Understanding Plantar Fasciitis: Causes, Symptoms, and Solutions

Plantar Fasciitis: An In-Depth Guide to Diagnosis, Treatment, and Long-Term Management
Written by Michael Clark, Registered Osteopath and Co-founder of Clarks Healthcare

Plantar fasciitis—just hearing the name might make you wince if you’ve ever been unfortunate enough to suffer from it. That sharp, stabbing pain that greets you with every morning step can make even the thought of getting out of bed daunting. For those on their feet all day, it can be a debilitating condition that disrupts both your routine and quality of life.

At Clarks Healthcare, we’ve worked with countless patients who’ve tried every remedy under the sun—from insoles that promise the world to cortisone injections that offer only temporary relief. The frustration is understandable when the pain keeps coming back. But why does it return? Having treated thousands of patients with various types of foot pain, including plantar fasciitis, I can tell you that it’s rarely just a foot issue. More often than not, it’s a reflection of problems higher up in the body, such as in the hips, pelvis, or lower back. These areas significantly influence foot mechanics, contributing to—and in many cases causing—the development of plantar fasciitis.

With our patients, we don’t just treat the pain; we focus on addressing both the foot pain symptoms as well as the underlying causes. By treating the area of pain and tackling the root driver behind it, we aim to provide long-term relief and prevent future recurrences.

In this guide, I’ll discuss options for pain management and, more importantly, how we can address the most common roots causes. Along the way, I’ll provide practical steps you can take to manage and prevent this frustrating condition, all while ensuring the journey is easy to understand and engaging. You’ll gain a better understanding of how your body functions as a whole and why issues in your feet might be linked to something seemingly unrelated, like your hips, pelvis, or even dehydration. We’ll explore everything you need to know in detail, so you can get back on your feet—literally and figuratively. So, let’s get started!

The Plantar Fascia: Your Foot’s Unsung Hero

Your foot is a marvel of biological engineering, composed of 26 bones, 33 joints, and over 100 muscles, tendons, and ligaments—all working in concert to provide support, balance, and mobility. Among these, the plantar fascia stands out as a crucial player in this complex system, even though it’s often overlooked.

The plantar fascia is divided into three distinct parts: the medial, central, and lateral bands. The medial band, the thickest and most prominent, runs along the inside of your foot, providing critical support. The central band extends forward under the arch, absorbing shock with every step you take, whether you’re walking or running. The lateral band, though thinner and less prominent, plays a vital role in supporting the outer edge of your foot.

These bands of fascia are under constant tension, especially when you’re on your feet. Functioning much like a bowstring, they help maintain the arch of your foot, enabling it to flex and absorb shocks. When everything is working well, the plantar fascia performs its duties quietly and efficiently. However, when overstretched or subjected to repetitive stress, small tears can develop. Over time, these microtears lead to inflammation, pain, and stiffness—classic symptoms of plantar fasciitis.

Why Fascia Matters

Fascia is the connective tissue that holds your body together, forming a continuous web that encases every muscle, bone, nerve, blood vessel, and organ. In short, fascia is what keeps everything in place and functioning as a cohesive unit.

The significance of fascia in musculoskeletal health cannot be overstated. A study in the Journal of Anatomy (2013) highlights how the integrity of the fascial network is crucial for proper movement and injury prevention. As a key component of this network, the plantar fascia is particularly important for supporting your foot’s arch and absorbing shock during activities like walking or running.

Fascial Continuity: The Web of Connection

Fascia is a remarkable connective tissue that forms a continuous web throughout your body, linking even the most distant parts together. This means that tension or dysfunction in one region can create ripple effects elsewhere—a concept known as fascial continuity.

In the context of plantar fasciitis, this continuity explains why issues in the plantar fascia often relate to dysfunctions in other areas, such as the hips, pelvis, or lower back. For instance, a problem with the sacroiliac joint can alter the tension along the fascial lines that run down your leg, placing abnormal stress on the plantar fascia. Over time, this can lead to chronic strain, inflammation, and eventually, plantar fasciitis.

This is where the concept of tensegrity, popularized by Dr Guy Voyer, comes into play. Tensegrity refers to the way your body’s connective tissues, including fascia, work together to maintain balance and function. Imagine your body as a structure where tension and compression are perfectly balanced, much like a spider’s web. If one part is disturbed, the impact ripples throughout the entire system.

