Plantar Fasciitis is a painful foot condition that affects 1 in 10 adults.
People with this condition experience sharp intermittent pain in the heel of their foot. About a third of sufferers will endure symptoms in both feet, which can make walking quite a challenge. Thankfully, the condition can usually be treated effectively.
Scientists have determined some critical risk-factors for its development. Understanding these can help prevent a painful flare-up of this condition.
Table of Contents:
What Does a Plantar Fasciitis Flare-Up Feel Like?
A bad flare-up of Plantar Fasciitis can feel like walking on needles. Stabbing pains are felt in the heel and are often accompanied by a hot, tingling sensation. In some cases, pain can radiate across the full base of the foot.
The pain is sharp and debilitating but usually doesn’t last too long. The first few steps in the morning are the most painful as the body adjusts to walking after a period of rest.
After a few minutes of continuous walking, pain usually subsides. However, it’s likely to return with a vengeance throughout the day, particularly when standing still for prolonged periods.
- Plantar fasciitis gets its name from the thick band of tissue that runs lengthways across the base of the of foot – the Plantar Fascia. This band connects the toes to the heel, enabling flexibility and movement. If it strikes, it’s because this band has become damaged or inflamed. In addition to causing pain, inflammation can cause the heel to become tender and swollen.
Although considered an ‘annoying niggle’ to some, Plantar Fasciitis can be very painful and disruptive for others. The good news is that many of the causes are preventable or controllable.
What Factors Can Cause Plantar Fasciitis?
- Exercise – Committing to an exciting training plan, or challenging marathon race may cause trouble for the heels.
- Foot Mechanics – Certain foot conditions and modes of walking are known to impact this heel condition.
- Footwear – Interestingly, footwear can be considered both a cause and treatment for Plantar Fasciitis.
- Weight Gain – Obesity can cause a variety of aches and pains in the feet.
- Employment – Certain modes of working can pre-empt a flare-up of Plantar Fasciitis
- Daily Activities – Activities involving repetitive and strained foot mechanics – such as driving – are a significant risk factor.
Plantar Facilities occurs most commonly in middle age – mainly between the ages of 40 and 60 years old. This is probably because younger people are more resilient to the negative physical impact of excessive exercise, weight gain, poorly fitting footwear and so on.
The most common causes of Plantar Fasciitis (and their treatments!) will be explained below:
1) Running
First on the list is running because running is known to be a key risk factor for Plantar Fasciitis. In fact, many refer to it as “runner’s heel.” So, why does running have such an impact on the heel?
It’s thought that micro-tears (small injuries) to the base of the foot might cause Plantar Fasciitis. As runners spend a lot of time pounding the pavements, they are more likely to cause these microtears to the Plantar Fascia. Trail runners are most likely to develop the condition because their feet are subjected to a higher ‘hit’ of force from uneven terrains.
Also, some studies have suggested that tight calf muscles might be the cause of Plantar Fasciitis. This is because a tight calf muscle places tension on the Achilles tendon – the tendon connecting the calf muscle to the heel. Because the Achilles tendon is also in contact with the Plantar Fascia, a tight calf muscle can indirectly cause tension at the base of the foot.
Can It Be Prevented?
Unfortunately, many runners aren’t aware of Plantar Fasciitis – until it strikes! As such they don’t necessarily think about preventing it.
First-time runners, or runners looking to improve their fitness, should increase their mileage gradually to protect against Plantar Fasciitis. Doing so will allow the body the chance to repair any ‘microtears’ in the base of the foot.
Sports trainers encourage runners to stretch their legs and ankles regularly. Stretches focused on relaxing the calf muscle may be particularly helpful for reducing the tension placed on the heels during running.
Can It Be Treated?
Applying ice to the feet immediately after a run will provide cooling and immediate relief. Also, ibuprofen can help manage heel pain.
