Is your sore foot Plantar Fasciitis?
Plantar fasciitis is easily the most common foot injury that I will see as a podiatrist. Some reports suggest that it affects 1 in 10 people! That’s absolutely nuts.
The problem with it being so common though, is that it has become a quick throwaway diagnosis for any type of foot pain- not only from your friends and family, teammates and coaches, but from qualified health professionals as well.
The foot is a very complex structure, and different conditions present themselves similarly to plantar fasciitis. It is important that we get the diagnosis correct to ensure you are on the right path with your rehab.
Here are the FOUR key signs that your foot pain might be Plantar Fasciitis:
1. The Location of the Pain
Firstly, the word “plantar” means “the sole of the foot”. Plantar fasciitis therefore occurs underneath the foot. Any pain that is on top of the foot will definitely not be plantar fasciitis, and pain on the side of the foot is also highly unlikely.
Secondly, when you actually look at the anatomical position of the plantar fascia below (the tissue that is injured in plantar fasciitis), you will be able to see where it attaches underneath the foot.
The primary attachment point is onto the heel bone (calcaneus), where most people experience the pain of plantar fasciitis. It can however present itself at any point along the length of the plantar aponeurosis, in the medial, central or lateral bands, which you can see in the image on the right (credit: Latt et al, 2020). You will see two circles drawn of the most common pain locations of plantar fasciitis that I tend to come across.
Why might someone experience plantar fasciitis pain in one part of their foot, but the other in a slightly different area? It may depend on the individual’s anatomy (we’re not all the same), activity levels, footwear, and movement patterns to name just a few things.
2. First step pain
Plantar fasciitis pain is usually noticeable first thing in the morning when getting out of bed.
Other times include in the middle of the night when waking up to go to the bathroom, or after periods of sitting for extended periods throughout the day. For example, you may sit down to eat lunch, drive a long distance, work at your desk, or watch television. Then when you get up to walk around after those activities, the pain is back again.
First-step pain, whether in the morning or during the day, is because the soft tissue under your foot shortens when you are resting. When you stand up to walk on it for the first time you then create a lengthening of the tissue, which means that the injured plantar fascia is stretched and pulled, aggravating the pain.
If you do not experience first-step pain after resting, then your plantar fasciitis diagnosis needs to be questioned, as this is quite a telltale sign.
3. The Illusion of Coming Good
After that first step pain, plantar fasciitis pain may “warm up” and reduce once you have been walking around on it for a while. For many people, this means that it goes away completely for the rest of the day, and they can go about their daily activities reasonably unaffected. For other people, the pain may always linger there, but it isn’t nearly as bad as that first-step pain.
This “warming up effect” can lure you into a false sense of security that it is going to be okay, and you don’t need to do anything about the pain. You may believe that if you can get through that first-step pain, you’re mostly okay and that it will resolve itself over time.
If you ignore it, that first step pain gradually becomes more intense and lasts longer, and then your baseline level of pain throughout the day may begin to increase as well.
4. Proportional Pain
Plantar fasciitis pain tends to be what I would call “proportional”. This means that the severity and duration of the pain is usually associated with the amount or intensity of activity you have been doing. The feeling of “overdoing it” is common when people are experiencing their plantar fasciitis pain to be higher than what it normally is.
Say for example you increase your training intensity or mileage, and you go for a much harder run than you are used to. The pain either during that run, or the next morning is likely to be worse than it was before. Likewise, if you are standing on your feet all day at work for a 12-hour shift, it will likely be more painful later that day, or the next morning, than if you did a shorter 4-hour shift.
If your foot pain is “disproportionate” in the sense that it seems extremely random (worse at different points of the day for no apparent reason), or it is quite intense even when you are sitting down or lying in bed, then further investigation is warranted.
Final Comments
So there you have it, the four key signs that you might have plantar fasciitis!
These are the real questions that I would ask someone about their foot pain, to forge a working diagnosis of plantar fasciitis. It doesn’t usually require an X-ray, ultrasound or MRI scan to diagnose unless something about your pain seems unusual.
The best thing for you to do would be to work with a podiatrist to help with your diagnosis, as in addition to these four key signs, they may ask you some more nuanced questions that are relevant to your situation.
If you are fed up with your foot pain and want to get it back on track, then don’t hesitate to book an appointment with me today to get your recovery on track!
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Written by Jackson Tisdell – Melbourne Podiatry Clinic
