Plantar Fasciitis: A Comprehensive Guide

Plantar fasciitis is a common condition that causes heel pain. It affects the plantar fascia, a thick band of tissue that runs along the bottom of the foot, connecting the heel to the toes. The condition is characterized by degenerative irritation at the point where the plantar fascia attaches to the heel bone. Despite the name, plantar fasciitis is not characterized by inflammation.

Here are some key points about plantar fasciitis:

• Symptoms include sharp pain near the heel, especially in the morning or after rest. Pain can also be present after activity. The heel may be tender to the touch.

• Causes often include overuse and strain, such as repetitive stress from activities like running or prolonged standing. Other factors can include improper footwear, certain foot structures like flat feet or high arches, and excess weight.

• Plantar fasciitis is more prevalent in women than men, in people aged 45-64, and in those with a higher body mass index.

• While heel spurs are often associated with plantar fasciitis, they are not the cause of the condition.

• Diagnosis is typically based on a physical exam. Imaging may be used to rule out other conditions.

• Treatment usually starts with conservative measures like rest, ice, stretching, orthotics, and physical therapy. Medications like NSAIDs can be used to manage pain. More advanced treatments, such as injections or shockwave therapy, may be considered if conservative measures aren't effective. Surgery is a last resort.

• Most cases of plantar fasciitis will resolve within 12 months, but recovery can take weeks or months.

The goal of treatment is to reduce pain and inflammation, and restore normal function. It's important to consult a healthcare professional for a personalized treatment plan.

Disclaimer: The content provided in this podcast is for informational purposes only and should not be construed as medical advice. It is not a substitute for professional diagnosis, treatment, or consultation with a qualified healthcare provider. Always seek the advice of a physician or another qualified health provider with any questions or concerns regarding a medical condition. By listening to this podcast, neither its hosts, guests, nor publishers establish a doctor-patient relationship, and no liability is assumed for any decisions made based solely on the information presented.

Episode Transcript

(00:00):
Welcome to the Podiatry Insight Hub, the leading informational audio platform for common care

(00:07):
and treatments related to lower extremity.
Get ready for another great podiatry topic in today's post.
Ready, set, here we go.
Disclaimer, the content provided in this audio is for informational purposes only and should
not be construed as medical advice.
It is not a substitute for professional diagnosis, treatment, or consultation with a qualified
healthcare provider.

(00:28):
This is to seek the advice of a physician or another qualified health provider with
any questions or concerns regarding a medical condition.
By listening to this audio platform, neither its hosts, guests, nor publishers establish
a doctor-patient relationship and no liability is assumed for any decisions made based solely
on the information presented.
Alright ready to dive deep.
Today it's all about plantar fasciitis, that foot pain, you know.

(00:49):
Oh yeah, plantar fasciitis.
And we've got a, well kind of a lot of info to sort through, we've got some actual research
from the government, no less.
Oh wow.
Yeah, a study on how common it is and what people do about it.
Then we've got this guide straight from like a podiatry clinic down in Florida.
Hands on advice of it.
Exactly.

(01:10):
Yeah.
And then to really get into the weeds, we've got stat pearls.
It's a medical resource.
Ah, so we're going from like big picture to the nitty gritty detail.
Exactly.
Now I know plantar fasciitis might sound, I don't know, kind of scary, but we're gonna
make it interesting.
I'm sure you will.
Yeah.
Ready to tackle heel pain?
Let's jump in.

(01:30):
Okay, so first things first.
You know how it's called plantar fasciitis?
Yeah, the athicitis makes it sound like all inflamed.
Right, but that's actually a bit of a misnomer.
It's not really mainly about inflammation.
It's more about degeneration, like wear and tear on that thick band of tissue on the bottom
of your foot.
Oh, the plantar fascia.
That's it.
So it's not just a flare up, it's more like, you know, fraying a rope over time.