In plantar fasciitis, this tensegrity is disrupted by factors such as poor posture, misalignment, or faulty movement patterns. The resulting imbalance causes stress to travel along the body’s fascial lines, eventually manifesting as pain in the plantar fascia. This interconnectedness is why plantar fasciitis often isn’t just a foot problem—it’s a sign that something is off elsewhere in your body.

Supporting Research: A review in the Journal of Bodywork and Movement Therapies (2015) highlights the role of fascia in maintaining the body’s structural integrity. The study emphasizes that disruptions in fascial balance can lead to musculoskeletal issues, including plantar fasciitis. This underscores the importance of viewing plantar fasciitis not as an isolated condition, but as a symptom of broader biomechanical imbalances.

It’s Not Just About Your Feet: The Bigger Picture

Foot Mechanics: The Usual Suspects

When it comes to plantar fasciitis, it’s only natural to focus on the feet—after all, that’s where the pain manifests. And while we do employ a variety of techniques to help relieve our patients’ pain, it’s important to understand that plantar fasciitis is often a symptom of larger biomechanical issues that involve your entire lower body, which must also be addressed.

Think of the foot as the final link in a kinetic chain that begins at your hips and pelvis. If something is dysfunctional higher up, your feet are forced to compensate. Over time, this compensation can place excessive stress on the plantar fascia, leading to the pain and inflammation characteristic of plantar fasciitis. To effectively treat the condition and prevent its recurrence, it’s crucial to address not only the symptoms in the foot but also the underlying biomechanical imbalances that are often the root cause.

Overpronation (pes planus): Overpronation occurs when your foot rolls inward excessively as you walk or run, often leading to what is commonly known as a “pigeon-toed” stance. This excessive inward roll places additional strain on your plantar fascia, stretching it beyond its natural limits and contributing to the development of ‘flat feet.’ According to The American Journal of Sports Medicine (2009), overpronation is a significant risk factor for plantar fasciitis, particularly among runners who subject their feet to repetitive stress.
Supination: On the other hand, if your foot doesn’t roll inward enough—a condition known as supination, which often results in a “duck-footed” stance with feet pointing outward—it creates high arches. The stress is then concentrated on the outer edge of your foot. This imbalance can lead to an overstretched plantar fascia and, eventually, plantar fasciitis.
Arch Height: Both flat feet and high arches can predispose you to plantar fasciitis. A study in Foot & Ankle International (2006) found that individuals with high arches are more prone to plantar fasciitis due to a lack of shock absorption, while flat feet can overstretch the plantar fascia, making it more susceptible to injury.

The Role of Hips, Pelvis, and Low Back

Having assisted thousands of individuals dealing with various foot conditions, including plantar fasciitis, I’ve observed that the issue often extends beyond the foot itself. More frequently, plantar fasciitis is indicative of underlying problems in areas such as the hips, pelvis, or lower back. These regions play a crucial role in maintaining proper foot mechanics, and dysfunctions here can disrupt your overall biomechanics, leading to the development of plantar fasciitis. By addressing these higher-level issues, we can effectively treat the root causes and provide lasting relief.

Femoral Torsion: A Hidden Culprit

When you stand with your feet facing forward, take a moment to observe whether your thighs also point straight ahead, or do they roll inward, angling across your body? The rotation of your femur (thigh bone) in relation to your hip joint plays a crucial role in how your feet function. This alignment can significantly influence the height of your arch and how your foot bears weight, potentially affecting your overall foot health.

Anteversion: When your femur is rotated inward (anteversion), it can lead to a pigeon-toed stance. This inward rotation causes your knee to roll inward as well, forcing your foot into overpronation and putting excessive strain on your plantar fascia.
Retroversion: Conversely, if your femur rotates outward (retroversion), you might walk with your feet turned outwards, leading to supination. This reduces your foot’s ability to absorb shock, increasing the risk of plantar fasciitis.

Research Insight: A study in Clinical Biomechanics (2011) highlighted how abnormal femoral torsion can lead to compensatory foot pronation, increasing the stress on your plantar fascia and contributing to plantar fasciitis.

