Everything You Need To Know About Plantar Fasciitis
Learn how to reduce your pain today.
Plantar Fascia Anatomy
The Plantar Fascia is connective tissue on the plantar (bottom) surface of the foot that runs along the arch. It originates from the inner side of your heel bone (calcaneus) and inserts near your toes. This fascia’s primary purpose is to absorb shock when you walk or run and supports your foot’s arch.¹
Inflammation vs. Degeneration
“-itis” is a suffix that describes inflammation. So when we add “-itis” at the end of a structure’s name, it means that a particular structure is inflamed. For example, dermatitis means inflammation of the skin; hepatitis means inflammation of the liver, and so on.
So what does Plantar Fasciitis mean? Inflammation of Plantar Fascia. Right? — Yes, you guessed it right, but there is a twist. Plantar Fasciitis actually does not involve inflammation. The “-itis” in its name is a misnomer.
Plantar Fasciitis is the degeneration (aka: breakdown) of the plantar fascia that results in pain around the heel and arch of the foot.² It was originally thought to be due to inflammation, but a study conducted by Lemont et al. in 2003 concluded that patients suffering from Plantar Fasciitis do not have any inflammation in their plantar fascia. The findings noted degeneration and fragmentation of the plantar fascia.³ Plantar Fasciosis (-osis = abnormal) or Plantar Fasciopathy (-pathy = disease) are better descriptors but are rarely used due to how common the phrase plantar fasciitis is. For the remaining article, I will use Plantar Fasciopathy.
Statistics
If you are suffering from Plantar Fasciopathy, you are not alone. Plantar Fasciopathy is not a rare disorder, and many people are affected by this daily.
- It is the most common cause of heel pain seen in routine practice.⁴
- It affects nearly 2 million Americans each year.⁵ This disorder is mainly related to the degeneration of plantar fascia due to prolonged stress.
- It is common in runners and accounts for nearly 10% of injuries seen in runners.⁴
Signs and Symptoms
The most common symptom is PAIN. In particular, pain in the heel of the foot and occasionally along the arch. This is because the plantar fascia originates from the heel bone (calcaneus), and that is the most common site where the breakdown occurs.¹
The Plantar Fascia is relaxed when you are not on your feet (non-weight bearing) and when your foot is pointing downward (plantar flexed). When you walk or run, the plantar fascia gets stretched, and you begin to feel pain in the heel/arch.
The most common complaint is that pain is worse first thing in the morning when taking a couple of steps. The pain gets a bit better after some time, but it can flare up again if walking or running for long distances. Pain can also begin to occur when you are on your feet all day and walking barefooted tends to make the pain worse.⁶
The pain is most commonly described as a stabbing sensation when taking the first couple of steps and occasionally it will ache afterwards.
Risk Factors
- Limited Ankle Mobility: If there is any ankle mobility issue, a person is 23x more likely to get plantar fasciopathy.⁵ This can be caused due to stiffness in the joint or tight calf muscles.
- Obesity: Obesity places excessive stress on the plantar fascia when a person walks or runs. This puts plantar fascia at risk of degenerating.
- Prolonged Weight Bearing: Persons who spend most of their time on their feet are at increased risk of developing plantar fasciitis. Runners are also included in this group.
- Age: Age is also a risk factor for plantar fasciitis. Plantar Fasciopathy most commonly occurs in persons aged 45–64 years.⁵
Treatment of Plantar Fasciitis
Manual Therapy
- Massage: Massaging the calf and bottom surface of the foot has shown beneficial effects in minimizing symptoms of plantar fasciitis. All you have to do is to apply deep pressure either with your hand, foam roller, or tennis ball and move it gently. I recommend doing this for two to five minutes a couple of times a day.
- Joint Mobilization: Sometimes, the joints in the foot can get stiff. Mobilizing the joint can reduce pain for some people. A physical therapist or another rehab professional mainly performs these mobilizations.
Stretching
- Calf Muscles Stretching: There are connections between the plantar fascia and calf muscles. So, if your calf muscles are tight, this also pulls the plantar fascia tight, increasing pain. Stretching your calf muscles each day can help a lot in minimizing the symptoms. I recommend the stretch below for 60 sec 2–3x/day
- Stretching the Plantar Fascia: The plantar fascia can also be stretched. It is easier to stretch a muscle vs. the plantar fascia because the muscle will improve in length quicker. Think of stretching a cotton shirt out (muscle) vs stretching denim (plantar fascia). This is why I highly recommend the stretch above but it is also beneficial to stretch the fascia as well. The following link contains a video demonstrating a plantar fascia stretch. I recommend performing for one to two minutes at a time.
