Have you ever stepped out of bed in the morning and felt like you stepped onto a Lego, but there's no Lego? If so, you have the primary symptom of plantar fasciitis.
I'll start with the pronunciation. The tissue that holds up the arch of your foot is the plantar fascia. Some people say "FOSH-uh," some say "FAYSH-uh," and I say "FASH-uh," like all of the other people who say it correctly. When we add the suffix "-itis" to anything, it means inflammation of whatever the prefix was. So this is inflammation of the fascia. But if you drop the "a" off of fascia, then add "-itis" you have two "i's" in the middle of the word. Some people pronounce both, and it comes out plantar "FA-shee-I-tis." It's fine. Go ahead. Say it like that.
Many of us pronounce it plantar "fash-I-tis." This, to me, is correct, and it keeps my blood pressure reasonable.
Regardless of how they pronounce it, if someone is talking about it, it's because at some point they have gotten out of bed and felt like someone was stabbing them in the heel of their foot.
The plantar fascia is a really thick, inelastic tissue that starts at the bottom of your heel bone, and stretches to the ends of the bones that make up the ball of your foot. It whole job is to support the arch of the foot. Without it you wouldn't have any spring in your step. Those foot bones would just slap on the floor as if you were wearing swim fins.
We all have the same bones and tissues, but you'd be surprised at how many different alignments there are in those tissues.
Here's what we call pes planus (flat feet):
See how the achilles makes a turn between the calf and the heel?
Here's what we call pes cavus (high arch):
The achilles is curving in the opposite direction.
When your plantar fascia gets inflamed, it lets you know, The intense pain first thing in the morning is the hallmark symptom, but there are other things to know about plantar fasciitis.
- Stage 1 - Your heel will hurt when you step out of bed in the morning. As the day progresses, your tissues warm up and the pain lessens.
- Stage 2 - Your foot hurts first thing in the morning, and that pain is getting worse. Your heel will hurt after physical activity, but not during physical activity.
- Stage 3 - Now your heel hurts all the time -- even when you're playing pickleball. After pickleball it's throbbing, and when you get up in the morning you're walking on the outside of your foot, which you are trying to close like a fist, in order to avoid putting the sole of your foot on the floor.
That fascia on the bottom of your foot is experiencing minor tearing at its origin point at your heel. The more you stress it, the more inflamed it gets. The more inflamed it gets, the more it will tell you to stop whatever it is you're doing.
When an athlete comes into the training room with plantar fasciitis, we do cold soaks, ultrasound, friction massage, and strengthening activities. All of these have limited success. We also have a specific tape method to support the plantar fascia, and this is more effective than the exercises and modalities. With the athlete seated, leg straight and ankle flexed, we put the foot into a neutral position, then apply tape to the ball of the foot and around the heel of the foot. When the athlete stands up, the tape prevents the foot from splaying. This relieves a lot of the stress experienced by the plantar fascia when someone is standing, running, and jumping on an overstressed plantar fascia.
But the MUCH MUCH MUCH better option is a rigid arch support.
Over-the-counter arch shoe inserts are available at every drug store. Simple insoles are similar to the inserts that come in your sneakers. They cost about $10, but they aren't supportive enough to relieve the stresses on your plantar fascia.
See how there's nothing under that arch? If you have low arches, this insole will just collapse under your foot. If you have high arches, this insole isn't providing any support. You'll need something more supportive.
The next level goes beyond a simple insert. These are marginally better. These cost about $20, and they put some cushion and padding under your arch. But that cushion is small and spongy, so it compresses under your foot.
There are over a dozen arch support options at any drug store. None of those are very effective for plantar fasciitis that has progressed to stage 2. There are other supports available that offer more support, like the ones below. These are about $70, and they are rigid.
If you aren't getting relief from these, I'd recommend custom orthotic insoles. They cost between $350 and $500, but in my own experience they're totally worth it. When you see an orthotist, she'll put your foot into a neutral position in a mold, then she'll create an orthotic to correct for your specific misalignment.
In my own experience, I started getting plantar fasciitis when I was playing soccer and diving in college. During soccer season I got orthotics, I initially got to help my severe shin splints that were on the verge of stress fracture. (The same forces that cause shin splints will contribute to plantar fasciitis.) A podiatrist took a cast of my foot and sent it to a lab, and a few weeks later I had my insoles. A few weeks after receiving my orthotics I moved from soccer into springboard diving, so I was jumping on bare feet for 2-3 hours every day, and my shins and feet got much worse. I've had custom orthotics continuously since 1987, and when my feet start to hurt I know it's time to get new ones. I can wear the same pair for 8-10 years without needing new ones. If I spend too much time in my Tevas during the summer, the soles of my feet get grumpy and I move back to my shoes with supports.
If you have foot pain (or sometimes shin pain, leg pain, knee pain...), you should see a doctor before it gets to stage 3. Amy had to have a PRP (platelet rich plasma) injection into her foot, and she does not recommend that experience to anyone. If you need orthotics, I'd strongly recommend Heather at Boulder Orthotics (boulderorthotics.com). Instead of getting a mold of your foot that's sent out to a lab, Heather will make the orthotics while you're in her office. Instead of waiting for your orthotics for a few weeks, Heather hands them to you while you're there, and then she'll watch your gait to make sure your foot position is properly aligned. Then she'll make more adjustments so that your orthotics are perfect. Amy and I have both gotten our orthotics from Heather, and both of us really notice a difference in our feet and legs when we have the right support.
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