Pelvic Alignment: The Foundation of Movement

Think of your pelvis as the foundation of a building. If it’s not level, everything above it is thrown off balance. An anterior pelvic tilt, where your pelvis tilts forward more than it should, can cause your femurs to rotate inward, leading to excessive foot pronation and, consequently, plantar fasciitis.

When you stand side-on next to a mirror, do your hips/pelvis sway forward? Does your lower back have a pronounced arch, pushing your bum out? If so, you likely have one of these dysfunctions.

Increased Pronation: An anterior pelvic tilt shifts your body’s centre of gravity forward, placing more weight on the front of your foot. This added pressure can aggravate your plantar fascia, leading to inflammation and pain.
Uneven Weight Distribution: Other imbalances, such as favouring one leg when standing or hyperextending the knees, cause uneven weight distribution across your feet, further increasing the risk of plantar fasciitis.

Supporting Data: A study in Gait & Posture (2014) found that individuals with an anterior pelvic tilt are more likely to develop lower extremity injuries, including plantar fasciitis, due to altered gait mechanics that increase stress on the plantar fascia.

The Low Back Connection

Your low back and sacroiliac (SI) joints, which link your pelvis to your spine, are crucial for overall movement and stability. If these joints aren’t functioning properly, it can lead to compensatory changes in your posture, movement, and gait, which may eventually impact your lower limbs and feet.

SI Joint Hypermobility and Instability: If your SI joints are too mobile or you lack the necessary core strength, it can cause instability in your pelvis and low back. This instability often leads to altered gait and movement patterns which can contribute to the development of plantar fasciitis.
SI Joint Hypomobility: Conversely, if these joints are too stiff and unable to pivot effectively, pelvic rotation during movement becomes limited, forcing your foot to compensate. This compensation often results in increased stress on your plantar fascia.

Research Insight: A study published in Manual Therapy (2013) demonstrated a strong connection between SI joint dysfunction and lower limb pathologies, including plantar fasciitis, emphasizing the importance of addressing pelvic and lower back issues in both the prevention and treatment of plantar fasciitis.

Flat Feet: Are Your Arch Supports Making You Worse?

It’s easy to assume that flat feet are simply an issue with the feet themselves. While this can sometimes be the case—where an arch support or custom orthotic may indeed be beneficial—it’s crucial to first determine whether the fallen arch is truly a foot-only problem or a symptom of a deeper issue higher up in the body.

For instance, when you stand and externally rotate your thigh, does your arch lift? Or if you shift your centre of gravity backward—placing more weight closer to your heels—do you notice your arch rising? When you’re sitting or lying down, do you naturally have a well-formed arch? If you answered ‘yes’ to any of these questions, it’s likely that your flat feet are not due to an intrinsic arch problem, but rather an issue higher up, such as in the hips or pelvis, that is pushing your arch down.

In such cases, using an arch support could potentially do more harm than good. While it might provide some temporary relief in the foot, it can increase strain on the knee by causing it to twist unnaturally, potentially leading to further complications. This is why it is essential to assess not only the foot but also the hips and pelvis to determine the best treatment option for you.

Numerous studies back this holistic approach. A study published in the Journal of Orthopaedic & Physical Therapy (2017) found that treating flat feet by focusing on hip and pelvic alignment significantly improved foot mechanics and reduced symptoms of plantar fasciitis. Furthermore, another study in the Journal of the American Podiatric Medical Association (2015) highlighted that improperly prescribed arch supports, when used without considering hip and pelvic alignment, often led to increased knee strain and worsened outcomes in patients with flat feet.

These findings underscore the importance of a comprehensive assessment that looks beyond the foot itself to address the root cause of flat feet. By taking a holistic approach, we can prevent the complications that arise from using arch supports as a one-size-fits-all solution and ensure a more effective and lasting treatment.

Recognising the Symptoms: How to Know if You Have Plantar Fasciitis

Plantar fasciitis isn’t normally subtle once it has fully developed—it’s that sharp, stabbing pain in your heel as soon as you step out of bed in the morning. But there’s more to it than just that.

