Why Do My Feet Hurt? Causes of and Treatments for Plantar Fasciitis
Key takeaways:
Plantar fasciitis is a poorly understood condition that causes heel pain.
Most cases resolve with time and stretching exercises.
Stubborn heel pain should be seen and treated by a healthcare provider.
Most people have modified their activity levels during the pandemic. For some, that means changing their routine because the gym is closed. For others, it means a large drop in activity altogether. These changes are bringing on new aches and pains for many, especially in the lower limbs. Foot pain— and, commonly, plantar fasciitis — are among them.
What is plantar fasciitis?
Plantar fasciitis is one of the most common causes of foot pain, affecting approximately 1% of Americans. It is so named because it is believed to come from the plantar fascia, which is a thick ligament that runs along the bottom of the foot from the calcaneus (heel bone) to the forefoot.
Pain from plantar fasciitis is usually limited to the bottom or inside of the foot at the heel. It tends to be worse in the morning, with the first few steps of the day. It can also come on after long periods of standing or walking. This pain can start suddenly or gradually but is not preceded by any type of injury.
Search and compare options
What causes plantar fasciitis?
The name “plantar fasciitis” is a bit of a misnomer. Anything that ends in “itis” generally indicates inflammation. However, plantar fasciitis is usually not an inflammatory condition. Experts believe it is caused by overuse or repetitive strain on the plantar fascia.
In short, we still don’t know much about the exact cause. More research is needed.
Who is at risk?
Runners and athletes commonly get plantar fasciitis. It may also be common in people who spend a lot of time on their feet (although the evidence is not strong).
Interestingly, cases of plantar fasciitis have been on the rise during the pandemic. This could be due to people changing up their footwear (more time barefoot or in flip-flops) or their activity routines. For example, more people have been running and walking more while workout facilities were closed, or they may have become more sedentary.
But activity doesn’t seem to be the only risk factor. Plantar fasciitis tends to be more common in people who:
Are older
Are female
Have a higher BMI
Other factors, such as high arches, running surface, and abnormal walking patterns (such as pronation) are usually cited as risk factors for plantar fasciitis. But there is not enough high-quality evidence to definitively say so. Many studies (such as this one and this one) have looked for a link between plantar fasciitis and these factors in athletes without much success.
How is plantar fasciitis diagnosed?
Plantar fasciitis is a clinical diagnosis, which means a specific test is not needed. In most cases, the diagnosis can be made based on your symptoms and a physical examination. Flexing the foot at the ankle and pressing on the insertion of the fascia at the heel tends to reproduce the pain.
X-rays are not necessary in this situation, but they may be performed to rule out other causes of foot pain (see below).
It’s important to know that heel spurs (growth of bone off the calcaneus) are not indicative of plantar fasciitis. Many people without bone spurs can have plantar fasciitis, and many people with bone spurs don’t have plantar fasciitis.
How is plantar fasciitis treated?
The good news is, most cases of plantar fasciitis are self-limited, meaning they will heal on their own over time with simple measures. First-line treatment involves stretching and activity modification (not avoidance).
Other recommendations commonly found online, and even in healthcare settings, are not supported by robust evidence. This is unfortunate, but until the medical community understands plantar fasciitis better, simple and affordable interventions are recommended.
Stretching and strengthening
Stretching of the plantar fascia, Achilles tendon, and the calf is an important part of treatment. If you’re prone to plantar foot pain, doing your stretches on a regular basis will be helpful. It can also help to strengthen the muscles in and around your feet to stabilize your movements.
These basic exercises are a great place to start. If you’d prefer guidance for your exercises, consider finding a physical therapist nearby or via telehealth.
Activity modification
If you’ve noticed an activity (such as running or dancing) that’s causing your pain, you may want to take a short break from it. It’s not a good idea to avoid activity altogether, but you can make some modifications to what you’re doing. Consider the following:
The surface on which you’re running or walking
The mileage on your running shoes; it may be time to switch them out
How much time you’re dedicating (if any) to stretching before and after your workouts
Always remember to start slowly when trying a new activity and listen to your body.
Footwear
There is no “best” shoe for getting over plantar fasciitis. If you think your arches (or lack thereof) or running/walking pattern could be causing the problem, there are a couple of simple things that could help:
Simply wearing shoes with better support can help. This is especially true if you spend a lot of time barefoot or in less supportive shoes (flip-flops, ballet flats).
Shoe inserts for the heel may be beneficial. These are available over-the-counter.
Custom-made orthotic supports are sometimes recommended. Know that they can be more expensive and may not work as well as other measures.
Last, you may have seen night splints online or elsewhere. These are meant to keep your foot flexed at the ankle while you sleep, keeping the plantar fascia stretched. Splints might be worth trying for some, but they have not been shown to work well.
Medical intervention
If your pain doesn’t improve after a few weeks of the changes above, consider visiting a healthcare provider. There are some interventions that may be available to you. It’s important to mention here, though, that the evidence to support them is not very strong. They should only be tried if other measures fail.
Steroid injection
An injection of steroids and numbing medicine into the painful area is often recommended when other measures don’t work. Studies show this works well for short-term pain relief, but there is a risk of plantar fascia rupture.
Extracorporeal shock wave therapy
This treatment delivers energy to the fascia through the skin. How it works isn’t exactly clear, but studies suggest it can provide pain relief.
Surgery
Surgery may be recommended as a last resort when pain continues for several months despite conservative treatment.
Other possible causes of heel pain
There are a few other things that could cause pain in the heel similar to plantar fasciitis. Other possibilities include:
Nerve pain
Stress fracture of the calcaneus
Paget’s disease (bone disease that can be seen on an X-ray)
Problems with the heel pad (the fat pad that normally sits between the calcaneus and skin)
If your heel pain is getting worse or not going away with the measures mentioned above, it’s probably time to seek help. Similarly, it’s a good idea to get medical attention if you have foot pain that doesn’t quite fit the description of plantar fasciitis. A healthcare provider skilled in treating foot problems can help find out what’s going on and recommend next steps.
The bottom line
Plantar fasciitis is a common cause of foot pain that can be treated conservatively. By stretching and changing up your activities (and shoes), there’s a good chance you can take care of it on your own. If you have stubborn plantar fasciitis, seek help from a healthcare provider. They can help determine if other treatments are needed or if something else is going on.
Why trust our experts?
