Plantar fasciitis

Are you experiencing pain under your heel or in the arch of your foot? You may be suffering from a condition called plantar fasciitis, sometimes referred to as inflammation of the arch tendon or heel spurs. For information on all these conditions, read on. You’ll find causes, symptoms, and treatments for your heel and foot pain below.

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Finn Johannsen Specialist MD in rheumatology

What is plantar fasciitis?

Pain right under the heel is often the result of an inflammation of the plantar fascia. This is the band-like connective tissue that runs along the bottom of your foot - a little like a thickened bowstring from heel to toes (see the image below).

The plantar fascia

This condition is called plantar fasciitis (Latin for 'inflammation of the plantar fascia'). The plantar fascia functions like a natural ‘spring’ helping your body offset pressure from landing after a jump. It serves as an important shock absorber.

Repetitive overuse of the plantar fascia (such as running, jumping or walking too much) can lead to irritation and inflammation i.e. plantar fasciitis.

Heel spurs can be a related condition in some cases. This is more often the case in athletes with a high load of jumping or running. Heel Spurs refers to calcium deposits at the heel bone, leading to small bony protrusions or 'spurs' forming on the underside of the heel bone.

This may show up on X-rays in patients suffering from foot and heel pain. But in many cases, they may not be the reason for your pain. Heel pain is more often the result of an inflamed foot arch.

Plantar fasciitis

  • Around 10% of the general population will suffer from plantar fasciitis at some point during their lifetime.
  • Plantar fasciitis is most prevalent in those aged between 45 and 64.
  • Plantar fasciitis is Latin and means ‘inflammation of the fascia at the bottom (of your foot)’

The fascia attaches to the tip of each toe, so it also plays a crucial role in everyday activities like walking. It helps stabilize the foot by forcing the toes to bend backwards during movement. This, in turn, helps to tighten and hold the curve of the foot in place, thereby ensuring arch stability.

Causes of plantar fasciitis

Inflammation of the fascia at the arch of the foot is typically caused by extra pressure during activities like running, jumping, unusually long walks or long hours of standing work. A heavy body weight and hard surfaces, also increase your risk. If you suffer from flatfoot or hollow foot, then you are at a higher risk of developing plantar fasciitis.

Symptoms

The most common symptom is heel pain when pressure is put on your foot. The pain is typically worst when you get out of bed in the morning. As your foot warms up, the pain often diminishes to some degree. If the pain is also present during inactivity, then it is common for the pain to be at its worst during the evening after performing activities during the day.

Symptoms of plantar fasciitis

  • The most common symptom related to plantar fasciitis is pain under the foot. The pain is often located in the heel under the foot.
  • Sometimes the pain will radiate outwards from the heel area towards the toes.
  • The pain will typically be at its strongest first thing in the morning after getting out of bed or when walking or standing up after a period of inactivity (such as sitting down).

Diagnosis and treatment

Avoid jumping, running and/or similar activities to relieve pain or discomfort in your foot. Those activities inflame or tax the arch of your foot. You can also try changing your footwear to reduce the pressure on your foot’s arches.

Training

Exercises that stimulate circulation in the damaged tissue can help treat plantar fasciitis. Focus on strength training, which has been shown effective in injury prevention. You may also benefit from stretching the Achilles tendon and the leg muscle, as well as exercises to increase arch stability and mobility in the foot and ankles.

Health facts and statistics about plantar fasciitis

How many people are affected by plantar fasciitis?

It is estimated that plantar fasciitis is one of the most common causes of chronic heel pain. Between 11% and 15% of all adults who see their physician about foot symptoms are diagnosed with plantar fasciitis. In fact, one in ten people will suffer from plantar fasciitis at some point in their lifetime.

Tenderness in the heel is one of the major symptoms related to this condition, particularly amongst older patients who suffer from plantar fasciitis. Approximately 7% of those who aged over 65 will suffer from this problem, with heel pain typically being the symptom most likely to cause them to seek out a diagnosis.

