You swing your feet out of bed, stand up, and the first step lands like a bruise on the bottom of your heel. A few minutes of shuffling around the kitchen and it eases off. Then you sit through a long meeting or a drive, stand up again, and it is back. That pattern, sharp heel pain with the first steps after rest, is the classic sign of plantar fasciitis.
This post covers what plantar fasciitis is, why it tends to hurt most first thing in the morning, what you can do at home, the signs that mean you should get medical care first, and when a chiropractic evaluation may be worth it.
Summary
- Plantar fasciitis is irritation of the plantar fascia, the thick band of tissue along the bottom of your foot that connects your heel to the front of your foot and supports your arch.
- The telltale symptom is heel pain with your first steps in the morning or after sitting for a while, which often eases after a few minutes of walking.
- Stretching your calves and the bottom of your foot, icing, supportive shoes and easing off high-impact activity are the usual first steps.
- Pain after an injury, a foot you cannot put weight on, redness, swelling, fever, an open sore, or foot pain with diabetes all mean you should see a medical provider.
- If the pain keeps coming back or is getting in the way of work or training, an evaluation of how your foot, ankle and calf are working may help you understand why.
What Plantar Fasciitis Is
The plantar fascia is a strong band of tissue that runs along the sole of your foot, from your heel bone to the front of your foot. It supports your arch, and it absorbs a lot of load every time you walk, run or stand.
According to MedlinePlus, the U.S. National Library of Medicine's health information service, plantar fasciitis happens when that tissue is overstretched or overused and becomes swollen. MedlinePlus describes it as one of the most common orthopedic foot complaints, and the American Academy of Orthopaedic Surgeons' OrthoInfo calls it one of the most common causes of pain on the bottom of the foot at the heel.
Why the First Steps in the Morning Hurt Most
OrthoInfo explains that most people sleep with their feet pointed down, which relaxes the plantar fascia overnight, and that this is one of the reasons for morning heel pain. When you stand up, that tissue is suddenly stretched under your full body weight.
The same thing can happen during the day. A long car ride or a stretch at your desk lets the tissue settle, and the first steps afterward bring the pain back. Climbing stairs, standing for a long time, and the period after intense activity can make it worse too, and the pain is often greater after exercise than during it.
The pain itself can be dull or sharp, and the bottom of the foot may also ache or burn.
What Makes It More Likely
OrthoInfo notes that in most cases plantar fasciitis develops without one specific, identifiable reason. These factors make it more likely:
- A change in activity. Starting a new running plan, adding mileage quickly, or picking up a new sport.
- Repetitive high-impact activity. Running, dancing and jumping sports, especially long distances, downhill or on uneven surfaces.
- Long hours standing on hard floors. OrthoInfo singles out healthcare workers, factory workers and teachers.
- Tight calves or a tight Achilles tendon. Tightness up the back of the leg adds strain at the heel.
- Foot shape. Both flat feet and high arches.
- Shoes with poor arch support or soft, worn-out soles.
- Weight. Carrying extra weight, or gaining weight suddenly.
- Age. It is most common between ages 40 and 60.
What About Heel Spurs?
A lot of people are told, or assume, that a heel spur is behind their heel pain. MedlinePlus says research has found this is not the case: heel spurs show up on X-rays in people with and without plantar fasciitis. OrthoInfo adds that most people who have heel spurs do not have heel pain, and that plantar fasciitis can be treated without removing the spur.
Self-Care That Is Worth Starting Now
For heel pain that came on gradually, with none of the warning signs further down this page, these are the first steps recommended by OrthoInfo and MedlinePlus.
- Calf stretch. Lean forward against a wall with one knee straight and that heel on the ground, the other leg in front with the knee bent. Push your hips toward the wall until you feel a strong pull in the calf. Hold for 10 seconds, relax, and repeat 20 times on each foot.
- Plantar fascia stretch. Sitting down, cross the sore foot over your other knee and slowly pull your toes back toward you. A towel around the big toe helps if you cannot reach. Hold for 10 seconds and repeat 20 times. This one is best done in the morning before you stand or walk.
- Ice. OrthoInfo suggests rolling your foot over a cold water bottle or ice for 20 minutes, 3 to 4 times a day.
- Ease off what aggravates it. Cut back on running, jumping and other activities that pound your feet on hard surfaces. Low-impact options like cycling or swimming put less stress on your feet.