(01:52):
Oh, okay, that makes sense.
So how common is this fraying rope problem?
Well that's where that government study comes in.
The NCCIH one.
Yeah.
And get this, they found that only about 1% of us adults, you know, at any given time,
have plantar fasciitis pain.
Wait, 1%?
That seems, I don't know, really low.
I feel like I hear about plantar fasciitis all the time.

(02:14):
Right.
It does seem low, but it's like a snapshot.
A snap.
Yeah, like at this moment, over a lifetime.
Oh, over time, yeah.
Way more people will experience it, you know?
Makes sense, but still even 1% of the whole U.S.
That's millions of people.
True, true.
So why did some people get it and others don't?
Well that's the big question, right?
And our sources point to a few things, age for one.

(02:36):
The older you get, the more wear and tear.
Makes sense.
Yeah.
And weight too, that's a big one.
Weight, how does that tie in?
Well think about it, every step you take puts stress on your feet.
The heavier you are, the more that fascia has to like absorb.
Oh, so it's like more force, more potential for those little tears.
Exactly.
And the NCCIH study, they actually found that being overweight significantly increased your

(03:00):
chances of getting plantar fasciitis.
Interesting, so it's not just the weight itself, but how it affects like the way your foot works.
Exactly, it's all connected.
Wow.
Okay, so what else did they find?
They also looked at foot structure.
Like flat feet, high arches, that kind of thing.
Yeah.
So they changed how your weight is distributed, putting extra stress on that fascia.

(03:21):
And then of course there's overuse.
Overuse, okay.
So that's where runners and...
Yeah, anyone on their feet a lot.
Right, right.
And that Florida guide had a whole list, occupations like nurses, teachers.
He's got lots of standing.
They even mentioned shoes.
Like wearing the wrong shoes can contribute.
It all adds up, right?
Plantar fasciitis is usually a bunch of things together.

(03:42):
So okay, say I'm thinking, hmm, maybe this is what's going on with my foot.
What are they like the signs?
Well the classic one is heel pain and it can be pretty specific.
Specific how?
The Florida guide, they mentioned that it's often worse in the morning.
Oh yeah, that first step out of bed.
Right.
And it makes sense.

(04:03):
Overnight, that fascia has been relaxing, almost shortening.
So suddenly you put weight on it.
Yikes, I can imagine.
And it's not just morning pain, stiffness too, especially after you've been resting.
Okay, so it's worse after rest, not just during activity.
Yeah, can be.
And of course, tenderness right there on the bottom of your heel.

(04:24):
And sometimes the staff, Pearl source mentioned the pain can even go up your leg.
Right, in more severe cases.
That's why it's so important to, you know, address it early before it really starts affecting
you.
So what can you do about it?
I'm assuming there are treatments.
Oh yeah, definitely.
And the good news is there's a whole range of options from simple things you can do at
home to like more advanced medical stuff.

(04:46):
But let's start with the basics.
Right, what's here?
So the Florida guide, they actually have like a really nice step by step approach to treating
clantar fasciitis.
They say start simple, conservative measures first, things you can do yourself at home.
Oh, like home remedies, I love those.
What do they recommend?
Well, they talk about the good old ricey protocol.

(05:06):
Rest, ice, compression, elevation.
The classic ricey.
So basically give your feet a break, ice the area, maybe wrap it up for support and keep
it elevated.
Exactly, simple things, but often that's all you need, especially when you're just starting
to feel the pain and then they're stretching.
Oh, stretching is always good.
Yeah.
But what kind of stretches are we talking about here?

(05:27):
Any specific ones?
They specifically mentioned stretching your calves.
Your calves.
Why your calves?
Because those tight path muscles can actually pull on the plantar fascia, makes the pain
worse, you know.
Oh, so you got to loosen those up?
Exactly.
They even suggest some easy ones you can do throughout the day, like using a towel to
pull your toes towards you or rolling a tennis ball under your foot.