Although it’s not what most runners want to hear, rest is probably going to be necessary! Indeed, many physicians agree that, if Plantar Fasciitis is caught early, and adequate rest is taken, it’s likely to heal very quickly.
In cases where runners are unwilling to take time off, ‘strapping’ the feet can provide extra support and prevent further damage or inflammation to the foot. Furthermore, sports massage focused on the legs and feet will increase blood flow to the area – which may speed up recovery time.
Whether massage speeds up recovery or not, it’s a great therapeutic treatment for the body, and can provide an excellent distraction for the mind for those runners itching to get back on the running machine.
2) Overpronation
The issue of Pronation follows closely in second place because it is mostly a runner’s concern.
Pronation refers to the movement of the foot when it hits the ground. Overpronation occurs when too much force is placed on the foot. This forces the ankle inwards so that the foot presses flat to the ground on impact. This phenomenon is sometimes referred to as flat foot syndrome.
Overpronation can cause a range of foot conditions –including Plantar Fasciitis. By forcing the foot to become flattened, overpronators stretch and tear the Plantar Fascia (the band connecting the heel to the toes). Overpronation disrupts the connection between the toes and the heel so places a lot of strain on the heel.
Runners with normal pronation are less likely to develop Plantar Fasciitis because they tend to have a more prominent foot arch. This means that their foot will not be as flat as overpronators, so the Plantar Fascia is less likely to become overstretched.
Can It Be Prevented?
It’s possible to mitigate the effects of overpronation by buying a pair of trainers suited to this style of running. These types of trainers will have adequate shock absorber built into the sole and will feature plenty of arch support. Alternatively, it’s possible to possible to purchase ready-made or custom-made orthotics (arch-support insoles or shoe inserts) to prevent overpronation.
The new ‘bare-foot’ trend for running has favored minimalist trainers over more traditional, shock-absorbing models. There is still limited evidence on the efficacy of minimalist running shoes, though it’s very likely they wouldn’t be suitable for overpronators.
Can It Be Treated?
Plantar Fasciitis caused by overpronation can be treated with the therapies already mentioned, such as applying ice, massage, and adequate rest – particularly when increasing mileage.
Stretches of the ankle can also be employed to improve flexion in this area, which may help to reduce some overpronation. Furthermore, it’s possible to work with a gait-analysis sports trainer to develop a healthier running style.
3) Footwear
Flat-soled shoes with no arch support are usually a bad choice for everyday wear because they will put a strain on the Plantar Fascia ligament. As mentioned, it’s crucial for overpronators to avoid flat-soled shoes.
Consistency seems a critical issue when it comes to footwear. For example, women who suddenly switch from wearing high heels to flat-soled shoes are at risk of developing Plantar Fasciitis. The reverse is also true. This is probably because the sole of the foot suddenly becomes challenged with a different type of movement and tension.
Can It Be Prevented?
In addition to choosing shoes with arch support, it’s recommended to opt for lace-up styles where possible as these offer a greater level of support.
Also, shoes with inbuilt shock absorbers and cushioned soles may protect against heel pain. Also, if women wish to wear both heels and flat-shoes, they would be advised to wear both styles regularly and take care when transitioning from one form of footwear to another.
Can It Be Treated?
If Plantar Fasciitis has already developed, it’s important to discard any ill-fitting footwear that may have caused the flare-up. Rest, massage and visiting a specialist footwear provider are likely to be the best treatments in this instance.
4) Body Weight
- A recent study published by the Journal of Bone and Joint Surgery reported that individuals with a Body Mass Index (BMI) of 30 or higher, are almost six times more likely to suffer from Plantar Fasciitis than those with a healthy BMI.
Being overweight can put a strain on many muscles, bones, and joints in the body. In the same way that running causes microtears to the foot through impact trauma with the ground, surplus body weight is thought to cause microtears by placing tension on the base of the foot. Indeed, obesity may encourage the ligament covering the base of the foot to become hot, tender and inflamed.