- Supportive shoes. Shoes with thick soles, cushioning and good arch support can reduce pain with standing and walking. Replace athletic shoes before they wear out. Soft heel pads and pre-made or custom shoe inserts can also help.
- Night splints. A night splint holds the foot in a gentle stretch while you sleep. OrthoInfo says it can take some getting used to, and that it is very effective at reducing heel pain from plantar fasciitis.
- Over-the-counter pain relievers. MedlinePlus lists acetaminophen or ibuprofen to reduce pain. OrthoInfo advises talking to your primary care doctor before using anti-inflammatories like ibuprofen or naproxen for more than a month.
Be patient with it. MedlinePlus says nonsurgical treatment almost always improves the pain and that most people feel better within 6 to 18 months. OrthoInfo reports that more than 90 percent of patients improve within 10 months of starting simple treatment methods.
When to Get Medical Care First
Not all heel pain is plantar fasciitis. OrthoInfo lists other causes a provider will want to rule out, such as a stress fracture of the heel bone, Achilles tendinitis or a pinched nerve in the foot, and X-rays can check for fractures or arthritis. The signs below, drawn from the MedlinePlus guidance on foot pain, mean it is time for medical care rather than home care.
Contact your medical provider if:
- You have sudden, severe foot pain.
- Your foot pain started after an injury, especially if the foot is bleeding or bruised, or you cannot put weight on it.
- You have redness or swelling of a joint, an open sore or ulcer on your foot, or a fever.
- You have foot pain and diabetes, or another condition that affects blood flow.
- Your foot does not feel better after 1 to 2 weeks of home care.
Numbness or tingling in the foot is also worth getting checked, since it can point to a nerve problem rather than the fascia itself.
When a Chiropractor May Help
Plantar fasciitis is one of the conditions Comprehensive Chiropractic and Wellness treats. If none of the warning signs above apply, a chiropractic evaluation may be worth it when:
- The heel pain keeps coming back, even after you have changed your shoes and kept up with the stretches.
- It is easing, but slowly, and it is getting in the way of work, running or training.
- You want to understand why it started, whether that is tight calves, how your ankle moves, a change in training, or how you are on your feet all day.
Dr. Jeffrey Haynes has practiced for more than twenty years. His certifications include Active Release Technique, extremity adjusting, sports chiropractic, instrument-assisted soft tissue mobilization and functional movement screening, which together cover the joints, the soft tissue and how you move. An evaluation is where he works out whether chiropractic care is a good fit for your heel, and if it isn't, you will hear that directly.
In his own words: "I don't believe in unnecessary treatment plans or keeping patients dependent on care they don't need."
For more on what a first appointment should involve, see what to know before you book a chiropractor in Lincoln Square.
Frequently Asked Questions
Can a chiropractor help with plantar fasciitis?
Plantar fasciitis is one of the conditions the practice treats. Whether chiropractic care is the right fit for your heel pain depends on what an evaluation finds. If it points to something outside chiropractic care, you will hear that directly.
How long does plantar fasciitis take to go away?
It varies, and it is often slower than people expect. MedlinePlus says most people feel better within 6 to 18 months, and OrthoInfo reports that more than 90 percent improve within 10 months of starting simple treatment. OrthoInfo calls stretching the calves and the plantar fascia the most effective way to relieve the pain.
Can I keep running with plantar fasciitis?
OrthoInfo recommends cutting back on or stopping activities that make the pain worse, including running on hard surfaces, and switching to low-impact exercise like cycling or swimming while it settles. If you are training for something specific, that is worth talking through at an evaluation so you have a plan for getting back to it.
Is my heel pain caused by a heel spur?
Probably not. Heel spurs are found in people with and without plantar fasciitis, and most people with heel spurs have no heel pain at all.
Do I need an X-ray for heel pain?
Not always. MedlinePlus and OrthoInfo both describe a physical exam as the starting point, with X-rays used to rule out other causes, such as a fracture or arthritis. That matters most if the pain followed an injury or is not behaving the way plantar fasciitis usually does.
If your heel pain is not settling and you are in Lincoln Square, North Center, Ravenswood, Andersonville or Lakeview, an honest assessment is a reasonable next step. Comprehensive Chiropractic and Wellness is at 4526 N. Lincoln Ave, Chicago, IL 60625, open Monday to Thursday 10am to 7pm, Friday 10am to 5pm, and Saturday by appointment. Call (312) 658-0658 or schedule your visit online.
