Are you experiencing heel pain so bad you can’t walk? It could be plantar fasciitis.
Your feet endure a significant amount of stress for every mile you walk. Too much stress can lead to irritation and inflammation of the tissues of your foot and ankle, leading to debilitating pain.
Let’s take a look at the symptoms, causes and treatment of plantar fasciitis as well as the other causes of heel pain.
Plantar Fasciitis: Symptoms, Causes, and Treatment
What is plantar fasciitis?
Plantar fasciitis is a painful inflammation of your plantar fascia. Overstretching can irritate and inflame its fibres, resulting in excruciating pain.
This degenerative condition that affects the plantar fascia is one of the common causes of heel pain. Moreover, this condition is common in middle-aged and older adults. It can affect both athletic and sedentary individuals alike.
What is a plantar fascia?
Image credit: flickr/sportEX journals
Also known as the plantar aponeurosis, the plantar fascia is a strong, thick band of ligament or connective tissue that runs from your heel bone to your toes. It is responsible for providing support and protection of your foot. The plantar fascia is divided into 3 bands; the medial, central, and lateral.
Not all heel pain is plantar fasciitis
Experiencing heel pain doesn’t always mean it’s plantar fasciitis. Other causes are:
- Heel spur
- Heel bursitis
- Achilles tendonitis/Tendinitis
- Foot arthritis
- Heel fracture
- Posterior Tibial Tendonitis
- Bone Infection (Osteomyelitis)
- Tarsal Tunnel Syndrome
Achilles tendonitis (or tendinitis) is the result of an overused or overstretched Achilles tendon, which ultimately leads to the development of microscopic tears. As a result, your Achilles tendon will thicken and become weak.
Treatment for Achilles tendonitis includes rest, supportive shoes, physical therapy, platelet-rich plasma (PRP) injections, OTC anti-inflammatory medicine, etc. Surgery may be required if the symptoms don’t go away.
A heel spur is a bony protrusion on the sole of the heel bone. Heel spurs are made of calcium deposits. Heel spurs are often caused by ligament or muscle strain, stretching of the plantar aponeurosis and repeated tearing of the membrane in the heel bone.
Treatment of a heel spur is similar to those of Achilles tendonitis and plantar fasciitis.
Fractures in the foot and ankle and other heel injuries are obvious reasons why you are experiencing heel pain, swelling and an inability to bear weight. Your podiatrist can diagnose if you have a bone fracture. Appropriate imaging may be required to confirm the diagnosis.
What are the symptoms of plantar fasciitis?
Plantar fasciitis can develop in several stages. Typically, it begins with slight discomfort in your arch or heel. Mild sporadic pain can develop into a regular and excruciating experience.
Some of the most common symptoms include:
- Arch pain
- Heel pain (typically one-sided: right or left)
- Morning pain
- Pain and tenderness in the Achilles’ tendons
- Tight calf muscles
- Difficulty walking due to pain
What are the risk factors for plantar fasciitis?
Plantar fasciitis risk factors are grouped into 3 major categories, which are:
- Shortened Achilles Tendon
- Very high arched feet
- Flat Feet
- Limited ankle movement
- Weak foot muscles
- Overpronation (inward rotation)
- Poor biomechanics
- Poor footwear
- Prolonged standing
- Leg length asymmetry
What are the causes of plantar fasciitis?
There are many causes of plantar fasciitis. Generally, the increased load on the plantar fascia causes this condition to become a chronic one.
Soft shoes, tight calf muscles, an increase in body weight and flat feet are some common causes of plantar fasciitis. Likewise, poor foot function due to biomechanical issues can trigger this condition.
Further, people who suddenly increase the frequency or amount of exercise or sporting activity are also at risk.
1. Plantar fasciitis and footwear
Generally, people wearing shoes that are flat, flexible, and less supportive are at risk. The lack of support on the plantar fascia and heel bone can be stressful, especially for those patients with a weaker foot type. Using soft shoes for long periods can lead to plantar fasciitis or other types of heel pain.
2. High arches
Image credit: flickr/Carlton Martinez
Patients with higher arches get less support from shoes and their liners. Meaning, that there is less contact through the arch or sole area. Remember, the plantar fascia runs through this area, which can become irritated and inflamed.
Hiking and functional running shoes still lack the support that some feet need, which may lead to plantar fasciitis and other forms of heel pain.
3. Flat feet
The Pes Planus or “flat foot” is often caused by a ligament laxity or weak ligaments. This inherent weakness in the ligaments forces the plantar fascia, tendons and other muscles to work harder. An increased load, when sufficient, can lead to straining, tearing and inflammation of the plantar fascia.
Even the most common calf exercises or stretches can place a certain amount of strain on the sole. Plantar fasciitis can come about when patients do so much stretching of their calf muscles.
5. Body weight and plantar fasciitis
People carrying more body weight are more at risk of heel pain and other foot problems. The addition in body weight increases more load on the feet, which causes plantar fasciitis.
