What is Plantar Heel Pain ? Symptoms , Causes & Treatment

What is Plantar Heel Pain?

Plantar Fascia is a thick, fibrous band of tissue that runs along the sole of your foot from the heel to the toes. Plantar fascia:

Connect the heel bone to the base of the toe.
Connect the bones in your foot.
Form the arch on the bottom of your foot.

Plantar Heel pain, or Plantar Fascia, is the inflammation of the plantar fascia due to overuse or overstretching. Overuse or overstretching causes the fascia to lose its elasticity, and therefore, it gets irritated when you walk or place weight on your foot. Plantar fasciitis is a common condition that causes heel pain.

What are the Symptoms of Plantar Heel Pain?

You know you have Plantar Heel pain if you feel a stabbing pain in your heel or at the bottom of the heel when you make your first step in the morning. Pain may also be felt when you begin an activity such as running, but it decreases with time. You may also feel pain when you stand after spending long hours sitting down.

Other symptoms of Plantar fasciitis.

Other symptoms of heel pain include:

Stiffness.
Pain in the arch of your foot.
Tight Achilles tendon.
Sudden pain.
Swelling around your heel.

Plantar heel pain can happen due to overuse, however, some factors trigger Plantar fasciitis. Below are pain triggers:

Overweight. Obesity or too much weight adds extra pressure on your plantar fascia.

Age. If you are over 40 years old, you risk getting Plantar heel pain.

Work or Occupation. If your occupation causes you to spend many hours walking or standing, you are at risk of getting Plantar heel pain. Examples of this occupation are factory workers and guards.

Exercises. Some exercises that stress your heel include: long-distance running, aerobic dancing and ballet dancing.

Foot mechanics. Your walking style or pattern of your feet, such as flat feet or high arch feet, affects the weight distribution in your feet, especially when standing, walking or exercising.

Try also: Physiotherapy

What are the Causes & Risk Factors of Plantar Heel Pain?

Primary cause:

The primary cause of plantar fascia is repeated stretching and tearing of the fascia. Fascia absorbs shock when you walk, and repeated stretching causes more tension and stress that irritates and inflames your fascia.

You get to overstretch the sole of your foot while exercising. The small tears in the fascia cause pain that may lead to plantar fasciitis.

Biomechanical issues:

Flat feet mean that you have little or no arch in the sole of your foot. Flat feet change the way you walk since your arches are too weak to hold too much pressure. The stress and tension may cause pain and inflammation in the plantar fascia.

High arch feet mean that you have high arches that never flatten to touch the ground, even when you put weight on them. You know that you have high arch feet if the middle part of your foot doesn’t show a footprint when you step on the ground.

High arches put too much pressure on the ball, heel, and other parts of the toe when you walk, and this may lead to discomfort or injury.

It’s difficult for high-arch feet to absorb shock and adapt to even surfaces. High arch feet biomechanical issues make your foot roll from the outside of the foot to the inside when you walk.

Tight calf muscles make it difficult for your ankle to bend properly. The pressure or strain goes to the heel bone and then to the plantar fascia. Too much tension in the plantar fascia leads to plantar fasciitis.

Lifestyle factors:

Obesity or being overweight causes plantar fasciitis. Naturally, your feet and lower leg carry the weight of your body. Excess weight means that a lot of pressure is placed on the lower limb and your plantar fascia will strain to support the foot arch in the right way and distribute weight through your foot. Sudden weight gain can lead to severe pain in the heels and arches.

As an athlete, you’re likely to get plantar fasciitis due to an increase in distance, intensity and frequency that may overstretch or stress your fascia. Your fascia is made of collagen that does not stretch too much, overtraining and increasing distance may lead to injury, swelling and pain in your lower foot.

If your occupation requires you to stand for long hours, such as waiters or factory employees, you are at greater risk of plantar fasciitis. Constant pressure due to long periods of standing or walking strains your ligaments.

Footwear:

If your footwear does not support your foot adequately, it puts excess pressure on the plantar fascia and causes a strain. Examples of such shoes include: flip-flops, minimalist running shoes and ballet flats.

Activities:

Sudden increases in physical activity, such as excessive training, increasing running distance and speed, can strain your plantar fascia.

Lack of enough activity can also lead to plantar fascia, this is because while resting your plantar fascia is shortened and stiff. Regular activities such as jogging, stretches and gym workouts make your fascia strong and flexible.

