Plantar fasciitis is the most common source of chronic heel pain in adults. This pain, which is usually worse in the morning, is caused by repetitive stress on the plantar fascia. The plantar fascia is a thick band of connective tissue that links the heel bone to the toes and provides support for the arch of your foot.
It used to be thought that plantar fasciitis was caused by injuries to the foot, but it’s actually a chronic and degenerative inflammatory condition. Medications like non-steroidal inflammatory drugs (NSAIDs) and orthotics like shoe inserts and heel cups are common ways to treat plantar fasciitis pain, but physical therapy and stretching exercises are a key part of recovery.
Physical therapy for plantar fasciitis combines the use of stretches and similar exercises with periods of immobility. Wearing a night splint is often used to maintain a neutral position of the foot. This can help avoid the formation of a contracture from the weakened connective tissue. It can also reduce heel pain in many people.
Beyond splinting at night and using medications to control pain and inflammation, there are a number of exercises and stretches that can help you manage plantar fasciitis. You may also try things like active release treatment or rolling. Learn more about your options for activities and exercises that can help plantar fasciitis below.
Active release treatment (ART) is a therapy that uses a type of massage to break up collections of scar tissue and improve blood flow to injured areas. A 2019 study comparing ART to myofascial release found that both treatments could reduce pain and improve function, but that ART was significantly more effective when it came to pain reduction. Check out our easy guide for this massage style here.
Active isolated stretching is a form of stretching where you are using only your muscles to perform a gentle stretch instead of propping yourself on a wall or other object. These stretches are done with less force than traditional stretching, and may help improve general recovery.
An example of this type of stretching for plantar fasciitis could be as simple as bending your foot back until you feel the muscles in your foot stretch, and then holding that position for several seconds. Yoga is a common method for practicing active stretching.
Rolling is another common therapy used in plantar fasciitis. There are many devices that can be used for rolling, but foam cylinders will get the job done. By rolling items like a foam roller on the underside of the foot, your mind is tricked into becoming desensitized to the pain from the tightened connective tissues in the fascia. It can also help to improve elasticity and make these tissues more flexible, therefore relieving pain associated with plantar fasciitis.
If there are certain activities that you notice make your feet hurt more, you should avoid them until your plantar fasciitis pain improves. Usually, this includes avoiding high-impact or jumping exercises like running or plyometrics.
Outside of exercises to do — or avoid — you should also consider wearing shoes at all times. Even at home, wearing a slipper or light support shoe can help. You should also avoid wearing old shoes, and if you are buying a new pair it’s best to look for something with good arch support. You can also purchase inserts made specifically to address plantar fasciitis pain.
Plantar fasciitis is a common cause of foot pain in adults. Many people experience this problem from prolonged stress on the connective tissues that link the toes to the heel. There is no quick fix for plantar fasciitis pain — physical therapy, stretching, and other exercises are the best way to treat pain and tightness. Just keep in mind that these things won’t help you overnight. It can take months for plantar fasciitis pain to resolve and, in some people, it may never go away completely.
If you have plantar fasciitis and your pain isn’t going away or is getting worse over time, talk to your doctor about additional options for treatment. Surgery is usually reserved as the last possible option for treating plantar fasciitis.
What is Plantar Fasciitis?
The term plantar fasciitis means inflammation of your plantar fascia. The plantar fascia runs along the bottom of your foot from your heel bone to the ball of the foot and through to your toes. It’s a very strong ligament, so problems usually occur beneath the heel at the attachment to the heel bone.
What Causes Heel Pain in The Morning?
People with plantar fasciitis often complain of heel pain, and it’s usually reported as being worse in the morning or after sitting or simply resting for a while. The reason for the severe pain when arising from rest is thought to be the result of micro-tearing of scar tissue when you first place load on the plantar fascia.
The plantar fascial ligament will undergo a process called fibrosis (or scar tissue formation) when at rest. When a person with a healing plantar fascia arises from rest, the scar tissue is then torn which causes pain with the first few steps. The tearing often occurs at the origin of the plantar fascia just beneath the heel bone. Eventually, the pain eases after 8 to 10 steps because the tearing reduces. If a person continues to stand and walk for long periods throughout the day, the pain will usually return. In summary, the heel pain in the morning is caused by microscopic tearing of the scar tissue which forms to heal the plantar fascia.
