One of the most common causes of heel pain, plantar fasciitis is the inflammation of a soft band of tissue called the plantar fascia which extends from the bottom of the heel to the base of the toes. Plantar fasciitis typically causes a stabbing, sometimes excruciatingly painful, sensation in the heel, especially during one’s first steps in the morning. As the foot limbers up, the pain often decreases but may return during the day, depending on one’s activities and foot wear.

“Plantar fasciitis is an overuse injury and most common in women, usually between the ages of 40 to 60,” says physical therapist Paige Larson, MPT. “It can feel like nails are being driven into the bottom of the foot.”

According to Larson, the most common causes are a change in a workout surface or intensity of a workout, weight gain, poor foot wear, prolonged standing, incorrect gait mechanics (how one walks/moves), a tight Achilles tendon, high arches and sometimes walking on hard surfaces like tile floors, especially barefoot. Each of these can cause the fascia to tear and become inflamed.

Diagnosis

Plantar fasciitis is most often diagnosed by a physician based on a physical examination and a patient’s description of heel pain. “Rarely does plantar fasciitis warrant tests such as an MRI or X-ray, but an ultrasound scan may show thickening and swelling of the fascia to confirm the diagnosis,” says Larson.

Treatment Options for Plantar Fasciitis

Fortunately, more than 90 percent of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods. However, it is important to get a diagnosis and treatment plan as soon as symptoms appear to avoid further injury.

Treatment may include: rest — decreasing or ceasing activities that make the pain worse, especially workouts on hard surfaces. Ice can help decrease inflammation. Rolling the injured foot over a frozen water bottle three to four times a day can be helpful. Nonsteroidal anti-inflammatory medication such as ibuprofen can also help reduce pain and inflammation. All medications should be discussed with a primary care physician, especially if needed long-term.

Exercise and stretching may also help relieve the pain of plantar fasciitis which is often aggravated by tight muscles in the feet and calves.

Calf stretch
Regular stretching of the calf muscle is important for preventing or treating plantar fasciitis. One effective stretch is to lean against a wall keeping one leg straight with the heel on the floor while the other leg is in front with the knee bent. Lean into the wall and hold the position for 10 seconds. Repeat this exercise 15 times for each foot. These stretches are even more effective following some kind of gentle body warmup exercise.

Plantar fascia stretch
This stretch may be performed in a seated position with the affected foot crossing over the knee of the other leg. Using one’s hands or a soft strap or cloth, pull the toes toward the chest. Hold the stretch for 10 seconds and repeat it 15 times with each foot. This exercise is especially effective if done before standing or walking in the morning.

Footwear
Ask your physician about the best footwear for lessening the pain of plantar fasciitis and preventing its return. Supportive shoes and orthotics may help. Soft heel pads may also cushion the heel.

Physical therapy
Depending on the diagnosis, physical therapy may be recommended for plantar fasciitis. Treatment may include specialized stretching, icing, massage and medication.

When the first symptoms of heel pain occur, consult a physician to get a proper diagnosis and treatment plan. “Plantar fasciitis can be very painful and debilitating,” explains Larson. “Do not ignore the early warning signs and consult your physician for proper treatment.”