Running causes your fascia to stretch and contract severally, and this may lead to swelling, microtears and pain in the fascia.

Diagnosis & When to See a Doctor

Plantar fasciitis is diagnosed through physical examination, medical history, imaging tests, and many other diagnostic procedures. Below is how plantar fasciitis is diagnosed:

Physical examination.

The doctor asks about your symptoms and may examine the foot to understand the root cause. The doctor examines your foot by lightly pressing your plantar fascia to check for swelling and pain levels.

Medical history.

Medical history focuses on understanding the intensity of pain, timings, onset, and location of the foot where you feel pain.

The doctor may ask you about the pain you experience daily for example while playing or performing your daily duties. The doctor may also ask where you feel more pain.

Xray.

An x-ray is suggested when your symptoms fail to improve, or when the doctor notices unusual symptoms. An X-ray may be used also when there is a risk of an existing condition, injury or disorder.

X-ray shares images of your plantar fascia. An X-ray may show a pronated foot or bony spur. Around 50% of patients with plantar fasciitis also have bony spurs.

Ultrasound.

An ultrasound is one of the most effective ways of examining plantar fasciitis. Ultrasound shows a thick fascia, formation of bony spurs, frequent calcification around the soft tissues of your hee, fat pad oedema, and degeneration.

MRI

Magnetic resonance imaging uses images to check the surrounding soft tissues. MRI assesses how thick the fascia is, bone tumours, pinched nerves and soft tissue lesions. MRI is mainly used to assess the cause of recalcitrant heel pain.

During an MRI, the doctor may notice:

A ruptured plantar fascia.
Achilles tendonitis.
Calcaneal stress fractures.
An increase in the signal intensity in the substance of the plantar fascia.
Generalised thickening of the plantar fascia.

Seek medical help if you notice pain that doesn’t go away in 2 weeks, pain that causes you to limp or pain that disrupts your sleep.

Treatment Options for Plantar Heel Pain

Applying ice to the area of treatment helps in reducing pain and inflammation. Wrap ice with a piece of cloth, and place it on the area of treatment for 15 minutes at least 3 times daily. You can also do an ice massage therapy where you roll frozen bottles under your foot. This helps in blood circulation, which promotes healing.

Over-the-counter pain relievers such as Ibuprofen and Naproxen help reduce the pain and swelling of plantar fasciitis.

Walking boots and crutches prevent you from putting more weight on your foot. Walking cats hold your foot in position and take off pressure from your plantar fascia. Your healthcare provider will recommend the number of days you are required to wear walking boots.

Orthotics help in the even distribution of pressure on your feet. Shoe inserts provide extra arch support. Always add them to your shoes before engaging in a running activity. Your healthcare provider may recommend pre-made inserts or custom-made orthotics. Custom-made orthotics are designed according to the shape of your foot. They can be the best option if you have flat feet or a biomechanical issue.

Night splints stretch your Achilles tendon and plantar fascia when you sleep. For night splints to work effectively, wear them each night before sleeping. Other functions of the Night splint include:

Stretching the calf muscle.
Supporting the arch of your foot.
Holding the plantar fascia and Achilles tendon in an elongated position.

During physical therapy, your physical therapist recommends workouts to stretch the plantar fascia and Achilles tendon and strengthen the lower leg muscles. Athletic tape offers support to the bottom of your leg.

Corticosteroid injections offer temporary relief. Your doctor injects the steroid medicine into the tender area to relieve pain. Your doctor may use ultrasound imaging to determine the right place to inject. It’s not recommended to have multiple injections since they can make your plantar fascia weak and cause a rupture.

Extracorporeal Shockwave Therapy involves directing sound waves to the area of treatment to stimulate healing. ESWT is recommended for people with chronic plantar fasciitis. You are said to have chronic plantar fasciitis if your fascia has not responded to previous treatment for a long period.

Ultrasonic tissue repair uses ultrasound images to direct the needle to the area of treatment. When the probe tip gets to the damaged plantar fascia tissue, it vibrates intensely to break the damaged tissue, which is later removed.

In rare cases, the doctor may recommend Plantar fascia release. Plantar fascia release involves making tiny cuts in your plantar fascia to relieve some extra tension. This surgery option is recommended only when the pain is so serious and other treatments have not worked for you.

