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How to bring plantar fasciitis to heel

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Overloading of the tissue that connects the heel bone to the toes can be crippling – and recovery from plantar fasciitis is a step-by-step process.

Wellingtonian Kate Harris loved her new exercise regime, clocking up to 20,000 steps a day and attending a dance class twice a week. “I went at it with great gusto – I kept pounding and pounding, harder and harder.”

She wore her daughter’s trainers rather than her own to dance in as they had clean soles, as requested by the teacher. It never occurred to her that they might not be supportive enough. Then she started getting pain under her left heel and along the arch of her left foot. Initially, it was only when she first woke up, but soon it became almost too painful to walk.

“I was in agony – I was in tears. I got to the point where I could hardly move.”

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Eventually, she saw a podiatrist, who diagnosed the common foot condition plantar fasciitis – inflammation of (or in Harris’ case, a tear to) the plantar fascia, the flat band of tissue that connects the heel bone to the toes and supports the arch of the foot.

Dancing was out and so was walking, except in small doses – no more than 10 minutes at a time. She got a new pair of trainers with more flexible and supportive soles, as well as custom-made orthotics to fit inside them. She started taking anti-inflammatory drugs and then began a series of exercises to help stretch her plantar fascia and strengthen the muscles in her foot. Her podiatrist also taped her foot to provide more support, and he suggested that she roll her sole over a drink bottle of frozen water to provide some relief.

Six months on, Harris is able to walk longer distances, although she has not yet returned to the dance floor and still massages her feet as soon as she wakes up.

“I’ve learnt that if I feel pain, I have to stop, rather than keep on pushing myself.”

Ben Lamb, chair of Podiatry NZ. Photo/Supplied

She’s one of thousands of New Zealanders who develop plantar fasciitis every year – it’s thought up to 10% of people will develop the condition at some point. Christchurch podiatrist Ben Lamb says it’s caused by putting too much load on the plantar fascia through such things as a change in activity, wearing unsupportive shoes or being overweight.

Runners and people who spend long periods on their feet, such as supermarket checkout operators, are at greater risk of getting plantar fasciitis, as are those aged 40 or older.

“The plantar fascia loses some of its intrinsic strength over time, so when you’re north of 40, there’s an increased incidence of it,” says Lamb, who is chair of Podiatry New Zealand.

This extra load can inflame the plantar fascia or, in more serious cases, cause it to tear, leading to pain under the heel or through the arch. “It can feel like a sharp tearing pain or almost like a stone bruise. People can have a range of different experiences, from minor irritation to finding it almost crippling.”

For most people, the pain is worst when they take their first steps of the day. It then goes away, but may return when they stand up after spending time sitting down.

Treatment involves what Lamb describes as “deloading” the plantar fascia to take the stress off it and allow it to heal. Possibilities include cutting back on the amount of activity you do, using orthotics, taping the affected foot, doing foot-strengthening exercises and buying shoes that provide better support. Lamb says custom-made orthotics are better than over-the-counter ones because they are made specifically for your foot: “Every person’s foot is different.”

Many people need anti-inflammatory drugs and some require corticosteroid injections. Podiatrists are also starting to use shockwave therapy, using a hand-held device to deliver shockwaves to the affected area.

The good news is that plantar fasciitis does go away, although it takes an average 4-6 months. And it’s important to follow your podiatrist’s advice, even if it means getting around in ugly trainers for a few months.

“The deeper connective tissues are a bit more sluggish in their ability to heal,” says Lamb. “You must maintain a high degree of vigilance to put it to bed properly.”

This article was first published in the February 16, 2019 issue of the New Zealand Listener.