About 34 million Americans suffer from this condition in their lifetime, and I see countless patients with the issue in my clinic.
Almost every morning, I have a new patient hobble in, wincing with every step, and clutching the back of their heel in agony, wondering what’s wrong.
Often, they are 40 to 60 years old and have been battling the condition for months. But in recent years, I have seen more runners in their 20s and 30s.
Many tell me of a stabbing pain in their heel that is at its worst late at night or first thing in the morning. During the day, patients sometimes suffer from a dull ache. They’ve tried everything to soothe it – foot rollers, massages and Epsom salt baths – but nothing seems to work.
These patients are suffering from plantar fasciitis, a condition where the plantar fascia, the thick band of tissue connecting your heel to your toes that helps you walk, has become irritated, inflamed and developed microtears.
It’s often worse just after waking up because the ligament shortens while we sleep, and is then suddenly stretched when we stand, triggering new tears and pain.
It can affect a wide variety of people, from builders to office workers, dancers and film crew members, and is normally linked to standing for long periods of time or the over-use of the feet.
Many patients may not realize their pain is indicative of something more serious than simply over-use. After treating many patients with the condition, I have come up with the three most common symptoms that reveal you have the condition – and effective ways to treat it.
About one in 10 Americans suffers from plantar fasciitis during their lifetime, estimates suggest. It has recently surged among runners (stock image)
Sharp, stabbing pain in the heel
Heel pain and tightness are among the most common symptoms that patients report.
They describe the pain as sharp, stabbing or shooting at the bottom of their heel. While they report that it’s usually worst first thing in the morning, many say it eases within a few minutes.
In some patients, the pain can also feel like a dull, constant ache throughout the day.
Pictured: podiatrist Jonathan Brocklehurst
The condition doesn’t normally cause pain at the front of the foot or in the toe joints – that kind of discomfort is normally linked to other complications, such as arthritis or damage to ligaments.
It’s important to note that plantar fasciitis does not normally cause a burning type of pain.
If someone starts to feel a burning in their heel, they should talk to their doctor to determine whether there is damage to the area.
Heel spurs (bony outgrowths that poke out below the back of the heel) are often linked to plantar fasciitis, but these are two distinct conditions. They should be reviewed by ultrasound imaging to determine the extent of the growths and whether action is needed.
Pain after activity, but not during
Heavy loads of physical exercise during the day can trigger the heel pain. But this normally happens after the activity rather than during it.
For example, builders may be on their feet for 10 hours a day while fashion fitters and film crews are similarly standing for long periods.
The above diagram shows the plantar fascia, the connective tissue at the base of the feet. The red areas show trauma that can cause pain in the foot
This overuse puts pressure on the plantar fascia and can cause any existing tears to widen or new tears to appear, triggering pain when someone sits down or rests.
The ligament does not hurt as much when in use because the movement keeps it stretched.
To help minimize the resulting pain, I tell my patients to wear supportive footwear if they must stand for long hours. They should also try to avoid putting all their weight on one foot when possible.
Tired old shoes
In some cases, problems with footwear can be the cause of the condition.
Those worn out sneakers falling apart at the seams may be saving you a few dollars, but they are wreaking havoc on your feet.
Some patients who develop plantar fasciitis simply choose – maybe unknowingly – to wear poor footwear that provides little support.
But in other cases, I’ve seen footwear required for careers – such as high heels or ballet shoes – also trigger the issue.
A lack of support in someone’s footwear can raise the risk of the ligament experiencing more microtears, which will eventually cause patients pain.
To avoid this, I tell my patients to wear shoes with a deep and wide toe box, secure and adjustable midfoot fastening, such as laces, and a cushioning and shock-absorbing heel.
Plantar fasciitis can be managed, and even cured, with simple lifestyle changes rather than surgery (stock image)
What raises my risk of suffering from the condition?
Many podiatrists warn that obesity can also raise the risk of plantar fasciitis.
This is because the feet support the weight of the body, so more weight means more strain and stress on the arch of the foot, particularly during exercise.
In my clinic, patients who are obese have also presented with pes planus, or flat feet, which can be a direct result of obesity.
Doctors add that having flat feet, which affects eight percent of adults in the US, and being in an occupation that keeps you on your feet regularly can also raise the risk of developing plantar fasciitis.
What treatments are there?
Doctors diagnose plantar fasciitis by examining the foot for areas of tenderness. Normally, no tests are needed. But patients may be asked to get X-rays or MRIs.
Many patients can recover in several months by icing painful areas, stretching or reducing their activity levels.
They can also take over-the-counter painkillers to reduce the discomfort.
For others, doctors may recommend physical therapy or stretches for the plantar fascia and Achilles tendon to help strengthen the lower leg and minimize pain.
Some may also switch to supportive shoes with padding to support the arch and heel, which would ideally minimize the impact from walking.
In less common cases, if the pain is intense, patients may receive steroid injections in their foot to reduce pain. They could also have ultrasonic tissue repair, where a needle-like probe is guided into damaged areas to trigger healing.
Rarely, patients may be offered surgery to ease their symptoms.
Jonathan Brocklehurst, MSc, MIRL, MRCPod, is a podiatrist based in the UK.