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You can easily feel your own plantar fascia. Just run your finger along the arch of your foot. You’ll feel that rope-like connective tissue that pops out when you pull your toes back. That’s your plantar fascia… and it’s really important.
When you’re walking, your plantar fascia stabilises your arch to enable you to push off properly. It’s the longest ligament in the body – and the strongest as well, able to withstand up to 30 times your body weight.
Technically, the chronic heel pain problem is actually more often to do with degeneration of the plantar fascia. That’s why podiatrists can refer to it as plantar fasciosis. However, we’ll use the more popular term, plantar fasciitis here.
People with plantar fasciitis usually complain of heel pain in the morning or after rest. Click To Tweet
Plantar Fasciitis is a common diagnosis for anything heel pain-related, but can be mis-diagnosed in up to 80% of cases. It’s important to get the right diagnosis to ensure you receive the most effective heel pain treatment.
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What are the symptoms?
You can feel a sharp pain when you are on your feet, and a dull ache when you’re resting, but usually it is worse in the morning when you are hobbling, or after you’ve been sitting down for a while.
It will usually hurt most intensely directly underneath the heel bone right in the centre of the pad of your heel. However, this is not always the case. Sometimes the pain will run along the length of the plantar fascial ligament or it may feel like foot pain to the side of the heel or the foot.
What causes plantar fasciitis?
Sudden overuse injuries, new shoes, doing more activity than normal, or perhaps just standing for longer periods than normal can all cause micro-tearing of the plantar fascia. The extra load pulls the plantar fascia from the heel bone and starts the process of inflammation and scar tissue formation.
Usually this damage will heal if you are off your feet for a while, for example, while sleeping overnight. The body heals the painful area with fibrosis or scar tissue formation. However if your foot isn’t getting a chance to rest properly, the new tissue can be damaged again as soon as you stand on the feet after rest.
This starts the injury cycle of pain and micro-tearing all over again. That’s why plantar fasciitis often hurts most after you’ve been resting for a while.
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Over time the plantar fascial ligament tissue starts to thicken and if inflammation continues, standing can become very painful. The body is clever, though, and if you let it go too long it will grow extra bone. This is the beginning of a heel spur.
If you let plantar fasciitis go, you can develop a heel spur. Surprisingly, the spur is rarely the cause of pain. The inflammation near the heel spur is often the problem Click To Tweet
Are some people more likely to get Plantar Fasciitis?
People who have recently changed jobs or started on a health kick can be more likely to get plantar fasciitis, and it’s not limited by age. More often, though, it’s middle-aged women and men that get it.
Some people who have injured themselves in the past can be more prone to plantar fasciitis as the body tries to compensate for the injury.
Generally, if the plantar fascial ligament is continually overused or overloaded through activity or structural problems in the feet and legs, then injury is more likely.
It’s actually quite amazing how our feet endure what we put them through. In a lifetime we will walk the equivalent distance to walking around the earth 3 times. There will be natural degeneration and weakening depending on your activity levels and injury history that might also contribute to getting plantar fasciitis.
In a lifetime we will walk the equivalient distance to walking around the earth 3 times Click To Tweet
If you have plantar fasciitis, are there exercises you should avoid?
If you have plantar fasciitis, make sure you are giving it a chance to heal. Long runs on hard ground, beach sprints that require bursts of power, jumping and lunging can all make it worse. You want to give it a chance to heal without damaging things further.
You need to find a balance between giving it enough rest to heal, and enough work to stay strong. That’s the tricky part, but if you get it right you can recover well enough to return to normal mobility.
What are the best exercises for plantar fasciitis?
Every person needs to be assessed as an individual but, in many cases of plantar fasciitis, the simplest and easiest stretching exercise we advise is a gentle, prolonged stretch of the calf muscle complex and plantar fascia. This is usually performed best in a prone position (i.e. laying on the tummy) with the toes and ankles extended as displayed in the image below. Be careful though… it’s crucial this stretch is performed correctly as prescribed and it can cause some discomfort if you have a condition called ‘Hallux Limitus’ or ‘Hallux Rigidus’ so it’s important to consult your Podiatrist before performing this exercise.