Prevention Tips.

Managing your weight helps you regulate the amount of pressure on your plantar fascia. Heavy weight puts extra pressure on your fascia therefore putting you at risk of plantar fasciitis.

Replace your worn-out shoes with new ones. Old and worn-out shoes may not cushion and support your feet correctly.

Have stretching routines before and after a workout to stretch your arches. Stretch your calf muscles, Achilles tendon and plantar fascia to prevent plantar fasciitis. Below is an example of a calf and Achilles stretch:

Stand with your feet parallel
Move your right leg back and slowly bend your left knee.
With your right foot straight, slowly lower the right heel and ensure it is flat on the floor.
Ensure that your back foot is pointing straight ahead.
To activate your Achilles and calves, bend your left knee and press your back heel down
Repeat the same procedure on each foot.
How far you bend your knee gauges the depth at which you stretch your Achilles tendon and calves.

Supportive footwear with arch support and cushioning protects your plantar fascia from too much pressure during athletic activities. While buying athletic shoes, ensure that they have a low or moderate heel, a good support arch and are well cushioned. Flat shoes and walking barefoot put you at risk of plantar fasciitis.

Interchange your sports weekly to avoid overstressing your fascia. For the first two days, you can go for a walk, run or even jog, the next day try low-impact exercises such as bicycling and swimming.

Can plantar fasciitis become chronic?

Plantar fasciitis is said to be chronic if you have been suffering from symptoms for more than 4 weeks.

Chronic plantar fasciitis can be treated through:

Corticosteroid injections.
Platelet-rich plasma injections.
Extracorporeal shock wave.

Are heel spurs the same as plantar fasciitis?

Heel spurs and plantar fasciitis are different, however, they can be the cause of your heel pain. A heel spur is a result of bone growth, while plantar fasciitis happens as a result of swelling of the plantar fascia, a ligament that runs at the bottom of your foot from the heel bone to the toes of your foot.

Plantar fasciitis develops at the bottom of the foot, while bone spurs develop near a joint where two or more bones meet.

Plantar fasciitis is found on your foot, while heel spurs can be found in the Knee, hands, hip, foot, ankle, spine and shoulder.

Plantar fasciitis is painful, while a heel spur can be painless in the beginning, but with time can lead to pain and loss of motion in joints.

Symptoms of plantar fascia include: Pain after an activity, pain when you stretch your foot, and sharp pain at the bottom of your foot.

Symptoms of Heel spur include: Inflammation on the front part of your heel, sharp pain in the heel when you stand in the morning and a dull ache during the day.
Also read: Common Running Knee Injuries & Their Treatment

Can I still exercise with plantar heel pain?

Yes, you can still exercise with plantar heel pain. However, you need the right exercise to avoid exacerbating the pain. Low-impact exercises such as swimming, cycling, and yoga prevent the symptoms.

Seek advice from an orthopaedic on the type of stretches and strengthening exercises that focus on your foot, ankle and lower leg. Stretches relieve pain and strengthen your plantar fascia to enhance flexibility.

If you are a runner, take a rest and avoid high-impact exercises such as running and jumping since they put stress on your feet and ankles. High-impact exercises also trigger muscle tightness and stress injuries. Warm up before an activity and cool down after an exercise to avoid plantar Fasciitis.

What’s the best shoe for plantar heel pain?

The best shoe for plantar heel pain is one that cushions the heel and provides arch support to relieve pain and manage plantar fasciitis.

As a runner, you should look for shoes that distribute weight evenly, support your feet and reduce strain. Before buying a running shoe, ensure that it:

Can absorb shock.
Support your heel.
Provide good arch support.
Well-cushioned insole.
Enough room for your toes.
Thicker heels.

If you have plantar fasciitis, avoid the following types of shoes:

Flip-flop shoes. Flip-flop shoes have no arch support.
High heels. High heels put more pressure on your plantar fascia.

Always ensure to shop for your shoes to try various options and choose according to your preference. If you experience pain while wearing your shoes or your plantar fasciitis gets worse while wearing a specific shoe, contact your healthcare provider. Your doctor will examine the root cause of the pain and suggest the right shoe to wear for your running activity.

Do massage guns or ensure to shop for your shoes and puncture help?

