Plantar Fasciitis Heel Pain

Painful feet can throw your whole body out of whack, especially your knees, hips and back. And the pain can spread. Pinpointing the cause of heel pain can be tricky, especially if arthritis affects another part of your body. Osteoarthritis (OA), rheumatoid arthritis (RA), gout and other forms of arthritis and related conditions, like tarsal tunnel syndrome — a pinched tibial nerve — all can affect the foot. Other causes include being overweight, standing too long, having arches that are either too high or too flat, or wearing unsupportive, hard-soled shoes. One of the most common causes of foot pain, though, is plantar fasciitis, affecting some 3 million Americans every year.

“These conditions have very different treatments. A correct diagnosis is critical,” says orthopaedic surgeon Steven Haddad, MD, former president of the American Orthopaedic Foot and Ankle Society. The sooner you see a doctor, the better your chances of effective treatment. 

Sharp pain, inflammation and/or tenderness of the sole of the foot near the heel are hallmark symptoms of plantar fasciitis. Pain, usually with the first few steps in the morning or after sitting for a while, improves as you walk around, but worsens later in the day — unlike osteoarthritis, which can last all day and worsens when moving or walking around.

The plantar fascia, a ligament connecting the heel to the ball of the foot, loses elasticity and develops tiny tears. The tears cause painful swelling in the ligament. Medical history, physical exam, including range-of-motion tests, and X-ray are used to diagnosis plantar fasciitis, which can last several days or weeks, even months if not treated promptly and properly.

Ninety-five percent of individuals who develop plantar fasciitis find relief through non-invasive, non-surgical treatments, and most have relief after a couple of months of at-home treatments.

Ice therapy and pain-relief medications, like ibuprofen, are good starts, but it's also important to stretch daily. Tight calf and foot muscles can make the pain worse. Avoid shoes with flimsy soles, and if your favorite pair of shoes doesn’t have arch support, purchase a firm, over-the-counter arch support insert — or get fitted for a custom-made device by a podiatrist or orthopedist. Shoes with a slight heel — even half an inch to an inch — take the pressure off the plantar fascia, which is why some women with this condition say it feels better when they wear heels than sneakers.

A podiatrist or orthopedist can fit a patient with a plantar fasciitis splint. Worn at night, this device passively stretches the bottom of the foot and the back of the heel while you sleep. 

In addition to nonsteroidal anti-inflammatory drugs, like ibuprofen, corticosteroid injections might help, but your doctor will likely limit the number you can receive to prevent further potential damage.

If more conservative options fail, you may be a candidate for surgery to release the plantar fascia, but surgery is typically considered only for people who’ve had symptoms for at least nine months and who continue to have pain despite daily treatment.

Try These Stretches

Before you get out of bed in the morning, and then periodically throughout the day, do the following exercises to increase flexibility and ease pain.

Slowly flex your foot and toes to stretch the bottom of your sore foot. Hold the stretch for 10 counts. Relax and repeat.

Do gentle ankle rolls to keep the tissues around the ankle and on the back of the heel flexible.

Sit on the edge of your bed and roll your foot back and forth over a tennis ball.