Night Splints/Orthotics/Taping
- Night Splints: Night splints keep the foot in a 90 deg position during the night and prevent the toes from pointing down while sleeping. When the foot is pointed down constantly, this can shorten the plantar fascia leading to a lot of pain in the morning. The night splints help keep a stretch on the fascia and have been shown to prevent pain. This is most beneficial for the first one to three months when the pain is high.⁸
- Orthoses: Orthoses help provide padding for the heel as well as keep the foot in an optimal position. Studies have shown that both custom orthotics and the kind that can be purchased at the store to both be beneficial, especially short-term when the heel is very painful.⁷
- Taping: Taping the foot in an optimal position is also another option. This works in the same way as orthotics. This is best if done by a rehab professional.
Strengthening and Loading the Fascia
Strengthening Exercises: When symptoms are under control, strengthening exercises of foot and ankle muscles are advised.Three areas that are most beneficial to strengthen: the calves, the foot musculature, and the hips.
- Calf Exercises: One option is to perform heel raises — raise up on the tip toes and slowly lower back down. When we stand tall on our toes, it increases the load on plantar fascia by 40%. I recommend working your way up to three sets of 15 taking three seconds to lower back down each time. Another great exercise can be found below. This one is very similar to the above heel raises, but it places more stress on the plantar fascia to stimulate growth. Check it out here: https://www.youtube.com/watch?v=AS1AT1yDLlc
- Foot Exercises: To strength the foot’s small muscles, I recommend placing some marbles on the floor and seeing if you can grab them with your toes and then transfer them into a cup. You can also do the same thing by perfoming towel scrunches with your toes.
- Hip Exercises: There are many different glute/hip exercises. I recommend lateral walks, clamshells, bridges, or glute extensions. The key is to build up endurance so try to work up to three sets of 20 reps.
Weight Loss
As being overweight is a risk factor for developing plantar fasciitis, reducing your weight can reduce symptoms. The less weight you have, the less stress that is placed over your plantar fascia.
Warm-Up Before Exercising
A proper warm-up before taking part in any sporting or athletic activity can prevent developing plantar fasciopathy and reduce pain if you have it. If possible, warm-up on a non-impact machine (stationary bike/elliptical) before performing your workout. Also, it can be beneficial to stretch out the calves before working out.
Things to Avoid
We mainly focus on the things that we need to do to but one should also be aware of the things that he/she needs to avoid.
Here are few guidelines for you related to plantar fasciitis.
• If standing for long durations, try to rotate the shoes you wear.
• Wear shoes with good support. Wearing poor quality shoes can put abnormal stress on your fascia.
• Avoid walking barefoot if there is still significant pain in the heel.
• When pain is irritable, avoid high impact activities such as running or jumping.
Realistic Expectations
Over 80% of all people experience significant improvements in their plantar fasciopathy. Due to it’s degenerative nature, recovery can take up to 10 months.
Positive outcomes are likely, but being 100% pain-free is more difficult to attain. It appears that around 50% of people will still experience pain from time-to-time but are able to perform all the activities they want and report being satisfied with their outcomes⁹.
References
- SNELL, R. S. 2011. Clinical anatomy by regions, Lippincott Williams & Wilkins.
- KISNER, C., COLBY, L. A. & BORSTAD, J. 2017. Therapeutic exercise: foundations and techniques, Fa Davis.
- LEMONT, H., AMMIRATI, K. M. & USEN, N. 2003. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. Journal of the American Podiatric Medical Association, 93, 234–237.
- BUCHBINDER, R. 2004. Plantar fasciitis. New England Journal of Medicine, 350, 2159–2166.
- RIDDLE, D. L., PULISIC, M., PIDCOE, P. & JOHNSON, R. E. 2003. Risk factors for plantar fasciitis: a matched case-control study. JBJS, 85, 872–877.
- DEMAIO, M., PAINE, R., MANGINE, R. E. & DREZ, D. 1993. Plantar fasciitis. Orthopedics, 16, 1153–1163.
- McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges
JJ. Heel pain — plantar fasciitis: clinical practice guildelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(4):A1-A18. doi:10.2519/ jospt.2008.0302. - Martin RL, Davenport TE, Reischl SF, et al. Heel pain-plantar fasciitis: revision 2014. J Orthop Sports Phys Ther. 2014;44(11):A1–33.
- Martin RL, Irrgang JJ, Conti SF. Outcome study of subjects with insertional plantar fasciitis. Foot Ankle Int. 1998;19(12):803–811