(05:50):
Okay, those sound pretty manageable, but what if those home remedies aren't cutting it?
What if the pain just keeps hanging around?
Well then it might be time to step things up a bit.
Both the Florida Guide and Snap Pearls talk about some more, I guess you could say advanced
options.
Okay, so let's dive into those.
What do they suggest?
Orthotics are a common one.

(06:10):
Orthotics, okay.
Those are like the inserts for your shoes, right?
Yeah, exactly.
They can be custom made or you can get some over the counter.
They help support your arch and cushion your heel.
So they kind of take some of the pressure off that fascia.
Exactly.
And then of course there's always physical therapy.
Physical therapy, right.
Physical therapists would give you specific exercises to do.

(06:31):
Yeah, they'll work with you on a program to strengthen the muscles in your feet and
legs and improve flexibility too.
So it's not just about masking the pain, it's about getting those muscles stronger and working
better.
Precisely.
But then if those conservative approaches still aren't helping enough, there are some
more invasive options.
Invasive, like surgery.

(06:52):
Well, surgery is definitely a possibility, but it's usually considered a last resort.
Makes sense.
It's not something you want to jump into lightly.
Right.
And it doesn't always guarantee success, plus there can be complications.
So not a decision to make lightly for sure.
Yeah.
But you said there were other things before we even get to surgery.
Oh yeah.
Corticosteroid injections, for example.

(07:13):
Corticosteroid injections.
Hmm.
Those are like steroids, right?
Yeah, basically.
They help reduce inflammation and can provide some pain relief.
It's usually just temporary though.
Okay, so kind of like a quick fix to give you some breathing room.
Just one way to think about it, and then there's also shockwave therapy.
Shockwave therapy.
Okay, that sounds intense.
What's that all about?

(07:33):
It might sound kind of sci-fi, but it's actually not invasive.
They use sound waves to try and stimulate healing in the fascia.
Wow, sound waves, huh?
So they're basically blasting those sound waves at your foot to try and get it to heal
better?
Pretty much.
It's not totally clear how it works, but studies have shown it can be effective for
some people.

(07:53):
Huh, interesting.
So it sounds like there are a lot of different options, from the super simple to the more
high-tech.
Exactly, and the key, like with any medical condition, is to work with your doctor to
figure out what's best for you.
Makes sense.
And speaking of working with your doctor, I noticed stat-pearls mentioned something
interesting about diagnosis.

(08:13):
They said that most of the time, plantar fasciitis can be diagnosed clinically.
Oh, right.
So it's not always about fancy tests.
So no MRIs, no X-rays, just a good old-fashioned doctor's visit.
Sometimes, yeah.
A skilled doctor can often figure it out just by listening to you and examining your foot,
checking for tenderness, seeing how much you can move it.

(08:34):
So they're looking for specific signs that point to plantar fasciitis.
Exactly.
But sometimes they might want to do an X-ray or an ultrasound.
Why would they do that if they can usually figure it out without it?
Well an X-ray can help rule out other things, like maybe you have a stress fracture instead
of plantar fasciitis, and ultrasound can actually show them the fascia itself, see if it's

(08:55):
thickened or swollen.
So it's about getting more information if the diagnosis isn't clear-cut or if the
initial treatment isn't working.
Okay, that makes sense.
But let's go back to treatment for a second.
Stat-pearls had a really important point about, well, any of these treatments really.
Oh, you mean about consistency.
Yeah, that's it.
They said it doesn't matter what treatment you choose, you got to stick with it.

(09:18):
Absolutely.
You just do your stretches every once in a while or wear your orthotics only when you
feel like it and expect things to magically get better.
They said you need to give it at least six weeks, no matter what you're doing.
Right.
And they also talked about how combining different treatments can be really effective.
Oh, so it's not necessarily either.
You could do stretching, wear orthotics, and go to physical therapy all at the same time.

