Johanna Youner
Johanna S. Youner, DPM, board-certified foot surgeon in private practice in New York, an attending physician at New York Downtown Hospital, and a Fellow of the American College of Foot and Ankle Surgeons.
Is heel pain bothering you? Don’t ignore it—it could be plantar fasciitis, a condition that will only get worse without care, warns foot surgeon Johanna S. Youner, DPM. Here’s what you need to know about plantar fasciitis symptoms, causes and treatment…
RICE—Rest…Ice…Compression…Elevation.
Gentle stretches.
Upgrade your shoes.
Replace sneakers every eight months.
Consider orthotics.
Lose weight
Plantar fasciitis is an inflammation of the plantar fascia ligament, the thick band of tissue that runs from the back of the heel to just under the big toe. This ligament supports the arch of the foot and absorbs the constant stress placed on your feet.
Plantar fasciitis occurs when the plantar fascia gets irritated and inflamed, possibly because of advancing age…excess weight, which puts more stress on the bottom of the feet…or from running (at any age) in unsupportive worn-out shoes.
It also can be a consequence of your foot structure. While some people have normal pronation—the degree to which your foot rolls inward when you walk or run—many people have either a pronated, more flat and flexible foot…or a supinated, higher-arched foot that is not very flexible. Feet that are pronated or overpronated (flat feet) need support to keep them stable. Supinated feet need support to mitigate the stress put on the ligaments due to high arches. In either scenario, plantar fasciitis can occur if your arches don’t get the specific support they need through your footwear. The condition can develop over time…or from wearing the wrong shoes for a single day. During the COVID pandemic, there was an increase in cases among people who were home all day, wearing flip flops or going barefoot.
The hallmark sign of plantar fasciitis is heel pain, usually in just one heel. It can be so painful that you can’t step down on the foot. It can extend to the forefoot and be very debilitating. You’re also likely to feel stiffness and see swelling in the area affected by plantar fasciitis, especially when you first wake up in the morning. Early on, plantar fasciitis pain may dissipate over the course of the day, but untreated, symptoms are likely to get worse—small tears in the the plantar fascia can develop and lead to a rupture. This requires a lot of rest and wearing a walking boot to enable the tissue to heal. The adjacent Achilles tendon can become affected, too, tightening up and even fraying. A possible sign of Achilles involvement is pain in the back of the heel.
It’s always important to see a board-certified podiatrist who can diagnose and assess your condition, identify its causes and review your footwear. For many, home remedies are the mainstay treatment, starting with RICE…
Rest. Pain signals an injury that needs time to heal. In severe cases, you may need to be on crutches for a week so help the foot rest, but in most others, just try to stay off the foot when possible.
Ice. This helps calm down the inflammation and is especially beneficial at night—you’ll wake with less swelling and better function. Also great for decreasing inflammation is the botanical arnica gel (store it in the fridge for a cooling effect).
Compression. This can be an Ace bandage style wrap. Wearing a device called a night sock splint also can help—it’s a compression sleeve with a strap that gently stretches the plantar fascia while you sleep.
Elevation. When you’re resting or seated, elevate your foot—at the office, prop it up on your desk or an open desk drawer, for instance.
Expect to feel relief in a week to 10 days.
If your pain level is high, medication can help. If you can tolerate an NSAID like Advil, take it with food. If you can’t tolerate it, try acetaminophen (Tylenol). In severe cases, your doctor may prescribe an oral steroid to relieve both the pain and inflammation.
Gentle stretching, especially in the morning, is an integral part of home care. Here are three stretches to practice…
Classic runners’ stretch. Face a wall, and put your hands on it at shoulder height. Step back with one foot, and press that heel into the floor. Bend your front leg, bringing the thigh parallel to the floor. You should feel the stretch in your back foot. Hold for 30 seconds, then switch feet. Repeat the full sequence three times. [Illustration TK]
Stair step-ups. Stand on the bottom tread of a staircase with your forefeet on the tread and your heels hanging off it. Lower your heels toward the floor below, hold for 15 seconds, then raise up on your tiptoes, and hold for 15 seconds. Repeat the full sequence three times. [Illustration TK]
Toe stretches. Sit on a rug, legs extended in front of you. Loop a towel around the ball of one foot, and use both hands to pull the towel ends toward you, toes stretching toward your ankle. Hold for 30 seconds, then repeat with the other foot. Repeat the full sequence three times. [Illustration TK]
Here are more helpful lifestyle fixes for plantar fasciitis…
Upgrade your shoes. Many manufacturers are making smarter shoes with stylish designs that offer arch support and cushioning. Leading brands: Asics, Hoka, Vionic, Brooks, New Balance and Aetrex.
Replace your sneakers every eight months. There are many internal components in shoes that break down—you can’t see them, but your feet will notice and start to hurt.
Add orthotics for arch support. If you’re on your feet all day or if even the best sneakers don’t fully address your arch needs, you might benefit from inserts. They are also great for occasions when you want to wear street shoes rather than sneakers. Leading brands: Superfeet and PowerStep.
Lose weight. Excess weight changes the entire curve of the body—a large abdomen will affect the backs of the legs down to the bottom of the feet. You’ll start to feel a difference when you lose 15 to 17 pounds.
For plantar fasciitis that doesn’t respond to these steps, medical treatment options include a series of three injections into the heel of corticosteroids or platelet-rich plasma…shockwave therapy using sound waves that pass through the skin to increase circulation and speed healing…and cold laser therapy, which delivers wavelengths of low-level light to stimulate healing.