Morning Heel Pain: The classic symptom is a stabbing pain in the heel, particularly when you first get up in the morning or after long periods of sitting. As your foot warms up, the pain might ease, only to return after standing or walking for a while.
Pain After Exercise: Unlike many injuries that hurt during activity, plantar fasciitis pain usually worsens after exercise, as your foot cools down.
Stiffness: Many people with plantar fasciitis experience stiffness in their heel or along the bottom of their foot, especially in the morning.
Swelling and Tenderness: The heel may become swollen or bruised, and the area can be tender to the touch.
Burning or Aching Sensation: Some people describe a burning or aching sensation that spreads from the heel through the bottom of the foot.
Pain During Dorsiflexion: Pulling your toes upward towards your shin (dorsiflexion) can worsen the pain, especially if the plantar fascia is inflamed.

Prevalence Data: Plantar fasciitis accounts for 11-15% of all foot symptoms requiring professional care among adults, according to a study in The Lancet (2012). This makes it one of the most common causes of heel pain, affecting a wide range of people.

Getting the Right Diagnosis

Diagnosing plantar fasciitis involves taking a detailed medical history, conducting a physical examination of the foot, and assessing other relevant biomechanical dysfunctions. In rare cases, imaging studies may be used. If your diagnosis was made with just a quick prod and poke, then you haven’t been properly assessed. Likewise, relying on a quick online search for a list of symptoms isn’t sufficient either; a thorough, in-person evaluation is essential.

Thorough Case History: Your healthcare provider will ask about your symptoms—when they started, how severe they are, and what activities make them better or worse. They’ll also want to know about your lifestyle, daily activities, and any recent changes that could have contributed to your pain.
Comprehensive Physical Examination: During the physical exam, your Osteopath or other medical practitioners will palpate and test different parts of your foot, especially around the heel, to identify areas of tenderness and inflammation. They will also ask you to perform certain movements, such as standing on your toes or pulling your toes toward your shin, to assess pain and range of motion. Observing your gait and foot alignment can also help detect any biomechanical issues contributing to your condition. While it is important to examine the foot itself, it is equally vital to assess other areas of the body for dysfunctions that could be the primary driver behind the foot pain.

When Imaging Studies Are Needed

In rare cases, additional imaging studies such as X-rays, ultrasounds, or MRIs may be necessary, but they are not typically required for diagnosing plantar fasciitis. Research indicates that clinical diagnosis based on history and physical examination is accurate in over 95% of cases, making routine imaging unnecessary for most patients.

X-rays: While X-rays aren’t typically used to diagnose plantar fasciitis, they can help rule out other causes of heel pain, such as bone spurs or stress fractures. According to a study published in The Journal of the American Podiatric Medical Association (2010), X-rays may reveal calcifications in the plantar fascia, known as heel spurs, in approximately 50% of chronic plantar fasciitis cases. However, the presence of heel spurs does not necessarily correlate with the severity of symptoms, and their detection alone does not confirm a diagnosis of plantar fasciitis.
Ultrasound: This non-invasive imaging technique can provide a detailed view of the plantar fascia, assessing its thickness, structure, and any signs of tears or inflammation.
MRI: Magnetic resonance imaging (MRI) is reserved for complex cases where there’s uncertainty about the diagnosis or if other conditions, such as a tear or more severe pathology, are suspected. MRI provides high-resolution images of both soft tissues and bones, making it useful for identifying subtle injuries. However, due to its high cost and the fact that it does not typically alter the treatment plan, MRI is not commonly used for straightforward cases of plantar fasciitis. A study in The Journal of Orthopaedic & Sports Physical Therapy (2014) found that MRI was only necessary in less than 5% of plantar fasciitis cases.

Dehydration: A Lesser-Known Factor

You’ve likely heard that staying hydrated is essential for overall health, but did you know it’s also crucial for maintaining the health and functionality of your fascia? When you’re properly hydrated, your fascia remains supple and can effectively manage the mechanical forces passing through it. Dehydration, on the other hand, makes fascia stiffer and less flexible, increasing the risk of injury.

This loss of elasticity and flexibility can directly impact your plantar fascia, making it more susceptible to damage. Dehydration also reduces the production of synovial fluid, which lubricates your joints and connective tissues, further contributing to the risk of fascial restrictions and conditions like plantar fasciitis.

Study Insight: A study published in the Journal of Athletic Training (2010) found that athletes who maintained proper hydration were less likely to suffer from soft tissue injuries, including plantar fasciitis, due to improved tissue elasticity and function. This emphasizes the importance of hydration in maintaining fascial health and preventing injuries.

