At a certain point it seems like everyone has either had it or knows someone who has. Plantar fasciitis is a nightmare to deal with, most of all because the pain it causes is tied to something most of us can’t avoid: walking around.
What is Plantar Fasciitis?
Like a lot of the conditions we discuss here, plantar fasciitis has a close link to inflammation. The plantar fascia is the band of tissues on the bottom of your foot that connects your toes to your heel bone. The condition starts when you injure the insertion of the fascia into the heel bone; that triggers an initial inflammatory response (normal for a new injury) that signals your body to send immune system cells and proteins to being the repair work.
Why does it hurt to walk?
The injury is obvious and painful, as with each step the plantar fascia stretches and contracts – and it is this stretching of injured connective tissue that causes the pain in the bottom of your heel. Plantar fasciitis is often most painful with the first few steps of the morning or when rising to your feet from a chair. That’s because the plantar fascia tends to contract and shorten during resting (especially overnight), leaving it more sensitive to being stretched. That extra sensitivity can fade as it stretches out, but for many the pain is constant and considerable throughout the day.
What causes Plantar Fasciitis?
Any sort of repeated stress can cause damage to the plantar fascia, eventually damaging it enough to trigger an inflammation response. Jobs or hobbies which require you to be on your feet for a long time, sudden weight gain (including from pregnancy), and even poor fitting shoes can cause the condition. Once it has developed recovery can take months or even years, as repeated stress from walking can hinder the recovery process.
A cycle of re-injury and chronic inflammation
The viscous cycle that leads to such a long healing time works like this: There is a small bit of healing overnight (along with some contraction of the fascia), weight bearing the next day stretches at the fascia creating new micro tears (which trigger a new round of inflammation), the new tears add to the existing injury and reset the healing process and prolong the inflammatory response beyond what is required (a few days at the beginning). Once chronic re-injury and chronic inflammation are in place it is very hard to heal, if at all possible. The chronic inflammation makes the tissues more prone to re-injury and actually impedes healing. As part of the many facets to healing, controlling inflammation that has run amok is a critical step.
How is it treated?
Once you’ve been diagnosed with plantar fasciitis by your doctor or surgeon, there are a few treatment options available, including various therapies and surgeries. It’s best to discuss this directly with your doctor, but in the meantime there are a few things you can do from home to make the pain a little less awful.
♦ The right shoes
Quality shoes will support and cushion your feet, serving as shock absorbers whether you’re running or just need to stand around all day. If your shoes have become old or worn out it might be a good idea to replace them, and most people will recommend that you avoid going barefoot when possible.
♦ Keep it light
Keeping your weight down is another solution, but of course that’s no easy task when walking is painful and any stress on your heel can worsen your condition. If you can find a way to exercise that doesn’t cause suffering – such as swimming – that’s great, but don’t feel obligated to do it. Limiting stress and allowing your heel to just rest and recover is also a way of getting better ASAP.
♦ Splints and Socks
Keeping the bottom of the foot extended overnight can help with the sudden stretch / injury that occurs with the first few steps in the morning; a Strassburg Sock or night splint can be very helpful in some cases. Worn regularly it can prevent the contraction of the fascia and take some of the stress off, reducing the daily re-injury.
♦ Steroid injection
Steroid injection of the plantar fascia is a powerful way to shut off the run amok inflammation that makes plantar fasciitis such a chronic condition, but comes with its own set of serious risks. In general it is reserved for cases that have become chronic and for which other more conservative therapies have failed. Repeated injections of steroids (i.e., more than once a year) should only be done in severe cases as steroids can lead to degeneration of the fat pad in the heel and cause an irreversible problem as bad as plantar fasciitis.
♦ Cold Therapy
Cold therapy is an excellent way to slow down (and sometime reverse) the chronic inflammation seen with plantar fasciitis. Cold reduces blood flow and slows the influx of new inflammatory cells to the heel, and can put the brakes on chronic inflammatory feedback loops. Cold dulls the pain signals emanating from the injured region, often providing much needed relief. The critical point is not to overdo it and freeze the heel, as frozen connective tissue is even more prone to re-injury (and that’s already going on every day with plantar fasciitis); moderate cooling a few times a day while avoiding freezing is ideal. You can check out the übertherm Foot & Ankle Pain Relief Cold Wrap here
If you’re suffering from what might be plantar fasciitis you should speak with your doctor directly about your next steps. Everyone’s body is different and there are no guarantees when it comes to your unique health, but taking a few self-care steps can make your recovery time considerably shorter.