What is Plantar Fasciitis?

You step out of bed and feel a sharp pain in your heel as soon as your foot hits the floor. After a quick look around, you don’t notice anything sharp, so what happened?

The answer is inside your foot. The plantar fascia is a band of tissue that runs along the bottom of your foot from your heel to your toes. It helps support the arch of the foot, moves to absorb shock when you walk or run, and provides rigidity to prevent the foot from collapsing. 

Too much stress on the plantar fascia—like running, jumping, or standing for long periods—can cause painful irritation or inflammation. This condition is called plantar fasciitis.

“Over time, pain builds, foot function decreases, and activity limitations skyrocket. People go from ‘it just bothers me after a run’ to ‘after a run and when I wake up’ to ‘walking is intolerable,’” says Colleen Brough, PT, director of Columbia's RunLab. We sat down with her to learn the basics of plantar fasciitis.

What Is the Plantar Fascia?

Plantar fascia is made up of collagen. It’s typically linear. The problem is when the plantar fascia becomes less linear. When your plantar fascia looks like spaghetti, it can’t provide the support you need. 

What Damages the Plantar Fascia?

Extreme physical activity creates pressure and tension, breaking up the plantar fascia’s linear orientation. What the plantar fascia can withstand varies from person to person. It depends on foot structure, overall health, and physical activity levels.

Most surfaces we walk on (concrete sidewalks, pavement, wood floors) lack the cushioning and irregularities found in natural terrains (grass, sand, earth). Back in the days before shoes, feet conformed to these natural irregularities, engaging foot muscles and flexing the arch to absorb impact, strengthening the foot core. Nerves on the soles of the feet sensed the terrain and adjusted accordingly. Walking barefoot can promote better sensory feedback. But when the ground is hard, feet are subjected to repetitive impact forces and less variation in movement. This can strain the plantar fascia and lead to plantar fasciitis.

Shoes provide a layer of protection and cushioning between the foot and the ground. They can help absorb shock and provide support to the arch. But, poorly designed or ill-fitting shoes contribute to problems, including plantar fasciitis.

Who is Most at Risk for Plantar Fasciitis?

You’re more likely to get plantar fasciitis if you:

• Have obesity or are pregnant: Excess body weight puts additional strain on the plantar fascia
• Have abnormal foot mechanics, such as flat feet (low arches), high arches, or inward pronation (ankle turns inward as you walk); these can alter weight distribution and increase stress on the plantar fascia.
• Have tight calf muscles or Achilles tendons.
• Engage in activities that involve repetitive impact on the feet, such as running, dancing, or jumping, especially on hard surfaces without proper footwear or support.
• Have a job like cooking, teaching, factory work, or health care that requires prolonged standing or walking on hard surfaces.
• Wear poorly designed or thin-soled shoes or high heels.
• Go barefoot on hard surfaces.
• Overstride.
• Rapidly increase running volume or speed (like, going from 5K to half marathon without prep).

How to Avoid Plantar Fasciitis

You’re probably wondering how to prevent plantar fasciitis. Here are a few tips:

• Wear shoes that provide arch support appropriate for your personal arch, cushioning, and sufficient toe box space.
• Insufficient arch support can strain the plantar fascia, especially if you have flat feet or high arches.
• Inadequate cushioning can increase the impact on the plantar fascia, especially when walking or running on hard surfaces.
• Tight or narrow toe boxes squeeze the toes together and lead to improper foot alignment and increased stress on the plantar fascia.
• Stiff, rigid soles restrict the foot’s natural movement and can alter the mechanics of walking.
• Exercise and stretch your feet regularly.
• Maintain a healthy body weight.

How to Fix Plantar Fasciitis

The goal of fixing plantar fasciitis is restoring its function by normalizing linear orientation. Being pain-free is a bonus. Here are a few things you might want to try:

• Exercise and stretch feet regularly (gentle toe curls in the morning; roll on a golf ball)
• Use ice packs if in the early stage when there’s inflammation (up to 20 days)
• In later stages (after 20 days) do eccentric heel drops
• Use specific shoe inserts (small heel lifts) to help relieve pain
• Use specific bedtime socks that hold the foot in a lengthened position. Warning: They can be tough to sleep with; Not everyone can tolerate them.

But How Long Will Plantar Fasciitis Last with These Treatments?

It could last for two months or two years. It’s hard to predict. Especially if you have waited a long time to treat it because its structure changes, and that’s hard to correct. I tell everyone: As soon as you start to feel pain, do everything you can. Take a kitchen sink approach: Do everything, and early.

Bottom line: It's important to give your feet some rest and take it easy until the pain goes away. Plantar fasciitis is usually a temporary problem that gets better over time. Contact a doctor as soon as you start to feel pain.