What Happens to Your Heel

Plantar fasciitis develops when the plantar fascia, the ligament that connects your heel bone to your toe bones, becomes inflamed. You’ll usually feel pain in the heel and arch of your foot, often during your first steps in the morning.

People of all ages develop plantar fasciitis, though it’s most common between the ages of 40 and 60. Doctors don’t entirely understand the cause, but point most often to overuse: too much heel-pounding exercise (like running or dancing) or long periods of standing. Your heels also take a hit from poor shoe fit, unsupportive insoles and obesity.

“You might inflame the plantar fascia if you run a 5K when you haven’t run in 10 years,” Dr. Saxena says. “Or you walk around a city for days in flip-flops while you’re on vacation.”

Care for Your Feet

Treat plantar fasciitis as soon as you feel heel or arch pain because the longer you wait, the more challenging it is to manage. When addressed early, heel inflammation usually resolves in four to six weeks.

Dr. Saxena recommends the following steps:

• Rest. Take a break from standing or stand on a rubberized pad.
• Massage the bottom of your foot by rolling a tennis ball under it first thing in the morning.
• Ice your foot at night by rolling a frozen bottle of water back and forth underneath it for 10 minutes.
• Stretch your arch before you get out of bed, before and after exercise, and before your bedtime icing. Pull your toes to your nose until you feel a stretch and hold that for 15 seconds.
• Wear supportive shoes both inside and outside the house.

“The key to managing plantar fasciitis is learning to control it,” Dr. Saxena says. If you stay committed to daily self-care, you can often avoid more intensive treatments.

Cortisone and Shockwaves

If daily care measures don’t help, your podiatrist might suggest cortisone injections, which can decrease inflammation and relieve pain for three to six months.  Custom orthotics can also provide additional support and cushioning.

“One of the most successful remedies is shockwave treatment,” Dr. Saxena says. Once a week for three weeks, soundwaves bombard your heel for four to seven minutes. The resulting micro-trauma triggers your body to release cells to block pain, and the shockwaves increase blood supply, which helps your feet heal.

The largest published clinical trial on shockwave therapy found it to be 72 percent effective when treating plantar fasciitis. “Shockwave therapy is the most rigorously studied treatment with the best long-term outcome,” says Dr. Saxena, the study’s lead researcher. A side benefit is that “treatment sessions occur in the office and don’t require anesthesia or immobilization, so if you’re athletic, you can go back to your sport the same day.” (Doctors also prescribe shockwave therapy for bursitis and tendonitis.)

In rare cases of plantar fasciitis, you might need surgery, which involves your podiatrist cutting part of your plantar fascia ligament to release tension and relieve inflammation.