Yes, massage guns help with plantar fasciitis since they help in loosening tight muscles and increase the flow of blood in the affected area. Loosening tight muscles reduces stiffness and blood circulation helps with reducing soreness.

While using a massage gun begin with a lower intensity and increase according to your comfort. For maximum effect use a massage gun for 10 minutes a day daily.

Why does my heel hurt more at night?

Your heel hurts more at night due to your sleeping position. When you sleep with your feet pointing downwards, your fascia relaxes causing early morning pain especially when you stand or stretch.

Wearing night splints works by stretching your foot arches and calves when you sleep. You don’t have to wear night splints after the pain is gone.

Can weight loss improve plantar heel pain?

Yes, weight loss can improve plantar heel pain. Excess weight puts pressure on the plantar fascia therefore contributing to plantar fasciitis. Weight should be evenly distributed in your plantar fascia, their weight loss can improve plantar heel pain. You can lose weight by reducing the amount of meals you take per day and exercising.

What is Plantar Heel Pain ? Symptoms , Causes & Treatment

What is Plantar Heel Pain?

Plantar Fascia is a thick, fibrous band of tissue that runs along the sole of your foot from the heel to the toes. Plantar fascia:

Connect the heel bone to the base of the toe.

Connect the bones in your foot.

Form the arch on the bottom of your foot.

What are the Symptoms of Plantar Heel Pain?

Other symptoms of Plantar fasciitis.

Other symptoms of heel pain include:

Stiffness.

Pain in the arch of your foot.

Tight Achilles tendon.

Sudden pain.

Swelling around your heel.

Plantar heel pain can happen due to overuse, however, some factors trigger Plantar fasciitis. Below are pain triggers:

Overweight. Obesity or too much weight adds extra pressure on your plantar fascia.

Age. If you are over 40 years old, you risk getting Plantar heel pain.

Work or Occupation. If your occupation causes you to spend many hours walking or standing, you are at risk of getting Plantar heel pain. Examples of this occupation are factory workers and guards.

Exercises. Some exercises that stress your heel include: long-distance running, aerobic dancing and ballet dancing.

Foot mechanics. Your walking style or pattern of your feet, such as flat feet or high arch feet, affects the weight distribution in your feet, especially when standing, walking or exercising.

What are the Causes & Risk Factors of Plantar Heel Pain?

Primary cause:

The primary cause of plantar fascia is repeated stretching and tearing of the fascia. Fascia absorbs shock when you walk, and repeated stretching causes more tension and stress that irritates and inflames your fascia.

You get to overstretch the sole of your foot while exercising. The small tears in the fascia cause pain that may lead to plantar fasciitis.

Biomechanical issues:

Flat feet mean that you have little or no arch in the sole of your foot. Flat feet change the way you walk since your arches are too weak to hold too much pressure. The stress and tension may cause pain and inflammation in the plantar fascia.

High arch feet mean that you have high arches that never flatten to touch the ground, even when you put weight on them. You know that you have high arch feet if the middle part of your foot doesn’t show a footprint when you step on the ground.

High arches put too much pressure on the ball, heel, and other parts of the toe when you walk, and this may lead to discomfort or injury.

It’s difficult for high-arch feet to absorb shock and adapt to even surfaces. High arch feet biomechanical issues make your foot roll from the outside of the foot to the inside when you walk.

Tight calf muscles make it difficult for your ankle to bend properly. The pressure or strain goes to the heel bone and then to the plantar fascia. Too much tension in the plantar fascia leads to plantar fasciitis.

Lifestyle factors:

If your occupation requires you to stand for long hours, such as waiters or factory employees, you are at greater risk of plantar fasciitis. Constant pressure due to long periods of standing or walking strains your ligaments.

Footwear:

If your footwear does not support your foot adequately, it puts excess pressure on the plantar fascia and causes a strain. Examples of such shoes include: flip-flops, minimalist running shoes and ballet flats.

Activities:

Sudden increases in physical activity, such as excessive training, increasing running distance and speed, can strain your plantar fascia.

Lack of enough activity can also lead to plantar fascia, this is because while resting your plantar fascia is shortened and stiff. Regular activities such as jogging, stretches and gym workouts make your fascia strong and flexible.

Running causes your fascia to stretch and contract severally, and this may lead to swelling, microtears and pain in the fascia.

