Heel Pain (Plantar Fasciitis): Causes, Treatments, and Prevention

What is Plantar Fasciitis?

Plantar fasciitis is the most common cause of heel pain in adults, affecting more than 1 million Americans each year. The plantar fascia is a fibrous ligament stretching along the bottom of your foot connecting your toes to the heel bone. [1]

This elastic ligament supports the arch of your foot by absorbing the shock forces from walking. Plantar fasciitis occurs when too much stress is put on the plantar fascia ligament, causing it to become irritated and inflamed. 

Plantar Fasciitis (Heel-Pain)

What are the common symptoms?

Plantar fasciitis is most commonly characterized by either a dull or sharp pain in the bottom of your foot near the heel bone.

Some people have also reported a burning or aching sensation extending out from the heel. 

Why does my plantar fasciitis hurt in the morning?

Typically, for people with plantar fasciitis, pain is most severe during the first steps after an extended period of rest, like getting up in the morning or standing up after sitting.

This pain is caused by a sudden tension or stretching of the plantar fascia ligament, which shortens after a period of inactivity. The pain will often decrease as the ligament has had time to stretch. [2]

How do I know if I have plantar fasciitis or heel spurs?

While plantar fasciitis and heel spurs are both associated with pain and inflammation near the heel, there are many important distinctions between the two conditions.

Plantar fasciitis is characterized by pain in the heel that results from an irritation or swelling of the plantar fascia ligament. By contrast, heel spurs are bony protrusions that develop on the heel in response to repeated damage or trauma.

While heel spurs are frequently accompanied by heel pain, they are rarely the cause of it; people with heel spurs are likely experiencing the pain from plantar fasciitis. [3]

Why do I have plantar fasciitis in only one foot?

It is common for plantar fasciitis to develop only in one foot as our feet often have subtle differences in structure that can affect both how our weight is distributed and how our feet absorb shock.

With time, any increase in pressure on one foot could cause plantar fasciitis to develop. Alternatively, this condition may appear in one foot as a result of previous damage or injury to that foot’s ligament. [1] 

Causes and Risk Factors

Plantar fasciitis is caused from a chronic overload on the plantar fascia ligament, preventing it from properly absorbing the shock forces on your foot. [3]

While this condition can emerge without a specific cause, there are many factors that increase its risk of developing.

  • Foot structure: Your foot’s shape and natural pronation affect how your weight is distributed between your feet and could be contributing to excessive strains on your plantar fascia. 
  • Age: This condition most commonly affects individuals between the ages of 40 and 60.
  • Physical Activity: High-impact activities, like walking, running, and dancing, can place more stress on your ligament, leading to an overuse or overload. 
  • Occupation: Certain occupations require more time spent walking or standing on hard surfaces, which can increase strain or damage to the plantar fascia.
  • Obesity: Excess weight increases the pressure on your ankles and feet.  

Diagnosis

Plantar fasciitis is diagnosed based on patient medical history, known risk factors, and physical examination. Your doctor will conduct a routine examination, checking for areas of tenderness or discomfort in your foot and studying your foot’s pronation.

They will often ask for a detailed account of your symptoms and your level of physical activity.

Typically, imaging tests are not needed to diagnose plantar fasciitis; however, they may be useful to rule out other heel pathology, such as bone cysts or stress fractures.

Treatment and Home Remedies

Nearly ninety percent of individuals with plantar fasciitis improve after months of noninvasive treatment, that includes a combination of rest, ice, pain medication, modified activity, and stretching.

Typically, doctors recommend resting for several days to initiate the healing process, icing your foot several times a day, and taking pain relievers, like Ibuprofen or Naproxen Sodium, to help reduce pain and inflammation.

Stretching exercises are also crucial to improve mobility of the plantar fascia ligament and strengthen muscles in the leg and foot. 

Does foot brace help plantar fasciitis?

In addition to resting, icing, and stretching, doctors may also suggest the use of a brace, night splint, or other orthotics to support your foot.

Foot braces are designed to compress your foot to reduce swelling and pain, whereas night splints keep your plantar fascia ligament and Achilles tendon elongated overnight to stretch your calf and foot.

Arch supports also provide additional support to the arch of your foot and ensure a more even distribution of weight on your foot.

Can plantar fasciitis go away on its own?

While plantar fasciitis can usually improve without treatment over time, patients can enhance the healing process with the physician-recommend measures.

A combination of rest, ice, and stretching exercises will likely alleviate some of the symptoms and facilitate recovery. If the heel pain continues to persist after many months of conservative treatment, your physician may begin to explore more aggressive options.

These could include corticosteroid injections, extracorporeal shock wave therapy, ultrasonic tissue repair, or surgery. 

Is it bad to walk barefoot with plantar fasciitis?

It is highly discouraged to walk around barefoot with plantar fasciitis as the shock from hard surfaces will aggravate the sensitive areas of the foot.

Instead, people with heel pain should wear comfortable shoes with good arch support and enough cushioning to prevent unnecessary flexing of the plantar fascia.

Prevention

There are many preventative measures that can be taken to decrease the risk of developing plantar fasciitis. First, it is recommended that you maintain a healthy weight as excess weight increases the pressure on your plantar fascia ligament and could exacerbate heel pain.

People should also wear shoes with adequate padding to support the foot and to help distribute weight more evenly. Simple prevention exercises, including towel stretches for your calves and arches, can also help to stretch and strengthen your foot muscles.

Lastly, it is advisable to avoid excessive high-impact activity, like prolonged standing, running, or dancing. If you begin to experience any slight discomfort near the heel, you should take every measure possible to make sure the pain does not worsen. 

References:

  1. Mayo Clinic Staff. “Plantar Fasciitis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 11 Dec. 2019, www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846
  2. “Heel Spurs: Symptoms, Risk Factors, and Treatment.” Medical News Today, MediLexicon International, 24 Dec. 2017, www.medicalnewstoday.com/articles/320411.
  3. Goff, James D., and Robert Crawford. “Diagnosis and Treatment of Plantar Fasciitis.” American Family Physician, 15 Sept. 2011, www.aafp.org/afp/2011/0915/p676.html.
  4. Schwartz, Emily N, and John N Su. “Plantar Fasciitis: A Concise Review.” PubMed Central, The Permanente Journal, 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC3951039/.

Elizabeth Miclau

Elizabeth Miclau is an undergraduate at Harvard College, planning to pursue a concentration in life sciences or sociology. As a member of both Puerto Rico’s National Diving Team and Harvard’s Women’s Varsity Swimming and Diving Team, she has a strong background in elite athletics. In the past year, she has contributed to several journal publications and peer-review-funded research projects.

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