It’s possible that obesity causes Plantar Fasciitis because being overweight often makes people less active. Lack of regular exercise is likely to result in the tightening of the calf muscle and a reduction in ankle flexibility.
Because ankle mobility (dorsiflexion) and calf muscle functioning are known to impact the health of the Plantar Fascia, it’s highly possible that obesity causes Plantar Fasciitis through the pathway of inactivity.
Unfortunately, pregnant women in their third trimester often suffer within this painful condition. This is because their weight gain has occurred quite rapidly, so the body has not had adequate time to adjust.
Scientists believe there may be other factors involved too – such as hormonal changes, though there is currently insufficient evidence to confirm this.
Can It Be Prevented?
Weight gain in pregnancy is inevitable. However, it may be possible to prevent Plantar Fasciitis from developing by stretching the legs and ankles regularly. This will aid mobility and increase blood flow to the Plantar Fascia.
Can It Be Treated?
The best treatment for weight-related Plantar Fasciitis is likely to be weight management. Ironically, this can be made difficult by the heel pain associated with this condition. As such, low-impact exercises such as swimming may be an ideal starting point.
5) Work-Related Hazards
There are many work-related hazards, particularly with regards to physical health. Plantar Fasciitis is a potential health hazard in jobs that require a lot of standing. For example, security guards, porters and waiting staff often complain of heel pain after a long shift.
Of all the standing jobs, the worst ones are thought to be the jobs that require employees to stand still. For example, stationary security guards in museums are most at risk of developing Plantar Fasciitis.
When standing still, many people place a lot of weight on to their heels and develop an almost ‘flat-footed’ stance. This stance places a lot of pressure on the base of the foot and tends to tighten the calf muscle. Tight calves will furthermore aggravate the base of the foot – so there’s no escaping heel damage.
Can It Be Prevented?
As previously suggested, purchasing shoes with arch support will give feet the best possible chance of protecting themselves against Plantar Fasciitis. Also, insoles and orthotics are likely to help.
If work rules permit it, it would be advisable to talk a short walk or stretch at least once every 10 minutes to prevent muscles and joints from tightening. Moreover, an occupational therapist may be able to offer some specialist, work-specific advice, specifically with regards to posture.
Can It Be Treated?
Once work-related Plantar Fasciitis has occurred, it can be challenging to treat effectively because continuing work commitments will usually prevent adequate rest.
Catching the pain early is likely to be crucial in treating the pain effectively. In cases where rest is not possible, a steroid shot administered by a physician can help dull the pain and may promote recovery.
6) Toe Alignment
In more recent years, Plantar Fasciitis research has focused on the role of foot mechanics. In addition to ‘flat-arch’ syndrome, poor toe alignment has been shown to cause Plantar Fasciitis.
People can be born with poor toe alignment, or it can be caused by poorly-fitting shoes. Underneath the big toe, there is a muscle called the Abductor Hallucis.
When toes become misaligned, this muscle becomes squashed. In turn, this applies pressure to the Plantar Fascia ligament. The pressure then weakens this ligament, which causes the heel pain associated with this condition.
Can It Be Prevented?
Toe misalignment can be prevented by wearing well-fitting shoes with adequate space in the toe area. This is particularly important when purchasing shoes for children – as they’ll need plenty of room in their shoes for their toes to spread out.
Can It Be Treated?
Massaging the toes – particularly the big toe may help loosen the Abductor Hallucis muscle. This may relieve some of the tension to the Plantar Fascia and encourage it to heal. Also, socks can be bought to help realign the toes. It should be noted that no studies have tested the efficacy of these socks.
7) Driving a Vehicle
“Driver’s foot” or “Driver’s heel” is used to refer to many driving-related aches and pains.
When a driver places his foot on the pedal, the Fascia is forced to become taught. Long distance drivers may remain in this position for very long periods of time. Also, when the foot is placed down on the pedal at speed, this can ‘lock’ the bottom of the leg, causing the calf muscle to tighten.
