Risk Factors, Treatment & Prevention Strategies for Plantar Fasciitis
Plantar fasciitis is one of the most common causes of heel pain. It’s not unusual for people to manage their plantar fasciitis effectively, only to have their symptoms come back when they stop treatment. For this reason, it’s important to develop strategies to help prevent recurrence. This article will present the risk factors, diagnosis, treatment & a proven prevention program.
I’m not a trained medical professional, so please use the contents of this post as guidance. As a certified coach, I have used a network of medical professionals as resources for my injuries to whom I refer my local clients. If you’re experiencing any kind of pain that forces you to change your gait, then you should stop running and seek professional medical attention to properly diagnose, treat and prevent recurrence of your injury.
Similar to many other running injuries, Plantar Fasciitis is often an overuse injury. It’s described as a stabbing pain that usually occurs with someone’s first steps in the morning. As the athlete gets up and continues to move around, the pain normally decreases. However, it might return after long periods of standing or after rising from sitting.
The pain comes from inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).
There are a number of factors believed to increase a person’s risk for developing plantar fasciitis. Plantar fasciitis is most common in, but not limited to runners. It’s often reported in athletes between the ages of 40 and 60, although anyone can get it. People who are overweight and those who wear shoes with inadequate support have an increased risk of plantar fasciitis. People who are overweight and run, can put extra stress on their plantar fascia.
The most common causes of plantar fasciitis are either structural (in the foot) or muscle/tendon weakness. For example, people who have problems with their arches, either overly flat feet or high-arched feet, could be more prone to developing plantar fasciitis.
The injury can be brought on by certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, among other activities, can contribute to an earlier onset of plantar fasciitis. Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces may damage their plantar fascia.
Plantar fasciitis is typically aggravated by tight muscles in your feet and calves.
Wearing non-supportive footwear on hard, flat surfaces can put abnormal strain on the plantar fascia and can also lead to plantar fasciitis.
All of these risk factors can cause plantar fasciitis. Understanding which, if any risk factors you exhibit can help you prevent or minimize the effects of this injury.
You should AVOID self diagnosis of injuries. Plantar Fasciitis is not limited to the following symptoms. Instead, these are the most common symptoms reported by runners.
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The pain described by people suffering from plantar fasciitis is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or rising from sitting. The pain is usually worse after exercise, not during it.
Under normal circumstances, the plantar fascia acts like a shock-absorbing bowstring. It’s purpose is to support the arch in one’s foot. If tension and stress on that bowstring become too great, small tears can arise in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.
Ignoring plantar fasciitis may result in chronic heel pain that hinders an athlete’s regular activities. If a runner changes the way they walk or run (their gait) to minimize plantar fasciitis pain, this might lead to foot, knee, hip or back problems. Bottomline, if you suspect you may have plantar fasciitis, seek positive diagnosis from a qualified medical professional.
Because heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation or in some rare cases, a cyst. It is important to have it properly diagnosed by a medical professional. A foot and ankle specialist is able to distinguish between all the possibilities and to determine the underlying source of your heel pain. Proper diagnosis will lead to correct treatment and hopefully speed recovery.
Accurate diagnosis begins with the athlete describing symptoms and discussing specifics of their injury. The doctor will examine the foot to pinpoint the source of the pain. The exam, along with the patient’s medical history, will help properly diagnose the condition. During the examination the doctor will look for areas of tenderness in the foot. While holding the affected foot, the doctor may bend the patient’s toes toward their shin and then press along the plantar fascia from the heel to forefoot.
A doctor may also order imaging tests so he or she can rule out any other causes of the pain, such as fractures or heel spurs.
Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. In my research, an MRI scan only seemed to be used if the heel pain was not relieved by initial treatment methods.
After diagnosis, the first priority with plantar fasciitis as with other injuries is to treat the pain. There are a few options your doctor could try to ease the pain and reduce inflammation. In my experience & research, it’s often recommended to try a few therapies at the same time to resolve the issue as quickly as possible.
Nonsteroidal anti-inflammatory drugs (NSAIDs) will help reduce pain and inflammation of the plantar fascia. A doctor may prescribe multiple doses a day for several weeks.
Depending on the severity of the pain, decreasing or even stopping the activities that make the pain worse are typical first steps. It’s common for a doctor to direct an athlete to temporarily stop activities like running.
Other typical treatment options include rolling affected foot over a cold water bottle or ice for 20 minutes. This can be done 3 to 4 times a day. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin.
Some people find that massage helps with symptoms. Focus on massaging the arch of the foot around the injured area. If surrounding muscles have become tense because of the pain, massage those areas as well.
