What is plantar fasciitis?
_________________________ Claire Sissons _ 11/10/2019
reviewed by Timothy Gossett, M.D.
Plantar fasciitis is a common condition that causes pain in the heel. A thick, strong band of tissue called the plantar fascia supports the arch of the foot. This tissue can become damaged or inflamed, causing pain and difficulty moving the foot.
According to the National Institute for Health and Care Excellence, plantar fasciitis accounts for about 80% of cases of heel pain. An estimated 10% of people will experience this problem during their lifetime.
In this article, we provide an overview of plantar fasciitis, including its causes, risk factors, symptoms, and treatments. We also discuss when an individual should see a doctor.
What causes plantar fasciitis?
The function of the plantar fascia is to absorb the impact of standing, walking, and running on the foot. This part of the body gets a lot of use, and too much pressure can damage the plantar fascia. Plantar fasciitis will not necessarily have one single cause. Several risk factors can increase a person’s likelihood of developing the condition. These include:
age, as plantar fasciitis is especially common in people between the ages of 40 and 60 years
doing exercise, such as running, that repeatedly impacts the plantar fascia
having flat feet, high arches, or tight calf muscles
having overweight or obesity or being pregnant, all of which put more pressure on the feet
having certain medical conditions, such as arthritis
frequently standing for extended periods
often wearing high heeled shoes
Women are more likely than men to experience plantar fasciitis. It is not clear why, but it may be because certain risk factors for the condition — such as pregnancy and wearing unsupportive shoes — affect women more than men. The condition usually develops with repeated impact or pressure, which, over time, can cause damage to the tissue in the foot.
Symptoms
The plantar fascia runs along the sole from the toes to the bottom of the heel. Excessive pressure on this part of the foot can cause small tears in the tissue. This damage leads to inflammation, pain, and stiffness.
The most common symptom of plantar fasciitis is pain in the plantar fascia. The focus of the pain is usually near the heel, where it can feel as though the tissue is tearing. The pain may develop gradually over time. It can be worse after a period of rest, for example, first thing in the morning or after a long journey. Alternatively, the pain may worsen after exercise or activity.
Heel spurs are small, bony growths on the bottom of the heel bone. People used to believe that heel spurs were responsible for plantar fasciitis, but they do not cause this pain.
Home remedies
Stretches and exercises that work out the leg or foot muscles can help ease the pain of plantar fasciitis and encourage healing. These exercises include
foot flexes,
calf stretches,
curling a towel between the toes,
and picking up marbles with the toes.
Resting the foot, applying ice to the area, compressing with a bandage, and raising the foot on cushions or a low stool can help.
Nonsteroidal anti-inflammatory drugs can reduce pain and swelling.
Some people may find that foot massage also helps alleviate foot pain.
Recovery can take time. After a week or two of rest and home remedies, a person may be able to walk normally without pain. Most people will make a complete recovery from plantar fasciitis within a year.
Lifestyle changes
Some simple lifestyle changes can help the foot recover and prevent plantar fasciitis from developing again.
Wearing comfortable and supportive shoes can help reduce the daily impact of standing and walking on the feet. The American Academy of Orthopaedic Surgeons provide a guide to choosing the right footwear. People should replace athletic shoes once they wear out. When the sole of a shoe becomes thinner, it does not provide as much support for the foot or absorb as much impact when the foot hits the ground.
It is also best to choose low impact forms of exercise to help prevent injury. Jogging on a soft surface, such as grass, puts less force on the feet and knee joints than running on the sidewalk. Swimming and yoga can both build strength and flexibility with minimal impact on the body.
Maintaining a healthy weight can also help reduce the pressure that a person puts on their feet. Eating a healthful diet and doing regular gentle exercise are effective ways to manage weight.
Treatments
The most effective treatment for plantar fasciitis is often rest and care at home. If home remedies do not work, a doctor may recommend additional treatment. Most treatments are nonsurgical, with doctors only recommending surgery if other treatments have not worked after a year.