Can It Be Prevented?
The development of this condition may be halted by wearing comfortable flat shoes. Also, taking regular driving breaks to stretch the ankle and leg muscles may prevent the calf muscle and foot arch from becoming ‘locked.’
Can It Be Treated?
If Plantar Fasciitis has already developed, it may be advisable to take a little time away from driving and apply the treatment methods previously mentioned – until the condition improves. If this is not possible, heel pads can be worn to manage the pain while driving.
8) Arthritis
Rheumatoid Arthritis is an autoimmune condition that affects the joints.
The body’s immune system mistakenly attacks the joints, which causes tissue to thicken and joints to become red and swollen. Although rheumatoid arthritis commonly affects joints in the hands and wrists, it can also affect the joints and ligaments in the base of the foot.
Because of these attacks on the joints, ligaments can become stiffened, making them more susceptible to damage. Also, oxygen may not be able to efficiently circulate in the muscle tissue which would prevent a speedy recovery form heel pain.
Finally, this condition reduces mobility, which is another risk factor for developing Plantar Fasciitis.
Can It Be Prevented?
Light conditioning exercises, if appropriate, may help prevent the development of Plantar Fasciitis in Rheumatoid Arthritis sufferers.
Can It Be Treated?
Prescription drugs for the treatment of Rheumatoid Arthritis work by slowing down the effect this condition has on the joints. As such, these drugs will provide some protection against the development of Plantar Fasciitis.
9) Exercise
Because Plantar Fasciitis is commonly referred to as “runner’s heel,” many people believe it’s only running that can cause Plantar Fasciitis. As such, many sufferers don’t consider that their physical activity could be a cause of their condition. In fact, under specific conditions – almost any form of exercise can cause heel pain.
For exercise to cause Plantar Fasciitis, it usually must be novel or excessive (or both). While a marathon typically springs to mind when thinking of excessive exercise, other sports meet this criterion if they are practiced excessively enough.
Secondly, novel or new exercise routines are not just ambitious training regimes or extreme sports activities. A novel activity could be something as simple as a yoga class. If practiced incorrectly or conducted at a pace too fast for the learner’s capabilities – even a yoga class could cause Plantar Fasciitis.
Finally, the mechanism of some sports can cause foot damage to occur. In the same way that driving causes Plantar Fasciitis cycling or horse-riding may do too – because of the reliance on pedals.
Can It Be Prevented?
Starting a new regime gradually is the best protector against exercise-induced Plantar Fasciitis. Moreover, wearing the correct and appropriate footwear is crucial.
Can It Be Treated?
Rest, rest and rest is usually advised as a first-line of treatment. However, switching to activities that rely less heavily on the feet might be an alternative option.
‘Mechanical’ treatments such as taping the foot and wearing appropriate footwear inserts are likely to be the most effective treatments for this condition. Indeed, the Medical Podiatric Association found the use of orthotics and taping to be the most effective treatment for sportsmen and women recovering from Plantar Fasciitis.
While Plantar Fasciitis can be treated with conservative methods, there are times when these methods are not enough. A small proportion of suffers have what’s called recalcitrant Plantar Fasciitis.
This is not just a flare-up of the condition, but a painful, long-lasting heel condition that has stuck around for at least six months. In these cases, more invasive treatments such as surgery or night splints are required.
The American Orthopaedic Foot and Ankle Society found that wearing night splints for three months significantly improved recovery from recalcitrant Plantar Fasciitis. While this treatment was effective, it was hard for people to tolerate uncomfortable splints.
Given that Plantar Fasciitis is a progressive condition that tends to get worse without treatment, it’s important to intervene as soon as possible to prevent recalcitrant Plantar Fasciitis from taking hold.
Modifying various lifestyle factors can go a long way towards encouraging positive heel health. Utilize these Plantar Fasciitis pain relief methods to reduce your level of discomfort!