What activities increase the risk of developing plantar fasciitis?

Inflammation of the plantar fascia and the subsequent cascade of symptoms associated with the condition are most commonly seen in those who engage in regular physical exercise. Athletes, runners, joggers – these are just a few of the categories most at risk.

Trying to maintain an active training regime, such as running or jogging, while ignoring the symptoms of plantar fasciitis can worsen symptoms, leading to more chronic conditions. Often, these types of physical activity will lead to intense muscle contractions, particularly in the plantar flexor muscles.

This can cause the plantar fascia to overstretch and thus, become inflamed, leading to muscle strains. This is because the plantar fascia is being forced to alternate between stretching and contracting over a protracted period.

Over time, this leads to micro-tears in the muscle, making the condition worse. While activities such as running and jogging should be avoided during recovery, the injured foot still needs to be treated with the correct types of exercises.

What jobs increase the risk of developing plantar fasciitis?

Activities involving prolonged weight bearing on the foot, such as standing for several hours, increase the tensile load on the fascia and lead to plantar fasciitis. Certain job categories such as hairdressing, sports and the military are associated with an increased risk of developing plantar fasciitis. Football players or soldiers standing guard are typical examples. Prolonged weight bearing on the foot, whether moving or stationary, is enough to cause the plantar fascia to become tensioned and inflamed.

Dancers, orienteering instructors and anyone whose work requires standing or walking on hard surfaces are also at increased risk of developing these types of problems. Studies have shown that plant assembly workers and truck/forklift drivers are another occupational group who are frequently diagnosed with plantar fasciitis.

Who is more at risk of developing from plantar fasciitis?

Certain groups of people have a higher risk of suffering from plantar fasciitis than others. Statistics reveal that 70% of all those diagnosed with plantar fasciitis are clinically obese (have a body mass index over 30), showing a clear link between high BMI and plantar fasciitis.

In fact, if you have a BMI over 30, you are five times more likely to suffer from these kinds of mobility issues than those with a lower value.

Demographically, the highest incidence of plantar fasciitis tends to occurs in middle-aged, clinically obese women but is also very common in in young male athletes. Pre-existing conditions, such as spondylarthropathy will also place you at greater risk of developing plantar fasciitis, as will a family history of similar issues.

Age is another risk factor. The prevalence of plantar fasciitis tends to peak between the ages of 45 and 64, but as a general rule, the older you are, the higher your risk becomes for developing the condition.

Exercises for Plantar fasciitis

  1. Glute exercise for pelvic balance
    10 reps x 3 sets

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    • Stand up with an exercise band around both legs at the ankle.
    • Put all your weight on one leg and make sure to keep your hip, knees and toes pointing in the same direction.
    • Lift the other leg, let your toes point forward and slightly inwards towards the other leg, so that your heel is pointing outwards.
    • With your heel pointing outwards, move your leg backwards and out.
    • Keep your body steady by tightening your abdominal muscles.
    • Gather your legs slowly, change leg and perform the same exercise to the other side.
    • Perform 3 sets of 10 repetitions with each leg.
  2. Heel lift on a flat surface I
    10 reps x 3 sets

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    • Stand up.
    • Lift yourself up on your toes with both legs.
    • Move your weight to one of your legs and slowly lower your heel back down.
    • Perform 3 sets of 10 repetitions.
  3. Heel lift on a thick book with towel I
    10 reps x 3 sets

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    • Stand with your toes on a coiled cloth placed on top of a thick book.
    • Lift yourself up on your toes with both legs.
    • Move your weight to one of your legs and slowly lower your heel back down.
    • If you have a hard time keeping your balance, you can place your hand on a chair for support but be careful not to use the chair too much.
    • Perform 3 sets of 10 repetitions with each leg.

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About the author

Finn Johannsen is a specialist MD of rheumatology with a diploma in sports and musculoskeletal medicine, as well as an award-winning specialist in rehabilitative treatment of sports and work-related injuries.