Orthotics
An orthotic is a support or device that can help with musculoskeletal problems, which are those relating to the bones, muscles, and ligaments. Wearing supportive shoes and using orthotics — such as cushioned inserts and heel supports — can help with plantar fasciitis pain. These reduce the impact on the foot when standing or walking.
A night splint
People usually sleep with their feet relaxed and pointing downward. In this position, the heel relaxes, which tightens the plantar fascia. It can also cause the calf muscles to become tight, which can increase arch pain. People can use a night splint to keep the foot flexed overnight.
Physical therapy
Physical therapy can help stretch the muscles to improve the range of movement, reduce pain, and support healing. Massage therapy can help by reducing both pain and inflammation.
Anti-inflammatories
Cortisone is an anti-inflammatory medication. Cortisone injections into the tissue can reduce pain and inflammation. However, it is best to limit the number of injections to minimize the risk of side effects.
Shockwave therapy
Extracorporeal shockwave therapy is a nonsurgical treatment that may stimulate healing. It is low risk and noninvasive, but more research is necessary to confirm whether it is effective.
Surgery
If none of these treatments are effective, a doctor may recommend surgery. Surgery for plantar fasciitis is low risk, but complications can include pain or nerve damage. There are two main options for surgery:
Gastrocnemius recession lengthens the calf muscles to increase the range of movement in the ankle, reducing stress on the plantar fascia. The surgeon will use either an open method or minimally invasive surgery, which may reduce recovery time.
Plantar fascia release involves a surgeon making a cut in the plantar fascia to reduce tension. People with a good range of movement in the ankle are better candidates for this procedure.
When to see a doctor
If pain is ongoing and does not improve with home remedies, it is important to see a doctor. Ignoring plantar fasciitis can lead to ongoing pain and possible damage to structures in the foot.
A doctor will usually ask the individual about their symptoms and medical history, as well as any lifestyle factors that may have contributed to the problem. They may also wish to know the exact location of the pain and whether it is worse at certain times of the day or after exercise.
The doctor will then examine the foot to look for signs of plantar fasciitis. These can include:
pain or tenderness in front of the heel bone
pain that worsens when flexing the foot and applying pressure to the plantar fascia
a limited range of movement in the ankle
After making a diagnosis, the doctor will be able to recommend treatment options.
Summary
Plantar fasciitis can cause significant pain and difficulty moving the foot normally. However, most people make a complete recovery from the condition.
Treating plantar fasciitis with home remedies and simple lifestyle changes is usually effective. A person can reduce the risk factors by engaging in low impact exercise, wearing appropriate footwear, and maintaining a healthy body weight.
Plantar fasciitis massage
___________________________ Zia Sherrell _ 21/10/2022
reviewed by Adam Hotchkiss, DPM
Plantar fasciitis is a painful condition that affects the sole of the foot. People can use stretching exercises and self-massage to relieve pain and inflammation.
Plantar fasciitis occurs when the plantar fascia, a band of tissue that runs across the bottom of the foot, becomes inflamed. It can cause pain in the heel or arch of the foot. The condition is particularly common among runners.
Doctors may recommend conservative treatment, such as plantar fasciitis massage and stretching, before turning to more significant treatment measures.
Massage can help stretch the plantar fascia and increase blood flow to the area, which can promote healing. People can also use simple stretches to treat the condition at home.
Read on to learn about how to perform plantar fasciitis self-massage, stretches, massage strategies, and more.
How to perform self-massage
Stretching the plantar fascia is effective for reducing heel pain. A person can facilitate stretching by gently massaging the foot. To massage the foot, a person can follow these steps:
Begin by rubbing the ball of the foot and the base of the toes in a circular motion.
Use both hands to massage the arch of the foot, using circular or back-and-forth motions.
Use the heel of the hand to apply pressure to the sole of the foot while stroking up and down.
Press the thumbs along the length of the sole, from the heel to the toes and back.
Gently pull each toe, starting with the big toe, away from the foot.