(09:41):
Exactly.
It's about taking a multifaceted approach.
And remember, the goal isn't just to mask the pain.
It's about actually restoring the proper function of your foot.
So you can get back to doing all the things you love without your feet holding you back.
Exactly.
Now, I know we've been talking a lot about all this technical stuff.
Maybe we should tackle one more thing before we wrap up this part.

(10:02):
Sure, but make it a quick one.
Okay, how about heel spurs?
Everyone talks about them like they're the boogie man of foot pain, but are they really
that big of a deal?
So heel spurs, are they really as bad as people make them sound?
Well, stat pearls actually had a really good explanation about heel spurs, or these bony
growths, right?
Yeah, and they sound kind of scary.

(10:23):
Like is there literally a spur digging into your heel?
Not quite.
They actually often show up on X-rays of people with plantar fasciitis, but they're not usually
the main cause of the pain.
So it's not like you're stepping on a spike every time you walk.
Exactly.
Think of it like this.
The plantar fascia, that band of tissue we were talking about, it attaches to your heel
bone, and when there's constant stress on that spot, sometimes the body tries to reinforce

(10:49):
the area.
And that's what forms the heel spur.
Exactly.
It's like the body's way of trying to help, but it doesn't always work out so well.
So it's more of a side effect of the plantar fasciitis itself.
Right, but even though the spur itself might not be causing the pain, it can be a clue.
A clue?
What do you mean?
Well, it can tell us that there's been a lot of stress on the fascia for a long time,

(11:11):
in some cases, if a spur gets big enough, it can actually start to irritate other tissues
around it.
So it's not always totally harmless, but it's usually not the main problem.
Right.
It all comes back to treating that plantar fasciitis.
Makes sense.
Now, before we wrap up, I wanted to touch on something from the NCCIH study.
They found that a lot of people with plantar fasciitis take over-the-counter pain relievers.

(11:34):
Yeah, that makes sense.
Plantar fasciitis can be really painful.
So what kind of over-the-counter options are we talking about?
The study mentioned NFAids, like ibuprofen and naproxen.
Those can help reduce inflammation and pain.
And then there's acetaminophen or Tylenol.
That one mostly just targets the pain.
They also mentioned that some people use herbal products or dietary supplements.

(11:55):
Right, but here's the thing.
There isn't a lot of solid research to back up those kinds of treatments for plantar fasciitis
specifically.
So it's more like people are trying them and maybe finding some relief, but we don't have
strong scientific evidence yet.
Exactly.
But, hey, everyone's different.
What works for one person might not work for another.

(12:18):
True, true.
But probably best to check with your doctor before you start experimenting with new things.
Oh, absolutely.
They can help you figure out what's safe and what might interact with other medications
you're taking.
Good advice.
Well, we've covered a lot of ground today.
We talked about what plantar fasciitis is, who gets it, what it feels like, and all sorts
of treatment options.

(12:39):
We even busted some myths about heel spurts.
Exactly.
But before we sign off, I think it's important to remember one thing.
What's that?
Dealing with chronic pain, no matter what kind, could be tough.
Emotionally, too.
That's such an important point.
It can really wear you down.
You know, it affects your mood, your sleep, everything.
It's easy to start feeling alone.
Absolutely.
So if you're dealing with plantar fasciitis, remember you're not alone in this.

(13:03):
Talk to your doctor, connect with other people who understand, or even reach out to a mental
health professional.
Taking care of your mental health is just as important as your physical health.
Couldn't agree more.
So to wrap things up, plantar fasciitis is common, but it's also manageable.
We've learned that there are lots of effective treatments out there, from simple things you

(13:23):
can do at home to more involved medical interventions.
And don't forget, those heel spurs, while they might sound intimidating, are usually
not the root of the problem.
Focus on treating the plantar fasciitis, and don't be afraid to seek support for the emotional
side of things, too.
Well said.
That's all for our deep dive into plantar fasciitis.
We'll catch you on the next one.