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Managing Plantar Fasciitis

Feb/04/2024 / by brian-sodoma

The most common cause of heel pain can be prevented and treated

Woman's foot doing a tennis ball roll massage
Photo via Shutterstock

Each year, millions of people wake up in the morning and feel a stinging pain in their heels as they take their first steps into the day. Often, an X-ray reveals plantar fasciitis, one of the most common causes of heel pain. It’s a condition about one in 10 people will experience in their lifetime, according to the medical journal, American Family Physician. Dr. Audey Nasser, a podiatrist and the founder of Illinois-based University Foot Associates, shares insights with SEEMA on the causes and symptoms of plantar fasciitis. The doctor also suggests treatment and prevention options.

What Is Plantar Fasciitis?

The plantar fascia is a ligament-like tissue on the bottom of the foot that extends from the heel to the ends of the toes. While its main purpose is not to hold up the arch, it does provide arch support. Over time, this tissue may stretch and the arch may flatten, causing flat-footedness. After the tissue stretches, it becomes less elastic over time and stays in this flat position, causing heel pain.

The most common first symptom is a sharp, shooting pain in the morning after you step out of bed, Nasser explains. Plantar fasciitis sufferers often need a few steps in the morning to loosen the tissue and for the pain to diminish. In more extreme cases, the pain may persist throughout the day. But not all patients have foot pain, Nasser adds. Instead, they may have bone spurs and mistakenly think that is the problem. “They think the bone spur is what needs to be treated, but it’s the attachment of the fascia to the bone spur that’s getting pulled that’s causing the inflammation,” Nasser said. “Once we see you have a bone spur and don’t have symptoms, we know it may be plantar fasciitis.”

Risk Factors For Plantar Fasciitis

Runners, those who are overweight or obese or who have careers that require prolonged standing or walking may be the most at risk for plantar fasciitis. However, Nasser says footwear is probably the biggest factor. “It depends on the type of shoes you wear,” he notes. Most sandals and flip flips offer “zero support for the arch, which will inherently cause plantar fasciitis. People who wear sandals or non-supportive shoes are more prone.”

Diagnosis And Treatment of Plantar Fasciitis

An X-ray is needed to diagnose plantar fasciitis. Other conditions like stress fractures, tendonitis, which is also associated with the arch, and tarsal tunnel syndrome, have pain that can mimic plantar fasciitis. So, the X-ray helps to rule those out as well.

Once diagnosed, stretching exercises are usually the first line of treatment. Any exercise that stretches the Achilles tendon also benefits plantar fasciitis patients. Exercises may include lunges, stepping on a stair and letting the heel drop off of it, and rolling a tennis ball under the arch. Some patients will roll a frozen bottle of water under their arch as well.

“The ice helps to reduce inflammation and decrease pain while you stretch it out,” Nasser added. “You may start doing these stretches for 10 minutes in the morning and evening. In many cases, the problem resolves over time. Once the pain is gone, you’ll want to continue stretching, but non-aggressively while making sure to wear shoes with arch support.”

For more acute plantar fasciitis cases, steroid injections or oral steroids may help. Some patients will opt for an immobilizing boot, which prevents the use of the plantar fascia and calms down pain and inflammation. For chronic cases, there is also Extracorporeal Shockwave Therapy (ESWT), which involves sending pulses to the plantar fascia area to stimulate new blood flow and break up scar tissue. In rare cases, plantar fascia removal surgery may be required.

Finally, the best prevention is to wear shoes with good arch support, Nasser emphasizes. “Some shoes are marketed today for not having arch support. That’s fine if you have a perfect foot, but most people don’t, and if you have a collapsing arch, these shoes will make the problem worse,” he says.


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