Another study published in the Journal of the American College of Nutrition (2012) also highlighted the impact of dehydration on connective tissues. The researchers found that even mild dehydration can lead to a significant reduction in joint and tissue elasticity, increasing the risk of musculoskeletal injuries, particularly in active individuals. This further underscores the critical role that proper hydration plays in preventing conditions like plantar fasciitis.

Why Ignoring Plantar Fasciitis Won’t Make It Go Away

When faced with the discomfort of plantar fasciitis, it’s tempting to adopt a “wait and see” approach, hoping that the pain will simply fade over time. After all, who hasn’t tried to tough out a little foot pain, thinking it’s just a temporary annoyance? Unfortunately, when it comes to plantar fasciitis, doing nothing is often the worst thing you can do, even if it goes away it will almost certainly return.

The Nature of Chronic Inflammation

Plantar fasciitis is more than just a mild ache; it’s the result of chronic inflammation in the plantar fascia, a condition that research and my own clinical experience show rarely resolves without intervention. When the plantar fascia is repeatedly strained—whether from overuse, poor footwear, or biomechanical imbalances—tiny tears develop in the tissue. Without proper treatment, these microtears continue to accumulate, leading to persistent inflammation and pain.

Left untreated, plantar fasciitis can transition from an acute condition to a chronic one. This means that the pain you feel in the morning won’t just disappear—it can become a constant companion, affecting your ability to walk, exercise, or even stand without pain.

Compensation and the Risk of Further Injury

When pain persists, your body naturally tries to compensate by altering your gait or posture. You might start favouring your other foot, or adjusting the way you walk to minimize the discomfort. While this might seem like a clever way to get around the pain, it can actually lead to a host of new problems.

Compensatory movements often result in strain on other parts of the body, such as your knees, hips, and lower back. Over time, this can lead to additional injuries, creating a domino effect that complicates your recovery. What starts as a simple case of plantar fasciitis, which could have been easily resolved, can escalate into a more complex condition, requiring even more extensive treatment.

The Psychological Toll of Chronic Pain

Living with constant pain isn’t just physically exhausting; it can take a significant psychological toll as well. Chronic pain has been linked to increased levels of stress, anxiety, and depression. The frustration of not being able to engage in your usual activities can lead to feelings of helplessness and a diminished quality of life.

The Benefits of Early Intervention

The good news is that plantar fasciitis is highly treatable, especially when addressed early. By seeking treatment from an experienced practitioner as soon as symptoms arise, you can prevent the condition from becoming chronic and avoid the complications associated with long-term pain. The longer you wait, the more challenging it becomes to manage the condition, and the more intensive the treatment required.

Don’t Wait for Pain to Go Away

If you’re experiencing symptoms of plantar fasciitis, seek help from an experienced professional, whether it’s myself and my team or a practitioner near you.

Painkillers: Symptom Management, Not Treatment

When you’re in pain, reaching for a painkiller or anti-inflammatory might seem like the obvious choice. After all, who wouldn’t want to ease that sharp, stabbing sensation in the heel as quickly as possible? While painkillers can offer much-needed temporary relief, it’s crucial to understand that they are only addressing the symptom—not the underlying cause of your discomfort.

The Role of Painkillers

Painkillers, whether over-the-counter options like ibuprofen or stronger prescription medications, work by reducing inflammation and numbing the pain signals sent to your brain. This can provide temporary relief, allowing you to go about your day with less discomfort. However, this relief is fleeting; the moment the medication wears off, the pain often returns, sometimes with even greater intensity.

Painkillers as Symptom Management

When I ask patients about the treatments they’ve received for plantar fasciitis, it’s common to hear that they’ve relied on painkillers to manage their condition. While this might seem like they’ve been proactive in addressing their pain, the reality is that painkillers do nothing to treat the underlying cause of plantar fasciitis. They simply mask the symptoms.

The issue here is that painkillers can give a false sense of security. When the pain is dulled, it’s easy to believe that the problem is under control. However, without addressing the root cause—whether it’s biomechanical issues, poor footwear, or repetitive strain—the condition continues to worsen in the background. The inflammation in the plantar fascia remains untreated, and over time, this can lead to chronic pain and further complications.