Diagnosis & When to See a Doctor

Plantar fasciitis is diagnosed through physical examination, medical history, imaging tests, and many other diagnostic procedures. Below is how plantar fasciitis is diagnosed:

Physical examination.

The doctor asks about your symptoms and may examine the foot to understand the root cause. The doctor examines your foot by lightly pressing your plantar fascia to check for swelling and pain levels.

Medical history.

Medical history focuses on understanding the intensity of pain, timings, onset, and location of the foot where you feel pain.

The doctor may ask you about the pain you experience daily for example while playing or performing your daily duties. The doctor may also ask where you feel more pain.

Xray.

An x-ray is suggested when your symptoms fail to improve, or when the doctor notices unusual symptoms. An X-ray may be used also when there is a risk of an existing condition, injury or disorder.

X-ray shares images of your plantar fascia. An X-ray may show a pronated foot or bony spur. Around 50% of patients with plantar fasciitis also have bony spurs.

Ultrasound.

An ultrasound is one of the most effective ways of examining plantar fasciitis. Ultrasound shows a thick fascia, formation of bony spurs, frequent calcification around the soft tissues of your hee, fat pad oedema, and degeneration.

MRI

Magnetic resonance imaging uses images to check the surrounding soft tissues. MRI assesses how thick the fascia is, bone tumours, pinched nerves and soft tissue lesions. MRI is mainly used to assess the cause of recalcitrant heel pain.

During an MRI, the doctor may notice:

A ruptured plantar fascia.

Achilles tendonitis.

Calcaneal stress fractures.

An increase in the signal intensity in the substance of the plantar fascia.

Generalised thickening of the plantar fascia.

Seek medical help if you notice pain that doesn’t go away in 2 weeks, pain that causes you to limp or pain that disrupts your sleep.

Treatment Options for Plantar Heel Pain

Over-the-counter pain relievers such as Ibuprofen and Naproxen help reduce the pain and swelling of plantar fasciitis.

Walking boots and crutches prevent you from putting more weight on your foot. Walking cats hold your foot in position and take off pressure from your plantar fascia. Your healthcare provider will recommend the number of days you are required to wear walking boots.

Night splints stretch your Achilles tendon and plantar fascia when you sleep. For night splints to work effectively, wear them each night before sleeping. Other functions of the Night splint include:

Stretching the calf muscle.

Supporting the arch of your foot.

Holding the plantar fascia and Achilles tendon in an elongated position.

During physical therapy, your physical therapist recommends workouts to stretch the plantar fascia and Achilles tendon and strengthen the lower leg muscles. Athletic tape offers support to the bottom of your leg.

Extracorporeal Shockwave Therapy involves directing sound waves to the area of treatment to stimulate healing. ESWT is recommended for people with chronic plantar fasciitis. You are said to have chronic plantar fasciitis if your fascia has not responded to previous treatment for a long period.

Ultrasonic tissue repair uses ultrasound images to direct the needle to the area of treatment. When the probe tip gets to the damaged plantar fascia tissue, it vibrates intensely to break the damaged tissue, which is later removed.

In rare cases, the doctor may recommend Plantar fascia release. Plantar fascia release involves making tiny cuts in your plantar fascia to relieve some extra tension. This surgery option is recommended only when the pain is so serious and other treatments have not worked for you.

Prevention Tips.

Managing your weight helps you regulate the amount of pressure on your plantar fascia. Heavy weight puts extra pressure on your fascia therefore putting you at risk of plantar fasciitis.

Replace your worn-out shoes with new ones. Old and worn-out shoes may not cushion and support your feet correctly.

Have stretching routines before and after a workout to stretch your arches. Stretch your calf muscles, Achilles tendon and plantar fascia to prevent plantar fasciitis. Below is an example of a calf and Achilles stretch:

Stand with your feet parallel

Move your right leg back and slowly bend your left knee.

With your right foot straight, slowly lower the right heel and ensure it is flat on the floor.

Ensure that your back foot is pointing straight ahead.

To activate your Achilles and calves, bend your left knee and press your back heel down

Repeat the same procedure on each foot.

Symptoms of Heel spur include: Inflammation on the front part of your heel, sharp pain in the heel when you stand in the morning and a dull ache during the day.
Also read: Common Running Knee Injuries & Their Treatment