What Is Plantar Fasciitis?

A common cause of heel pain, plantar fasciitis is an inflammation of the thick band of tissue (the plantar fascia) on the bottom of your foot, which connects your heel bone to your toes. You’ll know it by a stabbing pain right at the inner base of your heel, particularly in the morning when you first wake up after a long period of rest. Though the pain often dissipates as you move around, extended periods of standing or sitting may cause the pain to flare up again. Plantar fasciitis is most common in runners, those who are overweight, and those who wear shoes without adequate support. However, the answer to what is plantar fasciitis, what causes it and how best to treat it can sometimes be a mystery that we’ll explore below.

What Is Plantar Fasciitis and Who’s at Risk?

When the symptoms first arrive, a lot of people don’t know the cause of it. Because it’s a pain that starts in the morning and then lessens throughout the day, and because it’s often less painful while exercising than it is afterwards, it’s hard to pinpoint exactly what’s going on. Is it a sprain? A strain? Will it heal on its own? The answer is… maybe, depending on the underlying source of the issue, how severe it is, and in what state of health you are otherwise in.

Plantar Fasciitis Symptoms

The symptoms of plantar fasciitis appear gradually and then suddenly, meaning that what begins as a wince during a run and was never a cause for concern before, may result in you waking up a week later with a baffling shooting pain in your insole/heel that you don’t know how to stretch, rest, or treat. The symptoms of plantar fasciitis include:

• Sharp heel pain: The most classic plantar fasciitis symptom, a severe pain just where the arch of your foot and the inside of your heel meet.
• Heel pain after a prolonged rest: First thing in the morning after a long night’s sleep is the most shocking instance of this pain, which can recur after any long period of rest, like sitting at your desk all day, as the plantar fascia shortens and tightens up while at rest, and then is made to stretch suddenly again when you rise.
• Heel pain after prolonged movement: You can’t win with plantar fasciitis, because while resting will result in renewed pain, so will staying on your feet all day, stressing and weakening the ligament.
• Heel tenderness: Pressing or flexing your foot may cause pain as well, which leads to a lot of initial confusion when massaging and stretching don’t help.
• Tingling or burning in the foot: An itchy tingle or burning ache may accompany the sharp heel pain, possible indications of the strain and irritation that is causing this condition.
• Limping with the affected foot: A limp may arise to help lessen the weight and strain put on the affected heel while walking.

These symptoms may cause pain, discomfort, and interruption to your normal daily activities. How did this happen to you?

Plantar Fasciitis Risk Factors

Here are some general, statistically associated risk factors for developing plantar fasciitis.

• Your age: While plantar fasciitis does affect some people at an earlier age, it is more commonly seen in those above 40 and older.
• Certain exercises: Activities like running, jumping, ballet, and aerobic dancing which place extra strain on the heels and arches can bring about an incident of plantar fasciitis.
• Your foot mechanics: The shape of your foot’s arch or the movement of your gait while walking can contribute too (more on foot mechanics below).
• Obesity: Excess weight can put more strain not just on your feet, but your knees, hip joints, and back as well, all of which might trigger plantar fasciitis.
• Working on your feet: Teachers, factory workers, nurses, construction crew members, and anyone else who spends hours on their feet each day on hard surfaces might find pain flaring up in their plantar fascia.

What Causes Plantar Fasciitis?

This isn’t a one-size-fits-all kind of condition. The inflammation of the plantar fascia ligament occurs when it is overly strained. What causes that undo strain is the real culprit, and many factors contribute to chronic strain on the arch of the foot.

Picture the arch of your foot as a bow. The plantar fascia is the bowstring that gives you the spring in your step. It’s connected to the entire ligament, muscle, and bone system that allows you to walk upright. Consider that, and it’s easy to see how sometimes issues with the spine can cause plantar fasciitis. There is no one cause that makes for an easy answer.

Plantar fasciitis is, in essence, tissue fatigue in the foot, but it doesn’t always affect those you might expect it to. For example, while it’s common in runners, not all runners will get it, and while the obese are more vulnerable to plantar fasciitis, it truly depends on how they carry their weight more than the number represented on the scale. Much of the strain depends on how you move, and how you move is reliant on how you’re built (i.e. biological vulnerabilities), and what habits you form throughout your life to adjust to your own unique build. Let’s review some of the potential common causes of plantar fasciitis.

Bone Spurs

Bone spurs, or heel spurs, are the quickest guess when it comes to plantar fasciitis, mostly due to the fact that plantar fasciitis manifests as heel pain. However, while bone spurs are fairly common (10-20% of the population has some degree of bone spurs), and are indeed more common in those who have plantar fasciitis than those who don’t, they may not be the culprit.

• Bone spurs: These are bony outcroppings on the heel bone, but they are not fully calcified bones themselves, so it’s not like having a rock in your shoe.
• Calcification: Bone spurs are a slight calcification that forms along the plantar fascia where it connects to the heel.
• Looks worse than it is: Bone spurs will light up like bone on an x-ray, but because the calcification is so thin and brittle, it’s more like having a bone-crust over part of the plantar fascia, making it a bit crispy.

