Are you a runner? Do your feet often hurt in the morning or the first few steps after getting up? As the most common cause of pain at the bottom of the heel, according to The American Academy of Orthopaedic Surgeons, plantar fasciitis injuries plague lots of people who are constantly on their feet—including runners. Plantar fasciitis can be very painful for athletes and non-athletes alike. Understanding what causes plantar fasciitis can help prevent it from occurring as well as speed up the recovery process if you are experiencing it. In this post, we discuss what causes plantar fasciitis and what steps you should take to treat it.
Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).
The plantar fascia attaches to the heel bone (calcaneus) and to the base of the toes. It helps support the arch of the foot and has an important role in normal foot mechanics during walking. See this video from Mark Manual explaining plantar fasciitis.
Plantar fasciitis sufferers feel a sharp stab or deep ache in the heel or along the arch of the foot. The plantar fascia begins in the sulcus of the foot and runs along the plantar surface of the foot with three insertions in the plantar calcaneus: medially, centrally and laterally.
Another telltale sign of the condition: You feel pain as soon as you put your foot on the ground in the morning. The morning hobble you may experience comes from your foot trying to heal itself in a contracted position overnight. Taking that first step out of bed causes sudden strain on the bottom of your foot, resulting in pain in your heel or arch. The pain can recur after long spells of sitting, but it tends to fade during a run once the area is warmed up.
A third symptom those running with plantar fasciitis might experience is pain during push off while hitting your stride.
Your doctor might suggest an X-ray or magnetic resonance imaging (MRI) to make sure another problem, such as a stress fracture, is not causing you pain but most often this is not necessary.
Sometimes an X-ray shows a piece of bone sticking out (spur) from the heel bone. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain.
Plantar fasciitis is one of the most persistent conditions that many athletes are faced with. Whether it's due to sudden trauma or the result of repetitive strain, once damaged, the plantar fascia can be incredibly resistant to healing. It is estimated that as much as 7% of the Canadian population will be diagnosed with plantar fasciitis.
Due to the resistant nature of diagnoses in plantar fasciitis, it is important to seek treatment early. Research shows the sooner treatment is started the sooner symptoms resolve. For athletes, plantar fasciitis can impair the ability to train properly, interfering with practice and competitions.
Plantar fasciitis can be a stubborn sports injury and unfortunately, the time until resolution is often six to 18 months, which can lead to frustration for patients and their health providers, but with a dedicated treatment plan and team, recovery times can be shorter. Some studies have shown that rest is the treatment option worked best, but asking you to stay off your feet for several months may not be reasonable. Many sports medicine physicians have found that outlining a plan of “relative rest” that substitutes alternative forms of activity for activities that aggravate the symptoms will increase the chance of compliance and lead to a full recovery.
Wearing worn running shoes or constantly running on hard surfaces like asphalt or concrete can increase your risk of the condition. And to top it off, wearing high heels all day and then switching into flat running shoes may also increase your chances of heel pain from plantar fasciitis.
Finally, biomechanical issues may also cause plantar fasciitis. Those issues include high arches or flat feet or even excessive pronation.
There are a variety of treatment options and injury management available for plantar fasciitis pain. Stretching and strengthening exercises or using special devices may relieve symptoms. Typically, athletes do not have to completely refrain from training if treatment starts early enough in the disease process. In general, if there is no limping, a runner can continue to train while treatment occurs. They include:
Other treatment options include:
Some studies show 83 percent of patients involved in stretching programs were successfully treated, and 29 percent of patients in the study cited stretching as the treatment that had helped the most compared with the use of orthotics, nonsteroidal anti-inflammatory drugs (NSAIDs), ice, steroid injection, heat, heel cups, night splints, walking, plantar strapping and shoe changes.
At least one other study backs up the benefits of using myofascial release (think: foam rolling or self-massage) to help address plantar fasciitis pain. Research also shows that stretching (particularly the plantar fascia itself, but also the calves) can help to alleviate the aches associated with the condition.
While the running shoes you choose are important—you don't want to wear a worn-out pair or one that doesn’t support your gait—what shoes you wear when you’re not clocking miles also matters. The key feature to look for in all shoes is arch support. And keep in mind that walking around barefoot or in flimsy shoes can delay recovery.
Resolving plantar fasciitis can be overwhelming, here are 4 simple reminders to keep you focused on recovery.
Plantar fasciitis can be very painful so be sure to seek professional help. This challenging and debilitating condition is treatable and with some time, effort, and support you can get back to the activities you love pain free. Check out our other blog posts on plantar facsiitis for more treatment strategies and supports. At Human Integrated Performance, we are here to help. Check out some of our other posts on plantar fasciitis. Learn more about our physiotherapy services here. Contact us to get relief from your plantar fasciitis.
Yes, with proper care and treatment, most cases of plantar fasciitis pain will resolve and pain will be eliminated
Complete rest for plantar fasciitis is not realistic for many people. Relative rest and modified activities are excellent options to treat plantar fasciitis.