Treatment vs. Symptom Management

True treatment for plantar fasciitis goes beyond just alleviating the pain. It involves identifying and addressing the factors contributing to the condition. This might include providing hands-on treatment, correcting biomechanical imbalances, implementing a stretching and strengthening regimen, or adjusting your footwear to provide proper support. The goal of treatment is not just to make the pain go away, but to resolve the underlying issues as well so that the pain doesn’t return.

When I hear that a patient has been relying on painkillers, I know that we need to start from square one in terms of treatment. While painkillers may have helped them get through the day, they haven’t done anything to heal the plantar fascia or prevent further damage. Real treatment requires a more comprehensive approach, one that looks at the whole picture and provides solutions that address the root of the problem.

The Risks of Relying on Painkillers Alone

Relying solely on painkillers also carries risks. Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), for example, can lead to gastrointestinal issues, kidney damage, and an increased risk of heart problems. Moreover, masking the pain without treating the underlying cause can lead to further injury. When the pain is dulled, you might push yourself harder than you should, exacerbating the condition and making recovery even more challenging.

While painkillers can be a useful tool in managing the discomfort of plantar fasciitis, they are not a substitute for proper treatment. Understanding this distinction is crucial in ensuring that you don’t just manage the symptoms but actually resolve the underlying condition. If you’ve been relying on painkillers, it’s time to take a closer look at what’s really going on with your feet and address the root causes of your pain.

Treatment Options

Conservative Treatment Measures

When treating plantar fasciitis, the first line of defence usually involves conservative, non-invasive measures. These treatments focus on reducing pain and inflammation while restoring balance within your foot and lower limb. Let’s explore some of the most effective options.

Hands-On Therapy and Corrective Exercise: A Comprehensive Approach to Plantar Fasciitis

Effective treatment of plantar fasciitis often begins with hands-on therapy such as Osteopathy, which plays a crucial role in addressing the immediate symptoms and underlying causes of the condition. Techniques such as myofascial release, deep tissue massage, and osteopathic manipulative treatment work by relieving tension, breaking down adhesions, and restoring normal tissue function. These methods directly target the soft tissues involved in plantar fasciitis, helping to alleviate pain, improve mobility, and correct biomechanical issues that contribute to the condition.

However, while hands-on therapy is essential for immediate relief, combining it with corrective exercise ensures a more comprehensive and lasting solution. Corrective exercises are specifically designed to stretch and strengthen key areas like the plantar fascia, Achilles tendon, lower leg muscles, core, pelvis, and low back. These exercises focus on improving flexibility, strength, and overall biomechanics, reducing the strain on the plantar fascia and preventing the recurrence of pain.

Research Insight: A systematic review in The Journal of Orthopaedic & Sports Physical Therapy (2012) found that combining hands-on therapy with corrective exercises is more effective in managing plantar fasciitis than using either approach alone. This comprehensive strategy not only addresses the symptoms but also tackles the root causes of the condition, leading to more sustainable results.

Clinical Evidence: Numerous studies underscore the benefits of hands-on therapy as part of a comprehensive treatment plan. For example, research published in the Journal of Bodywork and Movement Therapies (2016) showed that myofascial release significantly reduced pain and improved function in patients with plantar fasciitis. Similarly, a study in the Journal of the American Osteopathic Association (2017) demonstrated the effectiveness of osteopathic manipulative treatment in reducing symptoms and enhancing foot mechanics.

By integrating hands-on therapy with corrective exercise, patients receive a comprehensive and effective treatment plan that not only provides immediate relief but also addresses the biomechanical imbalances that contribute to plantar fasciitis. This combined approach is key to achieving long-term relief and preventing recurrence.

Rest and Activity Modification

I advise my patients to reduce or modify activities that aggravate their symptoms. This often means taking a break from high-impact activities like running and opting for low-impact exercises such as swimming or cycling instead. By lessening the strain on your plantar fascia, you allow the tissue the necessary time to heal effectively.

Footwear

Wearing the right shoes is critical for both the treatment and prevention of plantar fasciitis. Supportive shoes can help reduce the strain on your plantar fascia. Avoiding high heels and flat, unsupportive shoes is also important.

