Q&A: Plantar Fasciitis
Updated: Sep 14, 2018
What is the Plantar Fascia?
The plantar fascia is the large ligament located along the bottom of the foot, extending from the heel bone to the forefoot. It functions to help support the arch of the foot. When added stress is placed on the ligament, it can become inflamed, tear, and cause pain. This is known as plantar fasciitis.
What caused my plantar fasciitis?
There are several reasons why the plantar fascia can become inflamed or injured. Often is associated with increased activities, especially higher impact activities (e.g. running, jumping, plyometrics) or prolonged activities (e.g. standing, walking). Change in shoe gear or walking barefoot can also contribute to symptoms of plantar fasciitis.
Certain foot types can also put a person at increased risk for developing plantar fasciitis. People with significantly high arches genetically have a shorter and tighter plantar fascia, so as this specific population ages and their soft tissues become less elastic, added stress to the ligament can cause it to tear, instead of stretch with the body. This is why children rarely develop plantar fasciitis. On the other end of the foot type spectrum, people with flat feet also tend to get plantar fasciitis because as their arch flattens, the plantar fascia gets stretched, causing stress and pain along the plantar fascia.
Why do I get pain in my heel when I try to get out of bed in the morning?
This specific pain, having it after periods of rest, is called post-static dyskinesia. It occurs because during rest, especially sleep, your feet go into a plantarflexed position (they point downwards). This allows the ligament to rest in a shortened, or more relaxed, position. Then, when you stand up, you acutely elongate and stress the ligament, thus causing pain. So, you may notice this pain may also occur if you have a desk job and you stand up at lunchtime for the first time, or it may even present while getting out of the car if you have a long commute.
Will a steroid injection cure my plantar fasciitis?
No, but it still may be very helpful in many ways. Steroid injections are used to help decrease the inflammation associated with plantar fasciitis, thus helping improve your pain. However, if you don’t treat the underlying reason why you developed the plantar fasciitis in the first place (e.g. poor shoe gear, lack of shoe gear, abnormal biomechanics, etc), the chances of you developing the symptoms again is greater.
I use steroid injections in people that have tried other conservative care on their own without success and in those who want a jump-start with pain relief and then plan to do other adjunctive treatments. Timing of the injection is important, though, so don’t wait until the last minute to see the doctor for the injection and remember that not all injections work for everyone and not all injections work the same each time administered. They also have their potential side effects and should only be performed 3-4 times per year.
I looked it up online and it said to try stretching, but it only seems to make my foot hurt worse. Why is this?
Timing of the stretching exercises is crucial. Every doctor may have his/her own protocol, but my recommendation is to not be too aggressive too soon. If you pulled your hamstring, you would not want to continue stretching your hamstring afterwards, right? The same philosophy applies here. In my opinion, it is important to allow the extremity to rest first, allowing the pain and inflammation to calm down (this may take up to 4 wks). Then, with your doctor’s approval, you can either start these exercises, or get a referral to a trained physical therapist to help assist you in your rehab.
How long will it take before my plantar fasciitis is healed?
This is a difficult question to answer because there are many factors that need to be considered when creating a timeline for recovery, including how long you have had the symptoms and what sort of damage has already been done to the ligament, what treatment options you have or have not tried yet, and what measures you are willing to take to allow the plantar fascia to rest and heal appropriately before returning to your activities. The good news is, though, that a vast majority of people get better over time with conservative care and surgical intervention is not required.
The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor, or your own healthcare professional, should you have questions or concerns related to your health.