Finish by rubbing the heel in a circular motion.
Plantar fasciitis massage can be painful, so it is important that the person goes slowly and stops massaging if the pain becomes too intense. Massage can make a person’s foot feel sore or tender, but it should not cause significant pain.
For best results, a person should massage their feet several times a day for at least 6 weeks. They can also add stretching to their routine. Useful stretches include the gastrocnemius muscle stretch and soleus muscle stretch:
Gastrocnemius muscle stretch
Stand with the feet shoulder-width apart and hands on a wall for support. Then, take the affected leg backward, keeping both heels on the floor and feeling the stretch in the sole.
Soleus muscle stretch
This is similar to the gastrocnemius stretch, but it does not require the person to take their leg as far back. Instead, keep the rear heel on the floor and bend the front knee until it causes a stretch in the arch of the foot.
Massage tools
A person does not need any special equipment to perform at-home foot massages. However, some people may find that using tools like a tennis ball or rolling pin can help reach all areas of the foot more easily.
To use a tennis ball, place the ball under the arch of the foot and gently roll it back and forth.
Likewise, to use a rolling pin, roll the foot over it from heel to toe.
Plantar fasciitis massage strategies
Cross-friction massage is an effective form of massage for plantar fasciitis. During this procedure, a massage therapist does not use lubricant, so the fingers massaging the foot do not slide across the skin. Instead, it takes the skin with it, allowing the force to transfer to the deep tissue.
The foot is dorsiflexed, which means the toes are pointing up toward the shin. The therapist then uses their finger pads to massage in a back-and-forth motion across the grain of the tissue, going from the heel toward the toes.
This type of massage is usually done with deep pressure over short periods of time.
Risks and precautions
There are very few risks associated with plantar fasciitis massage when done correctly. However, if a person massages aggressively when the fascia is inflamed, the sole of the foot can become sensitive. This may make the pain even worse.
It is important to go slowly and stop if the pain becomes too intense. Wait until any swelling, redness, or bruising has resolved before massaging the foot.
People should also try to massage when pain levels are relatively low. For example, a person may notice that their heel pain is most intense when they first get out of bed in the morning. Therefore, they may find it helpful to massage their feet before attempting to stand in the morning.
It may also help to take a hot bath or shower to relax and warm up the tissues first.
When to contact a doctor
Plantar fasciitis is a condition that often improves with home treatment and rest. However, some people may experience persistent heel pain that does not respond to self-care measures. In these cases, it is important to contact a doctor for further evaluation and treatment. Additionally, people should visit a doctor if they experience intense heel pain that prevents them from walking or doing everyday tasks.
Summary
Plantar fasciitis is a painful condition affecting the bottom of the foot and heel. Self-massage and stretching are simple home remedies that can reduce pain and promote healing.
A person can perform self-massage at home using their hands or simple tools, such as a tennis ball or rolling pin.
Best stretches and exercises
for plantar fasciitis
and heel pain
______________________ Zawn Villines _ 18/11/2021
reviewed by Amy Elizabeth Wolkin, PT, DPT, MBA
People with plantar fasciitis may find that foot stretches and exercises help by relieving pain, improving muscle strength, and promoting flexibility in the foot.
The plantar fascia is a thick band of tissue connecting the heel to the toes. Overuse, strain, and injury can cause inflammation in this tissue, which can be painful. This condition is called plantar fasciitis.
Plantar fasciitis can cause a deep, stabbing pain in the heel. It often occurs in people with excess body weight, but it can also occur as an overuse injury in runners. The pain is usually most severe in the mornings or after standing for extended periods.
A few simple stretches can reduce tension in the foot and calf. In doing so, they can provide both rapid pain relief and a steady improvement in symptoms over time.
Calf stretch
Muscle tightness in the feet and calves can make plantar fasciitis worse. Loosening the calf muscles can relieve the pain. People can try performing a calf stretch, which involves the following steps:
Lean the hands against a wall.
