Plantar Fasciitis: causes, symptoms and treatments

Plantar Fasciitis FAQs

Q: What is plantar fasciitis?

Plantar fasciitis, pronounced “PLAN-ter fash-ee-EYE-tiss," is a repetitive stress injury affecting the sturdy bands of connective tissue that run from your heel to the base of your toes. It is characterized by numerous tiny micro-tears along with this band, which results in pain ranging from a dull ache to a sharp stabbing feeling in the sole of the foot.

If left untreated, plantar fasciitis can last for months or even years. However, we treat patients with this condition every day, and if you’re engaged and active in your recovery, you should expect to be back to normal much sooner.

Q: Is plantar fasciitis the same thing as a heel spur?

Not technically. These two conditions are often related because heel spurs can actually be one of the causes of Plantar Fasciitis. Since the symptoms can feel the same., heel spurs are sometimes misdiagnosed as plantar fasciitis, but they are two distinct conditions that need to be treated differently.

A heel spur is a calcium deposit that causes a build-up of bony tissue on the bottom of the heel bone. Sometimes, a heel spur is completely painless. But other times, it can get intertwined with and pull on the plantar fascia, which can be painful. If that is the case, you need to resolve the heel spur before you can get some resolution to the Plantar Fasciitis.

Interestingly, a heel spur can form overtime when a tight plantar fascia pulls on the bone, causing the bone to react by building a calcium deposit. In this case, we also need to resolve the heel spur first.

This is why an accurate diagnosis is so important when treating Plantar Fasciitis.

Q: How did I get plantar fasciitis?

Most patients we are treating for plantar fasciitis cannot pinpoint a specific event that caused the problem. Usually, there was some kind of change in activity that occurred several weeks or months prior to the onset of the heel pain.

An example of a change in activity could be increasing mileage for running or walking workouts, walking barefoot on the beach, working long hours on your feet, or spending more time climbing ladders. Weight gain is another common change that affects your gait and your feet. Sometimes we just have to chalk it up to the natural process of aging.

Don’t spend too much time focusing on how you developed the heel pain; instead, focus on correcting the underlying factors such as poor shoes, inappropriate orthotics, and biomechanics.

Q: Is plantar fasciitis a tear in the plantar tendon?

No, it is not a true tear. With any form of injury, there is some mild microscopic tearing that can occur which causes inflammation but with plantar fasciitis, it's not a complete tear. There are a chronic overload stretch and microscopic tears of the fascia.

Q: What is the best treatment for plantar fasciitis?

There are many treatment options for plantar fasciitis. Treatments are available to help relieve inflammation and pain, allow the torn fascia to heal, improve strength and flexibility, and prevent future injury. With diligent treatment, you should soon be able to return to your normal activities.

While severe cases of plantar fasciitis may need surgery, most cases can be treated at home with little interruption to your daily life. We provide patients with a treatment regimen that includes stretching, icing, massaging their feet, and wearing night splints. We recommend giving the feet plenty of rest and taking anti-inflammatories to manage the pain. We can also help you pick out an over-the-counter orthotic, or fit you for a custom one, and point you towards the best, most supportive shoes for your favorite activities.

Q: How long does plantar fasciitis take to heal? 

Healing usually takes two to six months. More than 95 percent of patients get better just by doing their exercises and managing their pain with over-the-counter drugs. Orthotic inserts are highly recommended, not only to support the plantar fascia and allow it to heal but to prevent recurrence of the pain once the fascia has healed. Few patients require surgery to correct the problem.

Q: Are there medications I can take for plantar fasciitis?

Over-the-counter anti-inflammatory drugs, such as ibuprofen (Advil) and naproxen (Aleve), are usually effective. Icing for 10-15 minutes throughout the day will also help to relieve the pain.

Q: What is a night splint and should I use one?

A night splint is used to help relieve plantar fasciitis pain. One of the most painful times of day for a patient with plantar fasciitis is the morning. This is because, at night, fascia’s micro-tears start to heal while the foot is in a relaxed position. When you put weight on your feet again, the tissue is strained again, causing pain and soreness.

A night splint can ease this discomfort. It’s a partial boot that straps on to your foot and lower calf to hold the foot in a flexed position, keeping the plantar fascia and Achilles tendon stretched throughout the night. Your foot and ankle specialist can dispense one to you through your health insurance, or you can buy one online or at a pharmacy.

Q: Can plantar fasciitis come back?

Yes. Always ask for a thorough history and physical exam from your podiatrist to determine the exact cause of your plantar fasciitis. Correcting the root cause of a problem is always better than treating its symptoms. If the doctor determines that your plantar fascia became inflamed as a result of another foot condition, he or she will want to tailor your treatment plan to reduce the chance of recurrence.

Q: Can I still wear heels if I have plantar fasciitis?

Technically, yes you can. A lot of patients with plantar fasciitis actually feel better when they wear heels because it reduces the pull of the Achilles on the plantar fascia. However, wearing heels will shorten and tighten the Achilles over time, leading to worsening heel pain. If you’re a regular heel wearer, we recommend gradually switching from high heels to flats. Quitting your heels “cold turkey” might actually cause more harm.

If you make a quick switch from heels to flats, your shrunken Achilles tendon might overstrain itself, increasing the risk of a tear. Instead, you should transition gradually to flats by wearing shoes with a lower heel for a few weeks. If you’ve been wearing three or four-inch heels, try two inches for a couple of weeks, then one inch, and then flats. This will slowly stretch the Achilles tendon to prepare your muscles for flat shoes.

When you’re back to wearing flats, make sure they have enough support and if you can, get custom orthotics. They can make a world of difference and help prevent further heel pain.

Q: I have had plantar fasciitis for over a year and it is now very severe. I have tried ice rolling, taping, night splints, physiotherapy, and ultrasound. All of which provided temporary relief. I am now completely frustrated with the pain and am unable to do the things I need to do. Is there anything you can do to help me?

Yes. In your case, we would recommend a PRP (platelet-rich plasma) stem cell injection. PRP therapy will slowly help improve the affected area over a month or so. If you would like to read more about PRP therapy for plantar fasciitis, please click here.

Q: If I have to have surgery for plantar fasciitis, what type of recovery can I expect?

Plantar fascia release surgery involves cutting part of the plantar fascia ligament to release tension and relieve inflammation of the ligament. At UFAI, we perform plantar fascia release endoscopically through a minimally invasive half-centimeter incision. This allows for a much shorter recovery period than is with traditional open surgery. Our patients are weight-bearing after one week and back in shoes in 3 weeks

Q. I just had the Tenex procedure for my plantar fasciitis and I still have pain. When can I expect the pain to go away?

Heel pain should be gone approximately six weeks following the Tenex procedure.

Q. What is a typical recovery for plantar fasciitis restorative procedures?

For restorative procedures such as PRP, amniotic cell therapy, and topaz, patients are in a boot for 2 weeks but immediately weight-bearing. Totally recovery time is about 6 weeks because, as with all restorative procedures, we need to give the body time to heal itself.

Q. What are the success rates of shockwave therapy for the treatment of plantar fasciitis? How many sessions would it take?

Shockwave therapy for plantar fasciitis usually takes 3-4 sessions and we see a 70% success rate. Our physicians can also discuss other options once they get a sense of your exact condition.

Q. Can an altered gait, due to a history of knee and or ankle injury, cause one to develop plantar fasciitis?

Yes, this can definitely be a cause of plantar fasciitis.