Plantar Fasciitis: What a Pain in the Foot!

October 14, 2019

"We demand a lot from our feet, so we want to make sure that we're listening to them if they start complaining."

Dr. Keller Wortham, MD, is taking a look at an amazing, and often overlooked body part today — the feet! Our feet are incredibly intricate and complex, which makes sense because we use them a lot. Today, Dr. Keller will address Plantar Fasciitis, one of the most common causes of foot pain. We’ll learn what this condition is, what causes it, and what we can to if we’re suffering from it, to get back up on our feet (pun intended).

Video Highlights

  • 00:22: What is Plantar Fasciitis?
  • 03:06: Causes of Plantar Fasciitis
  • 05:15: Plantar Fasciitis Risk Factors
  • 07:34: How to Treat Plantar Fasciitis
  • 07:54: Natural Options
  • 10:00: Therapy Options
  • 11:06: More Invasive Options
  • 13:21: Preventing Plantar Fasciitis
  • 17:11: Wrap-Up

Our feet are amazing contraptions — incredible feats of ingenuity and engineering. Your foot has 26 bones in it, and it is one of the most intricate parts of the body, with tons of little joints, tendons, and ligaments. It makes sense that the feet are pretty complex, because they need to be super dependable. The College of Podiatry estimates that we walk approximately 150,000 miles over the course of our lifetimes! That means we're walking enough distance to go around the world six times… so your feet carry you a long way.  

Like many things in life, we might not listen to our feet until they start complaining. But when they do complain, it’s hard to ignore — especially if that complaint is pain. So today, we’ll talk about one of the most common causes of foot pain, which is plantar fasciitis. 

What is Plantar Fasciitis?

Plantar fasciitis involves inflammation, which is the ‘itis’ part of the plantar facia. The plantar fascia is an intricate web of tissue that spans from the toes back down the arch of the foot to the heel. It is responsible for supporting the arch of the foot, and for distributing the weight of impact on our feet so that we can continue to walk on our feet the 150,000 miles that they have to apparently carry us over the course of our lifetimes.

Causes of Plantar Fasciitis

So we know that plantar fasciitis is inflammation of the plantar fascia, the band of tissue that spreads from the toes, down to the heel. This band usually functions like a bowstring to help support the arch and to help reduce the stress on the different bones by kind of distributing the weight over all 26 of those bones in the feet. When it's functioning normally, that tension and stress is evenly distributed and you feel great. But if you have repetitive impact on that, or if the tension is either too severe, too frequent, or too much, then that band of tissue can start to tear. When that happens, it starts to get inflamed and you end up with the itis in plantar fasciitis — or inflammation. 

So, if you have plantar fasciitis, you will feel it — it is very painful. You usually feel it either back at the heel, or spanning the arch of the foot. Often, it’s worse in the morning when you first get up and put your feet on the floor.  Then it might get less painful as you warm up and walk throughout the day. However, it can be further exacerbated if you're standing for long periods of time throughout the day, or putting a lot of pressure on your feet.

Plantar Fasciitis Risk Factors

  • Age — this is the first risk factor. The most common age for plantar fasciitis is between 40 and 60. 
  • Certain kinds of exercise — High impact exercise can affect your feet. This can be a lot of sports that involve jumping, or dancing, especially ballet. 
  • Foot Mechanics —  If you were born with flat feet or very high arches, that can make you more susceptible to getting plantar fasciitis.  
  • Obesity — Having more weight that your feet have to support can increase the risk.  Our feet are having to do a lot of work already, but every pound that you carry increases the impact on your feet. 
  • Occupation — If you have a job that involves being on your feet a lot — like if you're a teacher, or a foreman at a plant, or walking around a lot in dress shoes, you can be at risk for plantar fasciitis. Which brings us to the next risk factor. 
  • Footwear — this is a big category. Dress shoes often have hard, rigid soles and they might not have good arch support. High heels can also be terrible for your feet. They look great, but they can be very bad for plantar fasciitis. This is because tightening the calf muscle can lead to plantar fasciitis. If your toes are always flexed down because you're in high heels, then your calf gets tightened and your Achilles tendon gets shortened.

How to Treat Plantar Fasciitis

So, if you end up with plantar fasciitis due to one or more of these risk factors, what can you do about it? Well, there are multiple stages of treatments.  First, you can start with a few very basic things you can do at home.  

Natural Options

  • Rest — If you start to get that pain in your foot, especially the pain along the heel and going over to the soft part of the arch, then just rest and try to stay off your feet until they feel a little bit better. Either keep them elevated for a while, or just minimize the amount of walking around you do.
  • Reduce Inflammation — There are multiple things you can do to reduce inflammation, like icing your feet, especially after a long period of walking or exercise. You can also try taking anti-inflammatories. There are anti-inflammatory drugs called NSAIDs out there — ibuprofen, Aleve, Motrin, and the like — which can reduce inflammation. But of course NSAIDS come with their own issues, so it may be better to look for more natural options, like curcumin. Smarter Nutrition’s Curcumin is a powerful natural inflammation-fighter. There are other things as well, like MSM and bioflavonoids, that can help reduce inflammation naturally.
  • Stretching — Stretching is a big thing for helping protect the integrity and the health of your foot. We already mentioned how a tightened calf muscle can really put you at risk for plantar fasciitis. So, stretching the calves, and the other tendons and ligaments around the ankle, can allow your foot and all those 26 bones to stack on top of each other properly and give your arch the best support it can have.
  • Choose Supportive Shoes — So not those high heels and rigid dress shoes we talked about. Whenever possible, you should be trying to wear athletic shoes with good arch support, especially if you have plantar fasciitis flaring up. This will help keep your foot in proper alignment so that you can help those little microscopic tears in the tendon to heal.