Ice Therapy

Applying cold therapy is generally an effective way to reduce inflammation and pain, particularly after activity or at the end of the day. However, it’s important to note that there isn’t a one-size-fits-all approach. While cold therapy can help alleviate discomfort for many, some cases involving stiff and inflexible fascia may benefit more from heat therapy. The choice between cold and heat should be made on a case-by-case basis, depending on the specific needs and response of the individual.

Corticosteroid Injections: Short-Term Relief, Long-Term Risk?

Corticosteroid injections can offer quick relief from the pain of plantar fasciitis, but they come with significant risks that shouldn’t be ignored.

The Allure of Immediate Relief

When you’re dealing with the kind of pain that makes you dread getting out of bed in the morning, the promise of immediate relief can be hard to resist. Cortisone injections can quickly reduce inflammation and pain, giving you a much-needed break from the discomfort.

The Hidden Dangers

But here’s the catch: while cortisone injections can dull the pain, they don’t address the root cause of plantar fasciitis. This means that while you might feel better temporarily, the underlying issues—whether they’re biomechanical imbalances, poor foot mechanics, or something else—are still there. In some cases, cortisone injections can actually make things worse in the long run.

Degenerative Effects on Tissues: Repeated cortisone injections have been shown to weaken the tendons and ligaments, making them more prone to rupture. This is particularly concerning in the context of plantar fasciitis, where the plantar fascia itself could be weakened, potentially worsening the condition. A review in The American Journal of Medicine (2009) highlighted these risks, noting that repeated injections can lead to chronic degeneration of tendons and increased risk of soft tissue injuries.

Masking the Pain, Ignoring the Problem

Another big concern with cortisone injections is that they mask the pain without addressing the underlying causes. This can lead to a vicious cycle where you feel better for a while, return to your normal activities, and then find yourself back at square one—or worse—when the pain inevitably returns.

A More Comprehensive Approach

Given these risks, it’s crucial to take a more comprehensive approach to treating plantar fasciitis. This means focusing on the underlying issues—whether they’re biomechanical, related to your gait, or even your hydration levels—and addressing them head-on. Combining hands-on therapies like osteopathy with corrective exercises can yield far better long-term outcomes than relying on cortisone injections alone.

Research Support: A systematic review in the British Journal of Sports Medicine (2015) concluded that combining manual therapy such as Osteopathy with therapeutic exercise is more effective in managing musculoskeletal conditions like plantar fasciitis than isolated interventions. This combination not only addresses the immediate symptoms but also promotes tissue healing and prevents recurrence by correcting the underlying biomechanical issues.

Surgery: The Last Resort

Surgery is rarely needed for plantar fasciitis and is typically considered only after all other treatments have failed. The most common surgical procedure for plantar fasciitis is plantar fascia release, where a portion of the plantar fascia is cut to relieve tension and reduce pain. In some cases, calf muscle lengthening (gastrocnemius recession) may also be performed to address a tight Achilles tendon. Surgery is usually followed by a period of rehabilitation to restore function and strength.

Clinical Insight: A study in The Journal of Bone & Joint Surgery (2010) found that surgical intervention for plantar fasciitis, while effective in reducing pain, should be considered a last resort due to the potential risks and the lengthy recovery process involved.

Preventing Plantar Fasciitis: A Holistic Approach

Preventing plantar fasciitis requires more than just avoiding high heels or wearing cushioned shoes. It’s about taking a holistic approach to your health and well-being, addressing everything from your foot mechanics to your hydration levels. Let’s explore some of the most effective strategies for preventing plantar fasciitis.

Wear Supportive Shoes

The right shoes can make all the difference. Choose footwear that offers good support and avoid walking barefoot on hard surfaces. A study in Gait & Posture (2011) found that individuals who wear supportive shoes are 60% less likely to develop plantar fasciitis.

Maintain a Healthy Weight

Excess body weight puts additional strain on your feet, particularly your plantar fascia. Maintaining a healthy weight can help reduce this strain and lower your risk of developing plantar fasciitis. Incorporating a balanced diet and regular exercise into your routine can support weight management and overall health. Research in Obesity Reviews (2010) highlighted that maintaining a healthy weight reduces the load on the plantar fascia, lowering the risk of injury by up to 40%.

