Dear Doctors: I’m getting this sharp pain under my right heel when I step out of bed in the morning. It feels like it’s bruised, but I know I haven’t injured it. A friend who had plantar fasciitis thinks that’s what it is. Can you please explain plantar fasciitis? How do you get it to go away?
Dear Reader: Plantar fasciitis affects an estimated two million Americans each year. That makes it the most common cause of heel pain in the United States.
It occurs when the long, thin band of fibrous tissue that runs just beneath the skin along the bottom of the foot becomes irritated, inflamed or damaged. Known as the plantar fascia, this tissue connects the heel bone to the bones of the toes and plays a role in supporting and stabilizing the arch of the foot.
Plantar fasciitis can be caused by something as simple as a change in the type of shoes you’re wearing or an increase in activities that result in repeated jolts or constant pressure on the foot.
Being overweight, having either flat feet or a high arch, rolling inward onto the arch of the foot when walking, having tight calf muscles or a tight Achilles tendon and running, walking or standing for long periods on hard surfaces can all contribute to developing the condition.
Plantar fasciitis often starts with a stabbing pain in the heel when you take your first steps of the morning. It often goes away as the tissues warm up with movement but can recur when you rise after sitting or while standing or walking.
The location of the pain helps to pinpoint its cause.
Because plantar fasciitis often begins with intermittent pain, you might be tempted to ignore it. But it’s important to get checked. Left unaddressed, the condition can lead to chronic pain.
And while it’s possible to mitigate the discomfort by altering your gait, the resulting misalignment can lead to foot, knee or hip problems.
Most cases can improve with nonsurgical treatment. That includes decreasing or ceasing the activities that activate the heel pain, switching to cushioned and supportive shoes and perhaps using orthotic inserts.
Because plantar fasciitis is associated with tight muscles in the calves and a tight Achilles tendon, targeted stretching might be recommended.
Over-the-counter pain medications can offer relief, and icing several times a day can help ease inflammation. Improvement can take three to 12 months.
Dr. Eve Glazier and Dr. Elizabeth Ko are internists at UCLA Health.
