Take care of your body’s shock absorber
For runners, walkers and others on their feet a lot, plantar fasciitis is a pain in the heel.
It’s an injury to plantar fascia, the fibrous band of tissue that extends from the bottom of your foot and heel to the base of your toes, and is usually caused by overuse, said Natalie Nielsen, MD, an orthopedic surgeon who specializes in foot and ankle surgery at Cape Cod Healthcare’s Falmouth Orthopedic Center. The plantar fascia acts like a shock absorber for the body, she said.
“It absorbs any of the high stresses and strain through your foot when you're walking, running or exercising,” she said. “Most of the time when people have a plantar fascia injury, it's a chronic overuse injury.”
Plantar fasciitis is common, accounting for up to 15 percent of foot injuries that are treated by doctors. It occurs mostly in active adults between 25 and 65, but is more likely to occur in women, according to the National Institutes of Health. It’s usually treated with nonsurgical methods, but it can take a while to heal and be frustrating for anyone who’s used to being active.
“You don't want to have to take time off work or exercise, right?” Dr. Nielsen said.
Q & A with Dr. Nielsen
Dr. Nielsen recently discussed plantar fasciitis, how it’s treated and how to prevent it. Here are her responses, which have been edited for length.
Are there causes of plantar fasciitis besides overuse?
Every once in a while, someone can acutely rupture the plantar fascia. More commonly, it's a chronic condition from exercise or somebody who, say, stands for work all day long on a hard floor. The plantar fascia tissue becomes inflamed at it’s origin, right at the base of the heel. This is the most common place that people have pain, but sometimes it can travel down the sole of the foot. Other causes of plantar fasciitis are anatomic, having a flatfoot or high arch. Calf tightness and being overweight can also contribute to plantar fasciitis.
How do I know when I have plantar fasciitis?
Most likely it's pain in your heel, and the most common symptoms are that people feel it first thing when they wake up in the morning. So, they get out of bed and it's difficult to walk. Or if you've been sitting for a long period of time and get up and start walking, you can have pain then. People may also have pain during or after exercise. It can progress to the point where it hurts all the time.
Are there things I can do at home to get relief?
Use either a heel pad – sometimes people like the gel ones – or there are orthotics that are made for plantar fasciitis that you can try. [Another treatment] is calf stretching. If you have tighter calves, you'll be more prone to getting plantar fasciitis. Plantar fascia stretches can be easily found on the internet. Icing can help.
A lot of people like the trick where you freeze a water bottle and then you roll it under your foot, so it's stretching and icing at the same time. Some people find a night splint helpful, which can also be ordered online. A night splint is a brace that you can wear at night that keeps your foot in a dorsiflexed position and stretches your calf while you sleep. If you can take non-steroidal anti-inflammatories, ibuprofen or Aleve can certainly help. There are other over-the-counter treatments such as Biofreeze that may help relieve symptoms as well.
What about footwear?
Good shoe wear is important – having shoes that fit well. A lot of people like Hoka sneakers and find those helpful when they're having plantar fasciitis because they have a lot of extra cushion. For sandals, Oofos is also popular.
When should I seek professional treatment for plantar fasciitis?
If it's been a month or two and you're not making progress, or it's getting worse, that's when it's time to go get it checked out. Or, if the pain started after an injury – if you had a fall or something happened, and you had the heel pain, you just want to make sure that it's not something else. It could be a problem with the Achilles, or sometimes you can get a stress fracture through your calcaneus (the heel bone).
What does a doctor do to diagnose plantar fasciitis?
At your office visit, an X-ray will be performed to look at the heel bone and any areas of calcification. Your foot will be examined to determine if the clinical exam is consistent with plantar fasciitis. If the X-ray looks good, but a clinical exam indicates it might be a stress fracture, it may require getting an MRI.
How does a doctor treat plantar fasciitis?
Physical therapy can often be quite helpful for people who struggle with plantar fasciitis. The physical therapist can help with calf stretching, massage and other treatments to help with the pain. If the pain continues, a short walking boot can be used for a few weeks to offload the heel and allow the inflammation to calm down. An occasional steroid injection can be helpful. However, I don't recommend doing multiple injections because the steroid can cause fat pad atrophy in the heel.
What about surgery for plantar fasciitis?
Greater than 98 percent of people with plantar fasciitis will get better without surgery through conservative treatment. It may take a few months, however the pain will usually go away. Surgery should be reserved for the rare occasion when a patient has tried everything, the pain persists and other causes of heel pain will be excluded.
Anything else that would be helpful?
If you're a runner or you’re walking long distances for exercise, sometimes it just requires taking time off of the high impact activities and focusing on the conservative treatments. Lower impact exercise such as biking or swimming could still be done while you recover from plantar fasciitis.
