Plantar Fasciitis: Causes, Definition, and Treatment

The feet are incredibly complex devices and in order to best understand the plantar fasciitis definition, we must understand the feet. Compared to the size of our bodies, they are relatively small, and are asked to support 3-4 times our body weight whenever we walk, run, or jump. The foot is made up of 26 bones, 30 joints, and over 100 tendons, ligaments, and muscles, all of which work together to support us as we go about our daily lives. 

One of the most important ligaments in the foot is the Plantar Fascia, where Plantar Fasciitis derives its name. It runs the entire length of the bottom of the foot, in a way that Dr. De Lucia compares to a large, flat rubber band. When you put weight on your feet, the Plantar Fascia stretches out to help your feet bear the weight of your body. As a result, the “rubber bands” in your feet stretch out too. It may help to see this difference visualized:

If too much stretching occurs, a Plantar Fasciitis tear may begin to occur. For the 10% of US adults who develop Plantar Fasciitis at some point in their lives, bearing weight on your feet can result in immense pain. According to Dr. De Lucia, patients that he sees with Plantar Fasciitis tend to have flat or high arches and experience a sudden change in activity in their daily lives which causes stretching and inflammation of the plantar fascia. Common cases include someone who begins regular physical activity after a few months off, starts a new job that requires a lot of standing or lifting, or wears a new type of shoe that they don’t usually wear.

When diagnosing plantar fasciitis, Dr. De Lucia looks out for heel pain or pain near the arch of the foot. This pain is often most pronounced in the morning and may lessen throuought the day. Symptoms of plantar fasciitis may also feel like pain and stiffness that can extend through the calf muscles if severe enough.

Unfortunately, Plantar Fasciitis won’t go away if left untreated - in fact, as more tearing occurs, it may actually get worse. According to Dr. De Lucia, failing to take care of Plantar Fasciitis over the long-term can lead to joint pain, gait disturbances, or scarring of the ligaments.

Even though plantar fasciitis can develop without an obvious cause, some factors can increase your risk of developing this condition. They include:

• Age. Plantar fasciitis is most common in people between the ages of 40 and 60.
• Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing and aerobic dance — can contribute to the onset of plantar fasciitis and heel spurs.
• Foot mechanics. Flat feet, a high arch or even an atypical pattern of walking can affect the way weight is distributed when you're standing and can put added stress on the plantar fascia.
• Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can be at increased risk of plantar fasciitis.
• Being pregnant - hormones associated with your pregnancy can cause your ligaments to relax. Along with the temporary weight gain, this can lead to plantar fasciitis and heel pain.
• Wearing unsupportive shoes. Without proper arch support to support the plantar fascia muscle, this can put strain on the fascia and cause it to stretch.

Even though a Plantar Fasciitis tear could be incredibly painful and persistent, the good news is that there are an abundance of plantar fasciitis treatments available. According to the Cleveland Clinic, 90% of Plantar Fasciitis cases can be treated within 10-months using at home remedies.

Short-term, At Home Remedies: Dos and Don'ts 

Do

• rest and raise your foot on a stool when you can
• put an ice pack (or bag of frozen peas) in a towel on the painful area for up to 20 minutes every 2 to 3 hours
• try regular gentle stretching exercises
• try exercises that do not put pressure on your feet, such as swimming
• take painkillers like paracetamol and ibuprofen
• ensure that you have proper arch support in all of your shoes

Don't

• do not take ibuprofen for the first 48 hours
• do not walk or stand for long periods
• do not wear high heels or tight pointy shoes
• do not wear flip-flops, or other unsupportive shoes
• try not to walk barefoot on hard surfaces

Plantar Fasciitis Exercise examples

Stretches for plantar fasciitis can help to reduce pain and prevent further damage. You can do these stretches yourself at home. You usually need to do them at least twice a day.

Achilles tendon and plantar fascia stretch

Keep a towel by your bed. Before you get up, loop a long towel around the ball of your foot and pull it. Keep your leg straight. Hold this for 30 seconds. Repeat this three times for each foot.

Wall push

Stand facing a wall, with one foot in front of the other. Your feet should be shoulder width apart and facing the wall, with your front knee bent and your back knee straight.

Place both your hands on the wall, shoulder width apart. Lean towards the wall by bending your front knee. You’ll feel the stretch through your calf in the back leg. Hold for 30 to 45 seconds, then relax. Repeat three to four times, two to three times a day.

The further the back leg is from the wall, the greater the stretch. So, you should start closer to the wall to begin and over time move the back leg further way from the wall.

Stair stretch

Stand on a stair, facing upstairs and holding onto the rail for support. Position your feet so that your heels hang over the end of the step, and your legs are slightly apart. Lower your heels, until you feel tightening in your calves. Hold this position for 20 to 60 seconds, then relax. Repeat six times.

Plantar fascia stretch

While you’re sitting down, roll your foot over a round object - such as a rolling pin, drinks can or tennis ball. Allow your foot and ankle to move in all directions. Carry on for a few minutes or until you feel discomfort. Repeat at least twice a day.

Another way to stretch your plantar fascia is to sit down, crossing one foot over your knee. Then, grab your toes and pull them back towards your body. Hold this for 15 to 20 seconds and repeat three times. Learn more about stetching exercises for plantar fasciitis in our full post.

Long-term treatment

For long-term, chronic Plantar Fasciitis, it’s best to take care of the feet by introducing arch support insoles into your everyday shoes. Proper arch support has the effect of alleviating the strain that your body places on your Plantar Fascia when you put weight on your feet (i.e. by standing, walking, or running). An insole with proper arch support is one of the best treatments for plantar fasciitis as it prevents the Plantar Fascia from stretching while flat, mitigating the strains that cause Plantar Fasciitis tears. See the benefits of an insole with arch support visualized below:

Fulton insoles are the brand of insoles that Dr. De Lucia recommends to his patients, as they provide comfortable arch support and mold to the shape of your feet over time. In the context of the visuals above, that means they align to your feet in a way that supports the bottom of your foot and your unique arch type and walking style. Learn more about Fulton insoles here.

In addition to adding arch support insoles into your shoes, there are other at-home ways to cure Plantar Fasciitis. The Cleveland Clinic recommends spending 15-20 minutes per day stretching your calves, massaging the feet regularly, using night splints, and applying ice 3-4 times per day. If the pain persists from more conservative approaches, that’s where Dr. De Lucia and the Foot and Ankle Surgeons of New York team comes in. They routinely perform surgeries on conditions like Plantar Fasciitis, bunions, metatarsalgia, and achilles tendinitis. Regarding Plantar Fasciitis, Dr. De Lucia noted that Endoscopic Plantar Fascia Release surgery is highly effective: it’s a minimally invasive surgery that helps reduce inflammation and ultimately repair the damaged ligament.

Plantar Fasciitis can quickly become the bane of your existence if not cared for properly. Understanding what causes Plantar Fasciitis and how to treat it are critical components of mitigating body pain and getting back on your feet. Take care of your feet - they’re the foundation of your body. Learn more about how Fulton insoles can help.

More about Dr. De Lucia

Dr. De Lucia is dual Board Certified as a Fellow of the American College of Foot and Ankle Surgeons and the American Board of Foot and Ankle Orthopaedics and Medicine. He specializes in complex adult and pediatric foot and ankle reconstruction and trauma surgery. He is an Honorary Police Surgeon of the New York Police Department.