Plantar fasciitis: heel pain treatment by video

The plantar fascia is a thick band of tissue that runs along the bottom of the foot, from the heel to the toes. When it is overstretched or overused, it gets irritated and painful: that is plantar fasciitis.

You are more likely to get it if you have flat feet or high arches, run long distances or on uneven ground, carry extra weight or gained weight suddenly, have a tight Achilles tendon, wear shoes with poor arch support or soft soles, or suddenly changed how active you are. In Puerto Rico, spending the day in flip-flops or barefoot on the beach gives your arch no support.

What about heel spurs? Heel spurs were once thought to cause plantar fasciitis, but research found they do not: some people have spurs and no pain, and some have plantar fasciitis with no spur.

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The typical signs are:

• Pain on the bottom of the foot, near the heel
• Pain and stiffness that are worst with the first steps in the morning
• Pain when you stand up after sitting for a while
• Pain that can be dull or sharp
• Pain that gets worse after walking or standing for a long time

Stretching is the backbone of plantar fasciitis treatment. The American Academy of Orthopaedic Surgeons (AAOS) recommends two stretches and a cold foot roll:

• Calf stretch: lean with your hands on a wall, the sore leg behind you with the knee straight and the heel on the floor, and bend the front knee until you feel the stretch in your calf. Hold 10 seconds and relax; repeat 20 times for each foot.
• Plantar fascia stretch: sitting down, cross the sore foot over the other knee and pull your toes back toward you until you feel the stretch in your arch. Hold 10 seconds; repeat 20 times for each foot.
• Foot roll: rolling your foot over a cold water bottle or ice for 20 minutes, 3 to 4 times a day, eases the pain, per the AAOS.

Do the arch stretch before you take your first steps in the morning. If an exercise causes sharp pain, stop and bring it up with the doctor at your visit.

Most people get better without surgery with this care, per MedlinePlus:

• Stretches for the sole of the foot and the calf, several times a day.
• Ice on the heel for 10 to 15 minutes at least twice a day, more often in the first days.
• Supportive shoes with good arch support and a firm sole; avoid going barefoot or wearing flip-flops.
• Relative rest: cut back on the activity that causes the pain, such as running.
• A night splint that keeps the foot stretched while you sleep.
• Over-the-counter pain relievers, such as ibuprofen, if appropriate for you.

Recovery is slow: per MedlinePlus, most people feel better within 6 to 18 months, and surgery is rarely needed. The AAOS reports that more than 90% of patients improve within 10 months of starting simple treatment. An X-ray is usually not needed; it is considered to rule out other causes, such as a fracture, or if you do not improve with treatment, and then we refer you. Steroid injections are considered after several months without improvement and are given in person.

If you have diabetes: check your feet every day. If you notice sores, blisters, color changes, tingling, burning or loss of feeling, your foot needs to be seen in person; we refer you.

Plantar fasciitis is not an emergency, but some foot and leg signs need in-person care soon. For your safety, go to urgent care or the emergency room, or call 911 if it is severe. See when to go to the ER.

• The pain started after a fall or a blow and you cannot put weight on the foot
• A red, hot, swollen heel or foot, especially with fever
• A swollen, warm or painful calf on one side
• Diabetes with a sore, wound or color change on the foot
• Numbness or tingling that does not go away