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The condition plantar fasciitis (pronounced fash-ee-ahy-tis) is, by far, the most common cause of heel pain in active people. The plantar fascia is a band of tissue, actually a ligament, that spans from your heel to the base of your toes on the bottom of your foot. Its job is to help maintain your arch, especially in the push-off phase of walking or running.
Plantar fasciitis can occur as a result of unsupportive shoes, a tight calf, excess activity or body weight, or activity on hard surfaces like concrete. It also can result from systemic diseases like diabetes, gout, Lyme disease or rheumatism. Most often, it starts as pain on the bottom of the heel when you get up in the morning or after sitting for long periods. Further, the pain is worsened by being on your feet for long periods of time; especially on hard surfaces.
If you think about your foot as though it is an ice cube tray, the job of the plantar fascia is to keep the cubes in the tray. The calf pulls up on one side (at the back of the heel) and the ground pushes up on the other (on the ball of your foot). Protecting the flexion (bending) and strain on the tray is critical to getting plantar fasciitis under control. A rigid yet cushioned running shoe — for everyday walking — is the first step, preferably one that if you pick it up you can’t bend it in your hands. For example, you might try the New Balance 1540, Mizuno Wave Prophecy, or Hoka shoe. An orthotic with arch support and a cushioned heel can help as well.
Stretching the calf and the plantar fascia is also important, and should be done two or three times each day. By stretching the gastrocnemius muscle within the calf (stretching with the knee straight), you offload the Achilles tendon’s pull on the ice cube tray. Night splints (braces worn at night to keep your foot flexed and toes pointing up) limit the tightness that develops in the calf overnight. That tension is what pulls on the heel, giving you that first step pain in the morning.
Deep tissue massage of the plantar fascia while pulling your toes up with your hand also helps loosen painfully contracted fascia. Rolling your foot on a lacrosse ball or an ice bottle can help symptoms as well.
Patience is critical. If you’ve had pain for three months, you can generally expect to need three months of active recovery with stretching, strengthening and modified activity. About 70 percent of patients see improvement after 12 weeks of stretching and using night splints.
In the meantime, modify your activities to avoid added stress on the plantar fascia. Climbing, jumping, running or any activity that makes the calf tight (e.g., getting up on the ball of your foot) can worsen the condition. If you are limping from the pain, why walk for exercise? You may need a CAM Walker boot to partially or fully immobilize the ankle to let the foot rest.
Adjust your workout plan by cross training for a while by riding a bike, picking up a yoga class, going for a swim or lifting weights. When the pain eases, you can get back on the elliptical or a level treadmill — but take it easy and build up slowly. Be sure you can walk comfortably before you attempt to run, climb or jump.
In the case of persistent pain despite these treatments, you may need to consider injections or surgery. You might be familiar with cortisone injections for pain, but these are different. Cortisone can make the plantar fascia worse or even cause a rupture.
The only injection I would recommend would be platelet-rich plasma (PRP). It is a concentrate of the platelets from your own blood injected into the unhealthy plantar fascia. PRP encourages healing, unlike cortisone, which breaks tissue down.
If your plantar fasciitis isn’t responding to treatment, you may need surgery to release the ligament (which can flatten the arch) and/or release a tight calf muscle. Surgical recovery can take up to 12 weeks.
Victor R. Prisk, MD is the Medical Director of Prisk Orthopaedics and Wellness. He is a board-certified orthopaedic surgeon with sub-specialty training and over 10 years of experience in treating complex conditions of the foot and ankle (through surgical and non-surgical methods alike). He originally graduated from the University of Illinois College of Medicine as an M.D. Graduate with Honors.
In his current practice, Dr. Prisk oversees the management of many sports and dance injuries that affect the upper and lower extremities, back and neck. In addition to his work as a board-certified surgeon, Dr. Prisk is a former NCAA All-American Gymnast, IFBB Professional Bodybuilder and Judge, and Professional Dancer. He cares for multiple ballet companies including the Bodiography Contemporary Ballet and The Pittsburgh Ballet Theatre. He has trained multiple NPC national champions and prepped professional athletes for the Arnold Schwarzenegger Classic and Mr. Olympia stages. These experiences allow him to offer various treatments beyond your typical orthopaedic surgeon with performance enhancement, weight management, and contest preparation.
While you visit him for assistance with orthopaedic problems or physical wellness and training, Dr. Prisk guarantees a hands-on, holistic care approach. You as the patient will always come first, and all optional avenues of care will be explored.
Prior to his current practice, Dr. Prisk was a surgeon at West Penn Hospital of the Allegheny Health Network. His books, The G.A.I.N. Plan and The Leucine Factor Diet, are available on Amazon.com.
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