Whether you wake up on the right or wrong side, if the first few steps out of bed cause stabbing pain, you might be experiencing plantar fasciitis. The condition is the most common cause of heel pain, and one of the most common foot orthopedic complaints.
We spoke with a foot and ankle orthopedic surgeon to get a better understanding of plantar fasciitis and how to get relief should you feel the common pain.
What is plantar fasciitis? What causes it?
The plantar fascia is a band of connective tissue that connects the heel to the ball of your foot and toes. The plantar fascia is stretchy, and bands the bones in your foot together to form the arch of your foot. It functions as a shock absorber — and as such, it can take a lot of wear and tear over time or if you're very active or on your feet a lot for work.
"Plantar fasciitis is painful inflammation at the origin of the plantar fascia — it's normally caused by micro tearing," says Dr. Stephanie S. Gardner, a foot and ankle orthopedic surgeon with Houston Methodist. "Patients describe heel pain. It's mostly worse in the morning with the first few steps or after rest, but it can also worsen at the end of a long day with increased activity."
Who experiences plantar fasciitis?
The condition can be very painful but is generally considered a temporary issue. It's common in athletes and people who are ramping up their physical activity, including those coming back to exercise after an injury or prolonged break, or people increasing mileage as they train for long-distance races. And those of us who work desk jobs aren't immune — prolonged sitting or even walking barefoot too much can lead to this heel pain.
"All types of feet can develop plantar fasciitis," Dr. Gardner says. "Most patients present with calf tightness."
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Treatments for plantar fasciitis
Dr. Gardner says that the condition does require treatment — but luckily for most of us, it is non-operative treatment.
"Most the time, conservative treatment such as stretching both your calf and the plantar fascia, massage, icing your arches by rolling your foot over a frozen water bottle, and then wearing good supportive shoes is effective," Dr. Gardner says. "But you have to do the conservative treatment; it's not normally something that'll go away on its own."
Rest and pausing any high intensity exercise is essential to healing. If you're an active person who wants to keep moving, opt for low impact exercise such as cycling or swimming to avoid the dynamic movement that can overwork the plantar fascia.
For those used to taping their own injuries, Dr. Gardner says that isn't sufficient for plantar fasciitis. However, a doctor may suggest a night splint to jumpstart pain relief first thing in the morning.
"I recommend the brace, which is a nighttime sock or splint that you can wear that keeps your foot stretched during the night," Dr. Gardner says. "And supportive shoes such as tennis shoes are very important. You want to avoid wearing really thin shoes that don't have much support, such as flip-flops. Being barefoot for prolonged periods can also exacerbate pain."
Physical therapy may also be recommended if the pain lingers. And there are nonsurgical treatments, such as ultrasonic tissue repair, cortisone or platelet-rich plasma injections, or extracorporeal shockwave therapy. But Dr. Gardner says that for 90% of us, the conservative approach will alleviate pain.
"Most of the time this is a non-surgical issue," Dr. Gardner says. "There is a surgery where you can go in and cut part of the fascia to relieve some of that tension."
Such surgery, called a partial plantar fascia release, is only recommended if symptoms persist after 12 months of continued treatment.
Can you prevent plantar fasciitis?
The reality is that any of us could develop plantar fasciitis, and our risk increases after we hit age 40. Plus, if you've experienced the distinctive heel pain in the past, you're more likely to experience the condition again.
Dr. Gardner emphasizes stretching as the No. 1 habit to add to your daily routine for prevention.
"Stretch out the calf, stretch out the plantar fascia — that's probably the best way to prevent it from developing," Dr. Gardner says. "It's especially important for people with calf tightness to stretch."
Wearing supportive shoes, especially those designed to support flat feet or high arches, is another way to help pain from developing, if you experience either of those issues. Shoe inserts can also help to make more fashionable shoes friendlier to your fascia.
Also, plan rest, warmups and cooldowns into your movement routine to help prevent aches and pains from developing and lingering. If you're taking on a new exercise practice or sport (hello pickleball!), start slow and gradually build up to a more strenuous routine.
And if you're using the same pair of rundown running shoes or trainers, consider getting a new pair. The interior structure of shoes breaks down long before the soles or exterior wears out, which can put you more at risk for issues with your feet and ankles.
