground with the middle of their foot or front of their foot when running).
• Middle age – As we get older our muscles and collagen changes which results in them not being as strong as they once were. This means that more pressure is placed through the heel.
• Flat feet– Sometimes the structure of your feet can be a contributing factor to the development of your heel pain.  Having flat feet can cause more pressure being placed through the sole of your feet. When you add this to a sudden increase in activity, this can lead to heel pain such as Plantar fasciitis.
• High arches – Having high arched feet can also lead to people having heel pain. Quite often, people with high arches have a higher load placed through their heel as their foot may not pronate enough to absorb the pressure being applied from the ground and body. They can also have more ankle and calf muscle stiffness which can lead to an increase in pressure through the heel.
• Medical conditions – Being a diabetic or having other conditions such as Rheumatoid Arthritis or systemic conditions, can be the cause of heel pain. If you have diabetes and your blood sugars are high (more than 7mmol/L) for a long time, this can change the structure of the cells that make up your muscles and tendons leading to pain in the heel. If your Rheumatoid markers have changed, this can also lead to the development of heel pain.
• Medications – Certain medications have side effects which can also be the cause of heel pain such as cholesterol medication or antibiotics (fluoroquinolones – ciprofloxacin, norfloxacin & moxifloxacin). If you have recently been taking one of these medications, you should consult your GP to see if another medication can be prescribed without these side effects.

How to prevent heel pain

There are many ways in which you can try to prevent heel pain and avoid the above causes. The list below on how to prevent plantar fasciitis is not exhaustive but can be a good place to start. Be aware that sometimes there is more than 1 factor that can help, these include:

• Losing weight – By losing weight, we reduce the pressure being applied through our feet. This can be done through diet and exercise.
• Gradual increase in exercise – If you have always been a person who does not exercise, you are looking to be more active, or training for a marathon, it is important that it is done gradually. By taking gradual increase in exercise (i.e. Two 30 minute walks a week for 2 weeks, then increase it to 3 walks and so on) it allows the muscles and ligaments to become stronger at a rate at which they can adapt to, which should minimise the development of heel pain.
• Footwear – Wearing the correct footwear is very important, not only does this help with your choice of exercise, it can also help prevent heel pain. Things you should be looking for in a good shoe are a firm heel counter (the back of the shoe doesn’t fold down), lace up or Velcro, firm midsole (shoe can’t fold in half) and a toe spring (the front of the shoe bends up). Having your feet measured for length and width is also very important. There are many different brands of footwear and within those brands they have different ones for support or high arched feet. If you are not sure what type of footwear would suit you best, feel free to book an appointment to discuss this further.
• Rest/Recovery – Making sure you have at least a day off after exercising is important to help prevent heel pain. By giving your muscles and tendons time to rest and recover, this allows them to be ready for the next time you train/exercise. If you were to exercise every day, this would result in a big increase in muscle/tendon use and eventually the cells that make up the muscles and tendons will begin to fail and break down causing pain.
• Sleep – It has been found that not having enough sleep (7-8 hours) can dramatically increase your likelihood of developing heel pain. The quality of your sleep is also important.
• Dealing with stress – Modern life is very busy and can also be stressful. Stress along with other mental health issues such as anxiety, can lead to the development of heel pain. It is important that if you are experiencing stress or other mental health issues you should speak to you GP or a psychologist/ counsellor to help you deal with this which over time.
• Medical conditions – Making sure if you are diabetic that you monitor your blood sugar levels and make sure that they do not sit above 7mmol/L for a long period of time. If you are struggling with controlling your diabetes, making an appointment to see your GP, endocrinologist or Diabetes Educator is very important and will help finds ways of stabilising your blood sugars.
• Strength – By adding in strength exercises, weights or body weight exercises, to your weekly routine it has been found to help your muscles and tendons cope with increased levels of activity. If you are a runner and do not have any strength sessions planned into your schedule, you really need to add a lower leg strength session as this can help prevent heel pain but has also been found to improve performance. If you are not sure what a strength session would look like, please feel free to use the book now button to make an appointment for us to help you with this.

How to self-manage your heel pain

Now that you know what the plantar fascia is, what is plantar fasciitis, the causes and ways to prevent it, it is time to discuss the means in which you can help manage your heel pain.

You should check your footwear and change them if you notice they are worn on the outsole or are not providing you with support like they used to.

Applying an ice pack to your heel for 5-10 minutes, three times a day will also help manage any localised inflammation that may be present in your heel. Remember to wear a sock on your foot when applying the ice to prevent a cold burn. *if you have neuropathy (where there is no feeling) you should avoid doing this until you have spoken to your health care practitioner.

Stretching your calf muscles will also help reduce the pressure on your heel and can help manage your heel pain. A straight leg calf stretch is sufficient, holding a stretch for 30 seconds and repeating 3 times on each leg.

Strapping your foot or heel can also help. Click on this link (taping your foot) which shows you how to strap your foot by yourself.

What if there is no improvement in the pain or I’m not sure if it is Plantar Fasciitis?

At Sports & Injury Management, we work with athletes and weekend warriors, who are struggling with persistent, stubborn, niggling injuries, and work together on a specific treatment plan to help fix this pain. This allows those athletes and warriors to become stronger, return to exercising, training, participating in sports and live pain free.

Recovery takes time, but persistent pain shouldn't hold you back. If you've tried everything and still not seeing improvement, your Diamond Creek Podiatrist is ready to help. Call today or book online to take the next step toward pain-free movement.

With over 14 years as a Podiatrist, I have successfully treated lots of patients with this and similar conditions. Come and join our community of active happy people.

SIM – Getting stronger, staying active