Heel Pain & Plantar Fasciitis
What Is Plantar Fasciitis?
At its core, plantar fasciitis (heel pain) is an inflammation of the fascia at your heel—that’s what the -itis part means. There’s lots of academic discussion around the true nature of plantar fasciitis. Some say it’s truly inflammation, while others argue that the tissues are degrading. For most people, plantar fasciitis means pain on the inside bottom part of your heel, especially when you wake up in the morning.
The hallmark of plantar fasciitis is pain on the bottom, inside part of your heel after periods of rest. You might be reading this and think, “But most of my pain is at night. What gives?” Don’t worry. While the majority of typical cases present with morning pain, some atypical cases hurt only later in the day.
What Are The Sympotoms of Plantar Fasciitis?
The hallmark symptom of plantar fasciitis is pain on the bottom, inside part of your heel after periods of rest. People describe the pain in a variety of different ways. It could be sharp, it could be dull, it could be achy, it could be burning. It could be all of those things. The quality of pain differs in how people describe it, but the location is usually the same.
Plantar fasciitis is often most painful right after you wake up in the morning and take your first 10 to 20 steps. If you have PF, that’s usually the worst part of your day. You’ve been resting for the longest period of the day while you slept. At night while you sleep, your foot relaxes. All the damaged soft tissue starts to half heal in this relaxed and shortened position. Then, when you get up and put weight on your foot, your arch lowers and you increase the stretch on your plantar fascia. That increases the tensile pulling on the attachment point at the heel. With every step, you’re re-tearing the half healing from the night before. That’s where a lot of the pain comes from, so that’s the most important part to pay attention to.
- Longer time spent standing or walking on hard surfaces
- Being overweight
- During pregnancy
- Over- training, or doing too much too soon too fast
- reduction in ankle range of motion
- compensation from another injury
How To Relieve Symptoms of Plantar Fasciitis
- Try range of motion exercises before you get out of bed in the morning
- Replace your old worn down running shoes with proper ones for you
- Consider off-the-shelf orthotics to move more pressure into your arch, and remove it from your heel
What are my options for treatment? Who can help?
Treatment for plantar fasciitis (heel pain) is often stepped in nature. First line therapy often consists of physiotherapy, ice, rest, off the shelf orthotics or gel heel cups, and sometimes medication prescribed by your family doctor. If your symptoms do not settle within 6-8 weeks, consider custom orthotics to help your on-going heel pain.
Seeing a physiotherapist and massage therapist may also be of benefit.
Plantar fasciitis is easier to prevent than heal. You can’t fix things like high arches, but you can minimize your risk factors by trying to keep your weight down, keep your flexibility and your range of motion up, and mitigating other risk factors such as hard surfaces for long periods of time and training errors. The other important thing you can do to prevent plantar fasciitis is keep your feet as strong as possible. If the supporting musculature of your foot and ankle is strong, PF is less likely. Once you’ve had PF, you’re more susceptible to getting it again, so it’s important to stay aware and keep your feet strong.
Staying active with pain
We have two rules for staying active during injury. Number 1: Don’t do anything that makes it worse during or after. Number 2: See rule Number 1.
Don’t make it worse. That’s not always as simple as it sounds. The problem with plantar fasciitis is that often people will be able to stay active and not have any big pain once they get past their first morning steps. If you’re functioning with a low baseline level of pain, you can go running, you can play soccer, you can play tennis. It’s only after you sit down from them and then go to get back up again, or when you get up the next morning, that you feel the damage. That’s when you’re in more pain, not when you were being active the day before. If your plantar fasciitis is bad enough that it’s painful while you’re doing your activity, you simply have to cut that activity out completely until you recover.
Typically, I tell people that pain shouldn’t be increased during or after activity. If you have more pain during, stop. If you have more pain after, then you want to reduce what you did by 15 to 20 percent at first. Try the activity again to see if the pain after is better. If it isn’t, keep cutting it back, possibly to the point where you just don’t do it for now. You might find that you can still play a round of golf, but maybe it means walking for nine holes and carting for the back nine instead of walking the full 18, or carting for the full course.