Straighten the knee of the affected leg and bend the other knee in front.
Keep both feet flat on the ground.
Hold the stretch for 10 seconds.
Repeat the stretch 2–3 times.
Rolling stretch
Placing a round object under the foot and rolling it back and forward can loosen the foot muscles. People can use a rolling pin, golf ball, or specialized foam roller for this exercise. Many sports stores and online retailers sell foam foot rollers.
Another option is to try using a frozen bottle of water for arch rolls. This technique may be particularly beneficial because the cold surface of the bottle may help reduce inflammation.
This simple exercise stretches the foot:
Sit tall on a chair.
Place a ball or another rollable object under the foot.
Roll the object back and forward for 2 minutes.
Seated foot stretch
A person may also be able to relieve muscle tightness in the plantar fascia using a seated foot stretch. They can perform this exercise by following these steps:
Sit on a chair and cross the injured heel over the opposite leg.
Pull the toes toward the shin to create tension in the arch of the foot.
Place the other hand on the bottom of the foot to feel for tension in the plantar fascia.
Hold for 10 seconds.
Repeat 2–3 times.
Towel curls
Curling a hand towel or washcloth with the toes can stretch the foot and calf muscles. People may find it beneficial to do these stretches before walking or completing any other morning tasks. The exercise involves the following steps:
Sit on a chair with both feet flat and a small towel in front of the feet.
Grasp the center of the towel with the toes.
Curl the towel toward the heels.
Relax the foot and repeat 5 times.
Marble pickups
Picking up a marble with the toes will flex and stretch the foot muscles. A person can try the following:
Sit on a chair with the knees bent and the feet flat on the floor.
Place a handful of marbles on the floor.
Pick up one marble at a time by curling the toes.
Repeat 20 times.
Other home remedies
People can use several home remedies to reduce the inflammation and pain of plantar fasciitis:
The RICE method
When the pain first appears, it is important to rest the injured foot. First aid for a foot injury typically involves the RICE method:
R: Rest the painful area for a few days. I: Ice the area for 20 minutes at a time to relieve inflammation. C: Compress the area with a soft wrap to reduce swelling. E: Elevate the area by putting the foot on a few pillows.
Anti-inflammatory medication
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, reduce both pain and inflammation. It is important to take this medication according to the instructions on the package or a doctor’s advice.
Some people find that a few weeks of NSAID treatment improves their symptoms.
Shoe inserts
Shoe inserts provide the arch of the foot with additional support. Inserts limit stress on the plantar fascia and may be especially helpful for people who spend much of the day on their feet. Soft, supportive arch inserts can work as well.
People who are interested in this option can contact a podiatrist, a doctor who specializes in foot health, for more information.
Ice massage
Some people find that massaging the injured foot with ice helps relieve foot pain. The best approach is to focus on massaging the arch of the foot around the injured area.
Medical treatments
If stretches, exercises, and other home remedies do not help, a doctor or podiatrist may recommend medical treatment.
Surgery is rarely necessary, but it is an option if other treatments prove ineffective.
Risk factors for plantar fasciitis
Plantar fasciitis is relatively common, affecting 7–10% of the population. Doctors do not fully understand why some people get this injury and others do not.
However, known risk factors for plantar fasciitis include:
standing for long periods
walking or running for exercise
having tight calf muscles
having excess body weight
having pes cavus, a condition that causes increased arch height
Outlook
Plantar fasciitis usually resolves within 6–18 months without medical treatment.
However, for some people, plantar fasciitis becomes a chronic condition. Symptoms may improve and then appear again, or the pain may remain consistent for a year or longer. A 2018 study suggests that people who have previously had the condition are more likely to have it again.
Summary
Plantar fasciitis is an overuse injury that is common in runners and people with excess body weight. It occurs when the plantar fascia, a thick band of tissue, becomes inflamed and painful.
People can usually manage plantar fasciitis at home with stretches, rest, ice, and NSAIDs. If the symptoms persist, it is advisable to contact a doctor.