    Therapy Options

    So, if those natural steps don't work, then you're on to the next category. 

    • Physical Therapy — You might start working with a professional physical therapist or a trainer. If you have a good trainer, they can show you exercises to strengthen aspects of your plantar fascia, and exercise that will help stretch the calf, ligaments, and tendons that might be causing improper alignment of your foot. 
    • Night Splints — These are devices that you wear at night to keep your foot in a dorsiflexed position, which will help stretch out that calf muscle. 
    • Orthotics — You could be fitted for orthotics with your podiatrist or orthopedic doctor, and these would be ideally be tailored to the specific needs of your foot. That might include something with an arch support, or a nice pad under the heel, because a lot of people experience their foot pain on the heel, so that additional padding can reduce the impact.

    More Invasive Options

    The next level, if those aren't working, would be moving on to more invasive treatments. 

    • Steroid Injections — One of the things that you can do to reduce inflammation is a steroid injection into the foot. However, there is a drawback to steroids. When you inject a steroid into a body part, it tends to weaken that body part with time. So if the original problem with your plantar fascia was that it was weak and started tearing, a steroid will reduce the inflammation, but could also possibly set your foot up for injury at a future date because you've probably made that plantar fascia band a little bit weaker. So, if at all possible, try to avoid a steroid injection.
    • Platelet-Rich Plasma Injections — Some doctors give a different kind of injection called platelet rich plasma, which is a treatment that you can ask your physician about. That's where your doctor might draw your blood, then extract the plasma portion of the blood that is very rich in platelets, and inject that into the area. Platelets can activate and release a bunch of growth factors and other signaling chemicals that can recruit healing cells to that area, and try to heal the underlying issues; those tears in the plantar fascia. 
    • Extracorporeal Shockwave Therapy — this involves applying a shock wave to your foot. The jury's still out on this treatment; it can help some people, but it also can cause pain and bruising. But if you're working with a doctor who recommends it, they might have more information. So, if you're dealing with plantar fasciitis and some of the other things haven't worked yet, it's something that you can investigate.
    • Surgery — If those things are not working, there are surgeries that can really help either release parts of the plantar fascia that might be too tight, or help to strengthen and realign other parts of it.

    Preventing Plantar Fasciitis

    So, those are some treatment options if you're suffering from plantar fasciitis. But you know what they say — an ounce of prevention is worth a pound of cure. So, what can you do to help prevent yourself from getting plantar fasciitis in the first place? 

    • First, try your best to maintain a healthy body weight. Again, that load of your weight on your feet is going to be very detrimental to them. If you're having issues with that, check out some of Dr. Keller’s other videos on weight loss and diet options. If that still isn't enough, you can talk with your doctor about it. There are certainly some strategies out there that could be helpful for you.
    • Second, choose proper footwear. Really try to reduce the amount of time you spend on your feet and in hard soled dress shoes, high heels, or even flat shoes like flip flops that don't have a lot of arch support, all of which can lead to plantar fasciitis. Along those same lines, don't exercise in worn out athletic shoes. Especially if your workout involves running and jumping, you could be putting yourself at risk for a very painful condition. 
    • Think about changing your sport — If you are starting to get signs of arch pain and heel pain, you might need to look at whether your sport of choice is worth the cost. If you’re doing some sports that are high-impact and really pounding your feet a lot, and you start to notice some of the early warning signs of foot pain, maybe it's time to put away the ballet slippers, switch to a type of exercise that has less potential to be a problem for you.
    • Stretch — We already mentioned stretching both as a treatment and as an important preventative measure.
    • Go Barefoot — According to some people, being barefoot was God's original design for how our feet should work. When we're barefoot, our foot is able to move the proper way, to be flexible, and distribute all of the weight properly. So, if your feet are not suffering from pain, try going barefoot when you can. Obviously we have to wear shoes at work, outdoors, and in most public places, but when you're at home try to walk around barefoot.
    • Try Barefoot Exercises — Yoga is a great one you can do barefoot. When you're doing postures in yoga where you're standing and balancing on one foot, you are engaging all of the muscles of your lower leg and your foot, and they're going to start to work better to protect your foot, to strengthen your arch, and to strengthen that plantar fascial band. And that is going to help prevent you from ending up with quite a debilitating condition like plantar fasciitis.

    Wrap-Up

    So, there you go. We hope you enjoyed this talk about feet — they’re so important, and we have to take care of them. We demand a lot from our feet, so we want to make sure that we're listening to them if they start complaining. If you start to feel like you might be having some of the symptoms of plantar fasciitis, take those preventative steps we talked about. And if you already have it, review this video or article and try some of the techniques we suggested for getting rid of this painful condition.

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