The stabbing heel pain of plantar fasciitis
By Howard Seidman, Staff Writer, myOptumHealth
Plantar fasciitis is a common foot problem that can affect anyone who plays basketball or tennis or runs long distances. It can also strike non-athletes who walk, stand or climb stairs often. The problem can be debilitating for people whose work includes a lot of walking or standing, like postal workers, nurses or wait staff.
Unlike common strains, sprains or even tendonitis, plantar fasciitis can cause a sharp, knifelike pain in the heel or arch of the foot.
Plantar fasciitis is an overuse injury. It may be caused by changes to the intensity or frequency of physical activity. For runners, a change in terrain or running surface can be factors.
Other factors that may contribute to plantar fasciitis include:
- Having flat feet (low arch)
- Having high arches
- Walking with excessive foot rotation
- Wearing poor footwear (bad heel or arch support)
- Being overweight
- Having diabetes
- Becoming very active in a short period of time
What is plantar fasciitis?
This problem comes from tiny, repetitive tears in the foot’s plantar fascia. This is a band of tissue starting at the heel that runs the length of a foot. It works like a rubber band between the heel and the ball of a foot, and forms the arch. A short band results in a high arch. A long one makes a low arch (flat feet).
A pad of fat in the heel covers the plantar fascia to absorb the shock of walking. When the plantar fascia is damaged, it can cause swelling and heel pain.
Pain may peak after periods of inactivity, like when you get out of bed. It can get worse at the start of workouts but ease somewhat during exercise. Because repetitive activities put persistent stress on the plantar fascia, you’ll need to modify activities to avoid making plantar fasciitis worse.
Treatment for plantar fasciitis
Treatment of plantar fasciitis is similar to most overuse injuries. Follow the PRICE principles:
Protection and rest mean you must stop activities that cause pain. You can often still keep up your fitness level with low-impact activities like swimming, bicycling and weightlifting. Check with your doctor first.
Ice on the bottom of the foot may help after exercise or at day’s end. But if you have diabetes or problems with the nerves or circulation in your feet, you should not use ice. Ask your doctor first if you have any of these problems.
Compression may include taping the sole of the foot or wrapping the foot. This has only been proven to help during the first week. Padded shoe inserts – orthotics – may also help. Orthotics may help support arches and correct foot alignment.
Elevate your foot while sitting or lying down to reduce swelling. Anti-inflammatory drugs (such as ibuprofen or naproxen) may give you limited relief. Check with your doctor to make sure these medications are safe for you.
Ask your doctor about whether a foot splint may help your pain.
In more serious cases, your doctor may suggest an injection of steroid medication to reduce swelling and pain.
If your heel pain lasts for six months or more and doesn’t respond to conventional treatments, your doctor may suggest plantar fascia release surgery. Part of the plantar fascia ligament is cut away during this procedure to release tension and swelling in the ligament.
Treatment for plantar fasciitis usually includes strength training and stretching. Frequent stretching may help keep the plantar fascia loose and elongated.
Choosing proper running shoes may help manage your plantar fasciitis. Pick shoes with a good heel counter and reasonable mid-foot flexibility. Custom-made orthotics can help improve the fit of sneakers.
Buy new running shoes every 500 miles or so. Shoes lose the ability to absorb the shock of running beyond this distance.
- Crawford F, Thomson C. Interventions for treating plantar heel pain (review). The Cochrane Library. 2008(2):1-42. Accessed: 06/17/2008
- Cosca DD, Navazio, F. Common problems in endurance athletes. American Family Physician. 2007;76(2):237-244.
- American Academy of Family Physicians. Plantar fasciitis: a common cause of heel pain. Accessed: 06/17/2008
- Pasquina P. Plantar Fasciitis. In: Frontera WR, Silver JK. Frontera: Essentials of Physical Medicine and Rehabilitation. Philadelphia, PA: Hanley and Belfus; 2002.