Tip: Dealing with early morning Plantar Fasciitis pain provided by the Hanson’s:“If you run early and find it difficult until the plantar warms up (or loosens), I suggest putting the foot in the bath tub under running warm water & keep adjusting the temperature until it is as hot as you can stand. This (will) help the early run hobble.”
Exercises that stretch out the calf muscles help ease pain and assist with recovery. When you walk without shoes, you put undue strain and stress on your plantar fascia.
Wearing supportive shoes with extra cushioning and orthotics if prescribed by a medical professional can reduce pain, especially if the patient is frequently standing and walking. I wear and recommend custom orthotics that fit into my running shoe. Although orthotics are not for everyone, if prescribed, they help correct underlying structural abnormalities that contribute to plantar fasciitis. A cushioned shoe or insert reduces the underlying tension and microtrauma that’s causing pain with the plantar. Soft heel pads can also provide extra support, they are inexpensive and work by elevating and cushioning your heel.
Although medication, rest and ice often eliminate the pain, working with a physical therapist (PT) can address bio-mechanic, muscle weaknesses or imbalances that were actually the root causes of the injury. A Physical Therapist will help with strengthening and stretching exercises (discussed below) that can prevent injuries to the plantar fascia, achilles tendon, and also lower leg muscles.
Kinesiology tape, straps and splints
Although I could write multiple detailed posts about the use of tape, straps and splints. I’ll keep it simple here. I have experience with using tape to alleviate pain (either myself or athletes I coach). Tape can help, but it must be applied correctly to achieve it’s maximum benefit. Below are a few videos that may be of interest. Proper taping of the foot or use of straps help support the foot and reduce strain on the fascia. The tape & straps will allow your foot and ankle to move well. Before applying kinesiology tape to your foot, be sure to speak to your physical therapist or doctor to ensure you are applying it properly.
Wearing a night splint can help to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some athletes. Remember that these devices help relieve the pain, but they don’t correct the root cause. The good news is that they won’t be needed once the pain is gone. As long as a regular preventative routine is implemented to address risk factors.
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Other (less common) Treatment Options
For those patients who don’t show progress after several months, a small percentage of patients may require surgery. From my research, the surgical option was rarely used and typically only considered after 12 months of aggressive nonsurgical treatment. A foot and ankle surgeon would discuss the surgical options with their patient and determine the most beneficial approach.
A few other treatment options are ultrasound, which is used to target and remove scar tissue. This procedure may allow the patient to get back to their regular routine much sooner than with surgery.
Stretches & Strengthening
Stretching exercises should create a pulling feeling. They should not cause pain. Ask your physical therapist or doctor which exercises will work best for you.
People can speed recovery, relieve pain and prevent recurrence with specific foot and calf stretches and exercises. Perform these exercises two or three times every day. Often, muscle tightness in the feet and calves can make the pain of plantar fasciitis worse. So, a good strategy is to gently stretch the plantar fascia, as well as the muscles around your foot and ankle. The more frequently you do this, the more you will improve foot flexibility, mobility and promote healing of the irritated fascia.
Calf stretch – Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch.
Plantar fascia stretch – This stretch is performed in the seated position. Cross the affected foot over the knee of opposite leg. Grasp the toes of the painful foot and slowly pull them toward the body in a controlled fashion. If it is difficult for the patient to reach their foot, then wrap a towel around the big toe to help pull toes inward. Place the other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of the foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or walking.
Placing a round object under the foot and roll it back and forth. This will help loosen up the foot muscles. People also use a rolling pin, golf or tennis ball or specialized foam roller for this.
Flexing the foot increases blood flow to the area and relieves tension in the calves, which can help with pain. This exercise uses a towel or elastic stretch band, which people can buy from sports stores or online.
Curling a hand towel or facecloth with the toes can stretch the foot and calf muscles. Try doing these stretches before walking or doing any other morning tasks.
Picking up a marble with the toes will flex and stretch the foot muscles. This exercise is tough, but highly effective.
If you’ve read through this whole article, you understand the pain resulting from plantar fasciitis and how frustrating and what a painful problem it is to manage. The upside is that there are steps you can take to help alleviate your symptoms, address the root causes of the injury and prevent it from returning. Regardless of the treatment you undergo for plantar fasciitis, you must address the underlying causes. Therefore, it’s important to continue with preventive measures which may include long term wearing of supportive shoes, regular stretching, strengthening and possibly using custom orthotic devices as discussed above.
I used many sources in my research for this article. I interviewed a Physical Therapist and numerous athletes who have suffered through plantar fasciitis. I also used articles from the following online sources.
Why Weak Glutes Are a Runner’s Biggest Enemy and How You Can Fix
Risk Factors For Achilles Tendonitis & How To Prevent
Four Great Ways to Avoid Running Injuries