Recently, I decided to go for a jog after not running at all for more than [redacted] years. I did a half-marathon a couple of presidential administrations ago, so surely it would be fine? It was! Until the next morning, when I rolled out of bed, put my feet on the floor and felt a sharp pain in my heel.
Plantar fasciitis, my old nemesis.
Maybe yours, too. It’s one of the most common causes of heel pain, affecting roughly 2 million people each year in the US, says Dr Lance Silverman, board-certified orthopedic foot and ankle surgeon. About 10% of people in the UK and US will experience it at some point in their lives.
Even the pros fall victim to it. “I don’t even know if I’ve admitted this to my wife or not, but I have had some plantar fasciitis in the last year or so,” says Dr Amiethab Aiyer, division chief of foot and ankle surgery in the Johns Hopkins department of orthopedic surgery. He suspects it was the result of suddenly cranking up the mileage on his treadmill. “I was in denial. But I’d get out of bed, and oh boy, there it is.”
So what exactly is plantar fasciitis, and how can you avoid it? We asked the experts.
What is plantar fasciitis?
To understand plantar fasciitis, you have to get familiar with the plantar fascia first, says Aiyer.
The plantar fascia is a thick band of fibrous tissue that runs from the bottom of the heel all the way to the toes. It is a ligament that connects the bones of the foot to one another, and supports the arch of the foot.
“The plantar fascia is constantly working to support our day-to-day activities,” says Aiyer. Whether you’re running, walking, standing or doing any sort of weight-bearing activity, you’re using your plantar fascia.
Graphic with three lines of text that say, in bold, ‘Well Actually’, then ‘Read more on living a good life in a complex world,’ then a pinkish-lavender pill-shaped button with white letters that say ‘More from this section’
Plantar fasciitis occurs when this ligament becomes inflamed or develops microtears. Generally, this presents as pain in the bottom of one’s heel that increases after periods of rest (like sleeping or sitting at a desk) and lessens as one moves around. “About 80% of these [cases] resolve on their own within a year,’ says Dr Brennan Boettcher, a sports medicine physician at the Mayo Clinic.
But if healing is delayed by continued overuse, warns Silverman, this could lead to the formation of large, painful scar tissue, which can lead to chronic heel pain.
What causes plantar fasciitis?
Plantar fasciitis happens when the plantar fascia is overloaded, says Silverman. This could be a result of sudden increases in activity (like going for a jog after not running for more than [redacted] years), prolonged standing, weight gain, abnormal arches or repetitive stress.
How can you prevent plantar fasciitis?
There are a number of ways to protect your plantar fascia.
Strengthen the muscles of the feet. Silverman suggests doing toe curls (with your feet flat on a towel, grip the towel with your toes and scrunch it towards your body) or marble pickups (using your toes to pick up marbles or similar objects from the floor).
Stretching. Specifically, stretching the calf muscles and the achilles tendon. Regularly stretching and massaging these areas “can help to not only assuage the inflammation, but prevent it from coming back”, says Aiyer.
Increase activity levels gradually. Allow your body to get acclimated to increases in activity levels rather than suddenly ramping up. Basically, don’t do what I did.
Wear the right shoes. Choose a shoe that’s too supportive, and your foot muscles can weaken over time, says Silverman. But choose a shoe that’s not supportive enough, and you may expose your plantar fascia to more direct trauma. Rather than sweating this Goldilocks challenge, Silverman says you should “choose footwear that matches the environment and activity”.
How do you treat plantar fasciitis?
Most cases of plantar fasciitis will resolve on their own after a week or so of rest. But according to the Cleveland Clinic, if the pain and symptoms don’t improve in a week or two, you should consult with a healthcare provider.
“Our first line of treatment often includes a short period of rest, activity modification, and initiation of stretching exercises and strengthening exercises,” says Boettcher. He adds that the rest period should be limited. One of the most common mistakes Boettcher sees in his clinic is people staying off their feet for long periods of time. “We sometimes see patients who are immobilized in a cast or walking boot for weeks or months,” he says. “That often leads to muscle atrophy and weakness.”
Physical therapy and regular foot strengthening works “the vast majority of the time”, says Aiyer. But if symptoms persist after several months, physicians may treat the condition with corticosteroid injections, shockwave therapy or plasma injections.
Extreme cases may require surgery, but these are rare, says Silverman. He explains that these procedures involve excising thickened tissue along the fascia.
What should someone who went jogging after [redacted] years of not running do?
I’m happy to say that after a few weeks of gentle, non-overloading activity, my heel feels great. I can probably lace up my sneakers again soon, but I’ll probably stick to my current preferred form of cardio: walking slowly on the treadmill while watching murder mysteries on my iPad.