This isn’t to say that bone spurs can’t be thicker, or painful, or indeed contribute to plantar fasciitis, but it is to point out that they don’t always cause tissue fatigue and inflammation. And bone spurs are certainly not the one and only cause of plantar fasciitis. Sometimes bone spurs are painless, and sometimes people with them never experience plantar fasciitis at all.

Regardless, it isn’t the spur that hurts, but the soft tissue underneath that is causing you to feel pain. Even surgically removing a spur may not take away the inflammation and injury that exists in the underlying plantar fascia (besides which, the spurs can simply grow back).

The general consensus currently is that bone spurs are incidental findings, which like wisdom teeth or the appendix exist sometimes harmlessly, sometimes uselessly, but cannot be totally counted out as either harmless or useless entirely.

Supination or Overpronation

Pronation is the natural motion of your foot as you walk or run. Normal pronation involves stepping down with your heel and rolling your foot slightly to the outside before shifting back to the big toe, which lifts off last from the ground as you take another step. The two ways this normal gait can go wrong in your ankle and feet are as follows.

• Supination (underpronation): A rolling motion towards the outside of the foot during each step, causing the feet to appear “pigeon-toed” when standing at rest, meaning the toes point inwards towards each other.
• Overpronation: A rolling motion where the ankle bends inwards, associated with “flat-footedness,” shin splints, a step-motion that goes straight from heal to toe, and a stance that at rest appears “duck-footed.”

To investigate your own gait (investigait, if you will), check the wear pattern on your shoes. If the soles of your shoes are more worn on the inner side of the heel, or the shoes tilt inwards towards each other, you’re an overpronator. If you find excess wear on the outer edges of the soles, or if the shoes when placed together tilt away from one another, you’re a supinator. Either of these can be helped with better shoe choices or by asking for advice from an orthopedist.

Flat Feet and High Arches

Adjacent to the topic of pronation is the distinction between flat feet and high arches.

• Flat feet: When the arch of the foot is lower to the ground, it can cause the foot to appear flat against the ground, which can lead to overpronation.
• High arches (pes cavus): When the arch of the foot runs high, it can cause more weight to be placed on the heel, which leads to instability and supination.

Again, depending on severity, you could try correcting these issues with more appropriate footwear, targeted stretching, or by consulting with a specialist. However, if you’re here for plantar fasciitis, even if you have one of these conditions, that might not be what’s causing the problem, or it might only be a part of it. Some people have flat feet or high arches and never get plantar fasciitis. Likewise some people have pronation issues that stem instead from spinal misalignment or one one leg being longer than the other, and it’s no relation to their arches at all.

In fact, your plantar fasciitis could have nothing to do with your bones and instead everything to do with tissue and muscle tension: tight calf muscles, or Achilles tendons, or back/neck/shoulder tightness that misaligns the body all the way down. Just as the hip bone’s connected to the thigh bone, and thigh to shin, shin to ankle, so one orthopedic issue anywhere in the chain could cause a problem somewhere else.

Any and all of the above could or could not be a contributor to plantar fasciitis. That’s the tricky part of trying to treat it: if you don’t know the underlying cause, then how do you find a solution?

Treatment of Plantar Fasciitis

Most cases of plantar fasciitis can be handled at home with conservative treatments like nonsteroidal anti-inflammatory drugs (such as ibuprofen, the active ingredient in Advil and Motrin IB) or with proper stretching exercises and footwear to alleviate foot pain and guard against future strain. In other cases the condition cannot be fixed simply, and a diagnosis from a doctor may lead to professional plantar fasciitis treatment or surgery. These options may include:

• Night splints: Night splints hold your food in a position that stretches your calf, your plantar fascia, and your Achilles tendon throughout the night, reducing pain in the morning.
• Orthotics: These would be wearable orthotic arch support items either bought or custom-made (anything from shoe inserts to specially made shoes designed for your needs).
• Physical therapy: A physical therapist may be needed to supervise stretches designed to strengthen your lower leg muscles, help stabilize your gait, and apply athletic tape to support the bottom of your foot.
• Injections: Steroid injections into the affected area can sometimes temporarily relieve pain, but are not a long-term solution.
• The Tenex procedure: A minimally invasive procedure designed to take out scar tissue from the plantar fasciitis without a full surgery.
• Plantar fasciitis surgery: Rare and rather extreme, this procedure involves an orthopedic surgeon detaching the plantar fascia from the heel bone. It is a last-ditch effort to alleviate pain when nothing else succeeds, and it results in a weakening of that foot’s arch.

Heal That Heel

If you find the symptoms of plantar fasciitis affecting the bottom of your foot, don’t let it go on so long that it becomes chronic heel pain. Do your research to find the cause or causes of the pain, and start trying the first line of treatment options at home. If the pain persists, contact an expert for advice, and follow that advice carefully so that you can avoid extreme measures, heal your connective tissue, and get back on your feet.