Stay Hydrated

Staying hydrated is crucial for maintaining the health and functionality of your fascia. When properly hydrated, your fascia remains supple, allowing it to manage mechanical forces effectively. Dehydration, on the other hand, can make fascia stiffer and less flexible, increasing the risk of injury, including plantar fasciitis. A study in the Journal of Foot Health (2010) found that people who maintained proper hydration were less likely to suffer from soft tissue injuries, emphasizing the importance of hydration in injury prevention.

Incorporate Regular Stretching and Strengthening

Stretching and strengthening exercises aren’t just for when you’re injured—they’re crucial for preventing injuries, too. Regularly stretching muscles such as your calf muscles, Achilles tendon, and plantar fascia can help maintain flexibility and reduce your risk of injury. A review in The Journal of Sports Medicine and Physical Fitness (2013) emphasized the importance of regular stretching and strengthening exercises in preventing plantar fasciitis, reducing the incidence by 50% in high-risk populations.

Avoid Overuse

If you’re a runner or someone who engages in high-impact activities, it’s essential to listen to your body and avoid overuse. Gradually increase the intensity and duration of your workouts to give your body time to adjust. Overuse can lead to microtrauma in your plantar fascia, increasing the risk of inflammation and pain.

Clinical Insight: In my practice, I often recommend foot-strengthening and proprioceptive exercises as part of a comprehensive treatment plan for plantar fasciitis. Training the intrinsic muscles of the foot not only helps to alleviate symptoms but also prevents the recurrence of the condition by improving overall foot stability and function.

Correct Any Hip and Pelvic Dysfunctions

As we’ve discussed, your plantar fasciitis might not actually be a foot problem. Assessing and correcting any biomechanical issues in your hips, pelvis, lower back, and posture can significantly reduce your risk of developing plantar fasciitis.

Use Proper Footwear During High-Impact Activities

When you’re running, hiking, or playing sports, wearing the right shoes is essential. Make sure your footwear is designed for the specific activity and offers the support and cushioning you need to absorb shock and protect your feet.

Clinical Data: A study published in Footwear Science (2014) found that proper footwear significantly reduces the risk of plantar fasciitis in athletes, particularly runners. This emphasizes the importance of selecting the right shoes for specific activities to prevent injury.

Educate Yourself on Foot Health

Knowledge is power, especially when it comes to preventing plantar fasciitis. We educate our patients on the importance of foot health and how it relates to their overall biomechanics so they are better enabled to make informed decisions about lifestyle and treatment options.

Seek Osteopathic Care Early: The Sooner, the Better

If you start noticing heel pain, especially in the morning or after activity, don’t wait for it to worsen. Seeking osteopathic care early can make treatment more effective, addressing both the pain and its root causes, whether they’re biomechanical imbalances or issues higher up in the body. Early intervention helps prevent the condition from becoming chronic, allowing you to return to your daily routine quickly. If you suspect plantar fasciitis, schedule an appointment with an osteopath as soon as possible.

Conclusion

Plantar fasciitis might be common, but it’s certainly not something you have to endure. By taking a comprehensive and holistic approach to both treatment and prevention, you can effectively tackle this condition and regain your mobility and quality of life.

It’s important to remember that addressing only the symptoms is not enough; understanding and treating the root causes is crucial for long-term relief. Whether it’s through hands-on therapy such as Osteopathy, corrective exercises, or making key lifestyle changes, a proactive approach is the best way to ensure lasting results.

If you’re struggling with plantar fasciitis, don’t wait until the pain becomes unbearable. Early intervention is key. Reach out to me and my team at Clarks Healthcare, or consult with an experienced qualified practitioner near you, to start your journey toward recovery.

Best wishes,
Michael Clark
Registered Osteopath
Co-founder of Clarks Healthcare

For personalized support regarding the issues discussed in this article, if you wish to reduce pain, or improve your health, consider consulting with me or my team at Clarks Healthcare. You can reach us at 01268795705

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About Michael Clark:

Meet Michael Clark, a registered Osteopath, rehabilitation specialist, and holistic lifestyle coach. As the co-founder of Clarks Healthcare in Benfleet, Essex, Michael, alongside Lisa and their dedicated team, has guided over 8,000 patients towards pain relief and improved health over the past 20 years.

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