How To Know If You Have Plantar Fasciitis (And How To Get Rid Of It)
When it comes to wellness, all we really want are clear answers and advice from people who know what they're talking about. That's why we love Ask the Foot Doctor: Real-Life Answers To Enjoy Happy, Healthy, Pain-Free Feet by Doug Tumen, DPM. If you've ever wondered "why does my foot hurt?" or "what's going on with my foot?" this book is sure to have an answer for you. Tumen uses every chapter to delve into different issues that can arise with our feet, explaining how the issue came to be, why (if you have it) you have it, and gives honest, knowledgeable advice to help you get to the bottom of the problem and fix it for good. In other words, this book is a foot bible. The below excerpt is from his chapter on plantar fasciitis—one of the most common foot ailments out there.
I am often asked what is the most common painful condition we treat in our practice. My answer is always the same: plantar fasciitis. In our offices, not an hour goes by without seeing a patient for treatment of a painful heel. This condition has sidelined many a professional athlete—quarterbacks Peyton Manning, Eli Manning, and Drew Brees have all suffered through seasons of painful plantar fasciitis—and it can hobble us mere mortals too, driving out all thought except the pain from each and every step we take.
Plantar fasciitis spares no one, from runners and athletes to moms, seniors, and everyone in between. If you see someone limping, there is a good chance they are being tormented by this condition. Over the last 30 years, plantar fasciitis seems to have risen to the status of an epidemic or close to it. The good news is we have a multitude of treatments for this condition that resolve the pain. Consult your foot specialist about the best option for you, and don't let plantar fasciitis keep you out of the game.
In the meantime, here are some answers to the most common questions and concerns I hear in my practice.
How do I know if I have plantar fasciitis?
Have you ever woken up in the morning, swung your legs out of bed, stood up, and felt terrible heel pain? That's a classic sign of plantar fasciitis, which affects the thick band of connective tissue on the bottom of the foot. The band (the plantar fascia) supports four layers of muscles running from the heel through the arch of your foot to your toes. Pain is usually felt where the plantar fascia attaches to the bottom of the heel bone. When it becomes irritated and inflamed, you can count on the plantar fascia to speak out.
But shouldn't my heel feel better after a night's rest?
You would think so, but while you sleep or rest off your feet, the plantar fascia contracts and tightens. Just like any other body part might get a little stiff after you sit, so does this injured connective band. When you stand again, the contracted plantar fascia pulls tightly on the heel bone where it is attached and inflamed—"Ouch!"
My heel hurts all of the time, not just after resting.
You may feel the pain from an irritated plantar fascia some of the time (like when you're standing), or most of the time, or in severe cases, all of the time. The most common pain point is the heel, but the pain often extends into the arch. If untreated, the condition may worsen. Patients frequently come into our office limping because they have waited too long to seek treatment and now can't put any weight on the heel because of the pain.
Why did I get plantar fasciitis?
If you asked a dozen different doctors this question, you could get a dozen different answers and each might be correct for a particular case. There are many causes of an inflamed plantar fascia. Let's look at what I consider the top five reasons for this type of heel pain. Of course, more than one factor can contribute to developing plantar fasciitis, and it is not uncommon for a combination of circumstances to add up to one terrible pain in the heel.
1. The sports you play
Stress, trauma, and overuse from participating in sports often irritate the plantar fascia. About 10% of all runners and athletes will suffer from heel pain at some point. Athletes find plantar fasciitis particularly frustrating to deal with for two reasons. First, it can be difficult to treat while continuing to participate in a sport, and most runners and athletes can't stand to miss a game, a run, or an event. And second, this condition does not always heal as quickly as other injuries athletes frequently contend with.
2. The extra weight you carry
I often tell my patients to pick up a 10-pound box and see how long it takes for their arms to tire out. It's usually only minutes before the box gets really heavy. When we put on weight, our feet have to carry those extra pounds around every day. They get tired and stressed, and the structures on the bottom of the feet responsible for holding it all up can get overworked and damaged. The good news is we can treat and cure plantar fasciitis regardless of body frame and current size, so you don't have to wait to reach the perfect number on the scale to get relief. Of course, I am an advocate for nutritious food choices and exercise. Any changes you make toward a healthier lifestyle are always appreciated by your feet!
3. The shoes you wear and the surfaces you work and walk on
Your shoe choices matter when it comes to heel pain. Flip-flops, thin-soled sandals, and slip-on flats offer minimal protection for the bottom of the feet, making the plantar fascia vulnerable to irritation and inflammation. Also, when your shoes get too old, the shock-absorbing materials wear out. More shock then goes into your feet, which can lead to painful heels. If you have a job where you are on your feet all day, you are more likely to develop plantar fasciitis because the hard, unyielding surfaces we work, shop, and walk on amplify the impact and stress on our feet.