The above exercise is just the starting point for exercise prescription and management. Further strengthening and stretching exercises are then prescribed over a 12 week period. These strengthening and stretching exercises are personalised to each individual’s needs and will change according to the severity of plantar fasciitis and the stage of heel pain treatment.
What are the best shoes for plantar fasciitis?
You’ll feel better and more comfortable with cushioning or padding under your heels. Firm, hard soled shoes will be much less comfortable than cushioned walking shoes or sneakers. But again you need to have a balance between something soft, and having enough support. So, wear comfortable, supportive shoes, and make sure you stretch every day.
It can also help to massage the area by rolling your foot over a tennis ball or golf ball. If pain persists, see an experienced podiatrist.
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What is the best treatment for plantar fasciitis?
Podiatrists are the health professionals dedicated to problems involving the feet, and have expert knowledge and training for helping people with plantar fasciitis. Plantar fasciitis treatment and management is something the podiatrists at Posture Podiatry have a special interest in. Successful treatment usually includes a combination of the following. Your podiatrist can:
- Order an X-ray and/or ultrasound scan to find out exactly what’s wrong
- Help you find the right shoes to wear
- Advise on appropriate plantar fasciitis socks
- Help you with specific plantar fasciitis exercises for your feet
- Help your muscles and joints work together with foot mobilisation to encourage healing
- Make specific orthotics for your shoes to offload the painful area and promote healing of the injured plantar fascia
- Assist with taping and plantar fasciitis strapping techniques to support the injured area
- Advise on appropriate night bracing if needed
- Help with shock wave therapy (ESWT) in chronic heel pain cases
- Advise on activity or training modification
- Work with you to make sure the problem doesn’t return
Everything is focused on treating the cause of the problem, and reducing the load on the plantar fascia. That’s how you can speed up healing and prevent the problem returning.
Once your pain has resolved, progressive loading can commence with a major focus on specific strengthening exercises, support and prevention of injury recurrence.
Looking for an Adelaide Podiatrist for plantar fasciitis heel pain treatment?BOOK ONLINE for an Initial Low or No Gap* Assessment
by experienced Adelaide Podiatrists or
Call 8362 5900 to schedule a Gap Free* examination to see if we can help.
What other heel pain treatments are available?
Podiatrists can also help you by checking your posture or walking style. They will also ask lots of questions about your injuries, and also check every muscle and joint in the area. This gives clues about other treatments that can help.
Massage, stretching, strapping, mobilisation, footwear advice and orthotic support are often sufficient but occasionally we may need to look at other treatment options. These may include:
- Extracorporeal Shock Wave Therapy (ESWT)
- Ultrasound-guided Cortisone injection
- Platelet-rich plasma injections (PRP)
- Surgery is always a last resort
Some football playershave gone to drastic measures, with stories of jumping off tables to tear the fascia completely so they can return to sport again and play with less pain.
It’s important to find the true cause of your plantar fasciitis, otherwise the problem will return later.
How long does it hurt for?
If treated correctly and promptly, plantar fasciitis can resolve very quickly within weeks. If left untreated for many months or years, plantar fasciitis will usually progress and become more resistant to treatment. This means it will take longer to respond to treatment and usually require more intensive treatment.
Over the last 30 years of clinical practice, we’ve seen very acute cases of plantar fasciitis heal within a few weeks with just some simple strapping, loading adjustment and exercises. We’ve also seen very severe cases with significant bone spurring all along the sole of the foot which had formed over a six year period. This type of problem required over 12 months of intensive treatment to stabilise. There is no guarantee that the right amount of spurring and thickening will lead to a pain free foot. This is why we suggest an early diagnosis and treatment to achieve the best possible pain relief and outcome and to reduce the likelihood of needing pain medication or surgery.
You can reduce pain in much less time if you receive the right treatment promptly.
Conclusion
People with plantar fasciitis experience heel pain in the morning or after rest. It’s common, and the podiatrists at Posture Podiatry are experts dedicated to helping people with plantar fasciitis.
There are many things you can do to help, so have it checked properly and promptly by an experienced podiatrist who can help you choose the right treatment plan for your specific needs.