Likewise, the increase in body weight forces the calf muscles to work harder in pushing the patient forwards. Consequently, this causes the muscles to become tighter and stiff.
Plantar Fasciitis Treatment Options
Treatment options will depend on how severe your condition is and the availability of the needed resources. Generally, conservative care is always the first method of treatment.
The common options for treating plantar fasciitis are:
- Conservative Care includes rest, stretching, physical therapy, orthotics, running shoes with arch support, night splints and safe anti-inflammatory medications
- Steroid Injections are the next option when conservative care fails. Steroids contain powerful anti-inflammatory agents. However, steroids can damage your tissues, cartilages and tendons.
- Surgery may be the last option when implementing conservative care and injecting steroids has failed. Typically, the surgery performed to treat plantar fasciitis involves cutting a portion of the ligament that connects the heel bone to the bottom of the foot.
FAQs on Plantar Fasciitis
1. How can I walk with severe plantar fasciitis?
Walking in itself does not make your plantar fasciitis worse. It’s how you walk that could be causing the added pain.
To avoid added or increased pain, you should:
- Wear shoes that fit your feet perfectly.
- When done walking, put ice on your feet to help reduce the inflammation.
- Do not walk on very hard surfaces for long periods.
- Use a foot wrap to provide that extra level of comfort, lift and support to the inflamed area of your foot.
- Do some stretching exercises when you have finished walking.
2. Can plantar fasciitis cripple you?
Plantar fasciitis can be crippling. You may reach a point where you experience heel pain all day long.
It may take a long time to get better if it goes untreated, which may also lead to permanent disability. If a plantar fascia is damaged, the effort of walking and weight bearing increases.
3. When should I go to the ER for plantar fasciitis?
Surgery may be the only option when severe heel pain continues for 6 to 12 months, and when other methods of treatment have failed. The purpose of plantar fasciitis surgery is to relieve the tension on the connective tissue (or fascia) by detaching it from the heel bone. Plantar fasciitis surgery is often carried out through a small incision or as an open procedure.
4. Can plantar fasciitis be excruciating?
Many patients suffering from severe plantar fasciitis often describe their experience as an extreme level of heel pain that is present all day long. These patients also experience throbbing when lying down or sitting. Further, they may begin to feel the psychological effects of having a condition that is both acute and chronic.
5. What can I do for excruciating heel pain?
There are several home remedies for treating excruciating heel pain. Often, it will go away after some stretching and walking around for a while. In some patients, however, prolonged sitting or standing may aggravate it again.
Try these tips for heel pain relief:
- Rest is the best way to recover from heel pain if the cause is an overused plantar fascia. Combining rest with daily stretching exercises will keep your plantar fascia from pulling and tightening up.
- Wearing shoes that perfectly match your actual feet and biomechanics will prevent stretching and irritating the plantar fascia even more.
- Use ice treatment 3 times per day. For 15 minutes, hold an ice pack over the bottom of your foot. Or you can use a frozen water bottle; roll your foot over it for 5 minutes.
- Wear a night splint to help stretch the tissue in the bottom of your foot and alleviate the pain.
6. What would make the heel suddenly painful to walk on?
Overstretching causes inflammation of the ligament that runs the length of your foot. The other causes are:
- ill-fitting shoes
- jumping and running on hard surfaces
- abnormal walking style
- certain diseases
- injuries and
7. What to do if you can’t walk on your heels?
An overused plantar fascia may develop tiny tears that often lead to irritation and inflammation. Other causes of heel pain include heel spurs, Achilles tendinitis, tarsal tunnel, stress fractures, etc.
If walking on your heels makes plantar fasciitis worse, try to:
- Wear shoes with enough arch and heel support.
- Consider using custom orthotics.
- Perform warm-up exercises before starting activities.
- Make sure to stretch before and after any activity.
- Stop activities until your foot pain goes away.
- Take over-the-counter anti-inflammatory medicine.
- Avoid high-impact activities until your heel pain goes away.
- Massage the affected area with a foam roller, or tennis ball, or get someone to help.
- Apply ice to the affected area.
8. When should I be concerned about heel pain?
You should see your doctor at once if you:
- Have swelling near your heel accompanied by severe pain.
- Can’t walk normally, rise on your toes, or bend your foot forward.
- Have heel pain accompanied by fever, tingling or numbness in your heel.
- Excruciating heel pain as a result of an injury.
Schedule a visit to your podiatrist or foot and ankle doctor if you have:
- Prolonged heel pain even when you’re not standing or walking.
- Heel pain that lasts for a few weeks even after you tried several home treatments.
Plantar fasciitis? Contact Adelaide Foot and Ankle
At Adelaide Foot and Ankle, our objective is not just to provide quick pain relief but a long-term solution to plantar fasciitis. Contact us today. Our podiatrists specialise in the diagnosis and treatment of plantar fasciitis and other foot and ankle problems.