4. The foot structure you were born with
There are three basic foot types: the flat foot, the normal arch, and the high-arched foot. Of course, there are millions of variations of each type, as no two feet are exactly the same, not even the two in a pair. In general, the flat foot is too flexible and tends to excessively roll inward when walking. This is called pronation, and it can contribute to stressing the plantar fascia and causing heel pain. A high arch can also lead to strain on the foot. High arches are usually rigid, which means they are poor shock absorbers. The extra wear and tear from taking a higher impact can irritate the heel.
5. The stuff you step on
I have seen countless patients who have stepped on something and triggered plantar fasciitis. Typical scenarios include stepping barefoot on a rock in the garden or driveway (known as a "stone bruise") and stepping on a child's toy in the house (I call this the "toy story"). Some parents have found their feet have a particular knack for finding Lego bricks in the dark. This kind of direct minor trauma can set off an inflammatory reaction that results in a painful episode of plantar fasciitis.
What can I do to self-treat my painful heel?
Self-treatment can be successful if begun early. First and foremost, try to figure out what may have triggered your heel pain. Can you link your pain to a recent activity such as jogging, playing with the kids, shopping, visiting a museum, or even just a change in shoe style? If you suspect a connection, take a break from that activity until your heel feels better. You can also try the following recommendations:
Inspect and evaluate your shoes.
Are the soles of shoes worn down or the cushioning deflated? Do you need a new pair? How long has it been since you went shoe shopping? Choose shoes with a firm, thick sole. Women should avoid flat shoes and slip-ons. Believe it or not, a higher heel or wedge shoe is better for heel pain that a flat shoe, so change to shoes with an elevated heel. A clog can also be a good choice. A running sneaker usually has lots of shock absorption and cushioning, which can help too.
No bare feet.
Not even in the house. Slip your feet directly into a shoe when you get out of bed. Continue to protect the heel until it gets better.
Ice your foot.
Ice therapy is a great anti-inflammatory treatment, and benefits are significant. It is easy to do, and you can fit it in around your schedule.
You can use an ice pack. I usually recommend a bag of frozen peas. The bag is flexible, covers a good amount of real estate on your foot, and is reusable without fuss or muss.
For those who are hearty, an ice bath is a good option. Put your painful foot into a bucket of water and add ice. An ice bath is mighty cold, but it's a great pain reliever. Professional athletes often soak their entire bodies in an ice bath to reduce aches and pains to get ready for the next game.
Another icy treatment is to put a bottle of water in the freezer and then roll the frozen water bottle back and forth over your heel and arch. This is a terrific way to combine deep massage and cool therapy.
Try topical anti-inflammatories.
Along with ice, any over-the-counter topical anti-inflammatory agent can offer pain relief and swelling reduction.
Keeping your calf muscles stretched is important for resolving heel pain. The more you stretch, the better. The two best stretches are the wall stretch and stair stretch.
How to do a wall stretch:
- Place both hands on a wall with your heel flat on the floor, and simply lean in and feel the stretch in your calf muscle.
- Do this stretch both with your knee straight and then bent to most effectively stretch all the muscles in your calf.
- Stretching should not cause pain. Just lean until you feel the stretch, and hold it for a few seconds.
- Repeat a number of times. Then repeat daily and often.
How to do a stair stretch:
- Stand on a stair and let your heel hang backward off the end of the stair as if it were reaching to the stair below.
- Hold for 2 to 3 seconds, then lift up your heel and relax.
- Repeat about 10 times.
- Hang on to the railing for balance as necessary. Again, just feel the stretch, and back off if you feel pain.
In general, any additional cushioning or support under your heel and foot can reduce pain and make walking more comfortable. Prefabricated arch supports and heel cups are the first line of therapy for heel pain.
Know that you can get better.
Plantar fasciitis is one of the most common, painful problems affecting the foot and can suddenly stop life in its tracks. Now that you know the real deal on heel pain, you no longer have to suffer. Foot specialists treat plantar fasciitis on a daily basis, and we are happy to report if you have plantar fasciitis, you can become one of the many who one day say, "I had plantar fasciitis."
Adapted and reprinted from Ask the Foot Doctor: Real-Life Answers To Enjoy Happy, Healthy, Pain-Free Feet by Doug Tumen, DPM. Ask the Foot Doctor is available wherever books and e-books are sold.
Dr. Doug Tumen is a board-certified podiatrist with 35 years of experience in treating tens of thousands of patients. He is a founding partner of Hudson Valley Foot Associates in Kingston, New York. He earned a Bachelor of Arts and Sciences, Cum Laude, from University at Albany, New York. He received a Doctor of Podiatric Medicine from Illinois College of Podiatric Medicine in Chicago. His residency was performed at Veterans Administration Hospital in Chicago. He is a Diplomate of the American Board of Podiatric Surgeons- Board Certified in Foot Surgery and a Fellow of the American College of Foot and Ankle Surgeons. Doug is the author of Ask the Foot Doctor.