Pain in the Plantar: FAQ about Plantar Fasciitis

By Omar Shamout

Our feet carry a big burden around with them every day—namely, us. The amount of stress we place on our feet can be detrimental to our health if we don't take the proper precautions to ensure that their needs are being met. A vital juncture in the anatomy of the foot is the heel—it provides the primary posterior point of support while walking or running, and it is also the area where the connective tissue is formed that creates the arch of the foot. Up to 2 million people in the United States suffer from some form of foot or heel pain each year. Let's examine one of the most prevalent foot ailments, plantar fasciitis, to understand why it occurs, what we can do to prevent and treat it, and what other injuries it puts you at risk for.

What is this plantar fasciitis business?

Like all repetitive use injuries, plantar fasciitis is a product of our own making. Plantar fasciitis is a medical condition that occurs when the fibrous tissue on the sole of your foot known as the plantar fascia becomes inflamed due to overuse, a condition that can be made worse by improper foot mechanics while walking and/or running. This connective tissue near the heel is the center of weight distribution and helps maintain the arch in your foot. Therefore, even a slightly off-kilter stance or landing position of the foot can place a lot of extra stress on an already heavily worked area. The fascia is susceptible to a small amount of tearing, and when the fascia is overused, these tears can lead to an inflammation in the tissue.

Plantar fasciitis may not happen overnight, though the stabbing pain associated with it definitely worsens during sleep, when the tissue tightens up while not being used. The first few steps in the morning are often the worst of the entire day as the tissue remembers that it's still angry with you for not taking care of it properly.

And who gets it?

The condition is more prevalent among the overweight, pregnant, and middle-aged, though it can occur in all age groups, depending on exercise type and frequency.

Yikes! How do I prevent it?

Plantar fasciitis can be described as a sort of gateway injury, because it leads to other injuries that we'll discuss later. Taking proper care to prevent it will also aid in staving off related problems down the line.

According to the Mayo Clinic and the Plantar Fasciitis Organization, proper support is crucial to avoiding this painful condition, especially among those who run frequently or stand for long periods of the day, so make sure your shoes fit and have sufficient arch support. Also, be aware of when it's time to buy new cross-trainers. If you've logged more than 500 miles in any pair of shoes, it may be time to consider heading to the store for a new pair.

That said, there is a school of thought that wearing running shoes may actually increase the likelihood of impact-based injuries like plantar fasciitis because they promote heel-first impact, adding much more stress to the foot. Barefoot runners have a much greater tendency to land on the balls of their feet, reducing the force of the impact, and their risk of heel or ankle injury. However, there are other obvious risks that need to be factored in when deciding whether or not to go shoeless, especially for city-dwellers who run outdoors. (The Mayo Clinic does advise against barefoot running, especially on hard surfaces.) Inexperienced runners would be advised to ease into barefoot running slowly, as their calf and foot muscles would need time to acclimate to a new gait.

Okay, got it. But what about those other injuries you mentioned?

Here are two of the more common medical conditions associated with plantar fasciitis.

1. Heel spurs. A heel spur is a hook that forms on the heel bone at the bottom of your foot, where the plantar fascia is most likely to become inflamed. It's easy to confuse the symptoms of a heel spur with those of plantar fasciitis, because the pain associated with each condition can be similar. While about 70 percent of plantar fasciitis sufferers also have a heel spur, it's possible to have a heel spur without any other symptoms, and only an X-ray will provide a conclusive diagnosis.
2. Tarsal tunnel syndrome. The tarsal tunnel is the area of the foot between the fibrous plantar fascia tissue and the bone where the tibial nerve is located. Tarsal tunnel syndrome, which is analogous to carpal tunnel syndrome in the hands and wrists, occurs when the nerve in this narrow passageway becomes pinched. One common symptom is numbness along the bottom of the foot, along with pain such as burning or tingling. Specific tapping tests performed by a doctor, along with electrodiagnostic exams, are the only way to properly diagnose the disorder.

In addition to repetition and overuse, other medical conditions, including fractures, arthritis, spurs, ganglions, and tumors, can contribute to the onset of tarsal tunnel syndrome by adding further stress to the region and causing the nerve to become more restricted. Those with plantar fasciitis are more susceptible to the problem.

Ow! My feet hurt just reading that. If I have these conditions, how do I treat them?

There are several things you can do for plantar fasciitis and heel spurs.

1. Get rest. Rest is the best way to treat plantar fasciitis. Your tissue needs time to heal, and staying away from high-impact activities is essential for at least several days.
2. Maintain a healthy weight. High-impact exercise exerts a lot of stress on your feet, and any extra pounds will have a negative impact on your podiatric health.
3. Wear shoe inserts. Shoe inserts, like orthotics, can be worn to provide additional protection. Sometimes night splints are also used to prevent the arch from tightening up overnight.
4. Apply ice packs. You can also apply an ice pack 3 to 4 times a day for no more than 20 minutes when the pain is severe.
5. Take anti-inflammatory medications. Some, like ibuprofen or naproxen sodium, can be purchased over the counter; others can be prescribed by your doctor.
6. Stretch. Take care when you wake up in the morning to stretch your feet around a little before getting out of bed. At first you may even want to step directly into your training shoes so your arch stays supported. (Soon it will be strong enough that this additional "step" won't be necessary.)
7. Ease back into your normal routine. Take it easy—get back into the swing of things slowly, because if you continue to push yourself through the pain, your plantar fasciitis could easily turn into a chronic condition.
8. Tape your foot. Taping your foot can provide support and relief while you're on the mend.

Is there anything I can do that's a little more proactive, like exercises or something?

While we can't replace the guidance of a qualified physical therapist in one short article, here are three exercises courtesy of Beachbody's own Steve Edwards that will help alleviate—and possibly even prevent, if begun early enough—the pain caused by plantar fasciitis:

1. Sit with feet flat. Place your fists together between your knees and squeeze your knees together, not hard, just enough pressure to keep your fists from falling (you can use a small ball as well). Rotate your feet inward until your toes touch (or nearly touch), keeping the weight on the outside of the foot. Then rotate your feet outward, raising your toes and keeping the weight on the inside of the foot. Do sets of 40, once or twice a day.
2. Sit in a chair on a tile (or slippery) floor. Place a small towel (like a washcloth) on the floor with your toes at the edge. Use your toes to scrunch up the towel, then go the opposite way and push it back out until it's flat again. Start slowly but build up until you can do this over and over.
3. Stand on one foot. (Hold on to the back of a chair with one or both hands if you need help balancing.) Curl your toes so that your foot bunches up, then press it as flat as you can toward the floor. Do 40 reps. Switch feet.

And what about tarsal tunnel syndrome? How do I treat that?

Doctor-prescribed oral anti-inflammatory medication or a cortisone injection is a typical treatment for the problem. Foot inversion through the use of orthotics is also used to relieve pressure around the nerve. If these are not successful, a surgical procedure known as a tarsal tunnel release, which creates an incision in the area in order to relieve compression, may be required.

Heel pain may be diagnosed in different ways, but the key to preventing its various forms is the same. Know your limits, and allow your body time to recover between high-impact workouts. If you frequently find yourself in pain following these types of routines, consider trying a low- or no-impact routine to help ease the pressure and stress on your heel and foot. Ignore telltale signs of heel pain at your own peril, because these conditions are known to recur, and can end up causing you problems for a very long time.