Plantar Fasciitis

Tara Fussell
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Dr. Tara Fussell provides expert foot and ankle care in both our Altamonte Springs and Orlando offices.

According to Psychology Today, there are several explanations as to why people might have difficulty waking up in the morning. Some individuals have conditions like insomnia, sleep apnea, and restless leg syndrome. Others struggle with depression or bipolar issues and have a hard time breaking from slumber. And there are those who simply are deep sleepers – including many teenagers (which comes as no surprise to their parents!).

sleep and heel pain

One fairly common issue that could make just about anyone want to delay getting up in the morning is plantar fasciitis. In this condition, the first steps of the day are often accompanied by a sharp heel pain. Intense pain like that is a truly unpleasant experience, especially for those who are already hitting the snooze button multiple times!

When it comes to the medical conditions that bring patients in for heel pain treatment at our Florida foot doctor offices, plantar fasciitis sits atop the list.

Plantar fasciitis might be the most common source of heel pain (for adult patients), but it’s not widely understood. If you have the condition, you already experience sharp pain with the first steps after extended periods of rest, especially after a night’s sleep.

Why does this happen, though?

The pain that follows after inactivity is known as post-static dyskinesia. To best explain this, let’s start by looking at the anatomical feature most affected – the plantar fascia.

This particular fascia is a tough, fibrous tissue that runs across the bottom of the foot and helps support and maintain the shape of the foot arch. It attaches at the bottoms of the heel and forefoot. If you can picture that, and take into account the foot arch, you will see it is quite similar to a bowstring.

plantar fascia

One of the key functions of this connective tissue is to assist in absorbing the tremendous physical force feet have to endure with every step.

When the plantar fascia is excessively strained—often due to overuse—the tissue becomes damaged with tiny tears. This leads to swelling and inflammation, which makes the fascia rather sensitive.

So how does this relate to the pain in the morning? After all, you probably didn’t walk around too much when you were asleep!

Well, the body works to repair those tears during periods of rest, and especially during a night’s sleep. As you stand up and start walking in the morning, those mending tears are ripped back open. In turn, painful sensations are triggered by the irritated tissue. Essentially, this is your body’s way of saying “Hey, I need more rest!”

If you hear one of our doctors mention the term “post-static dyskinesia,” now you know what we’re talking about.

Whereas the pain is strongest in the morning, it tends to subside as the day progresses. Do not mistake this as a sign the condition has gone away, however! In fact, if you rest for a certain amount of time, you will experience the morning pain all over again with your next steps.

It is important to note that the pain from this condition is experienced in the bottom of the heel. You can develop heel pain from a different aggravated connective tissue—your Achilles tendon—but that will be felt in the back of the ankle. Also, Achilles tendinitis subsides during periods of rest and worsens with physical activity.

Depending on the severity of your case, there is a very good chance we can resolve the problem with conservative (nonsurgical) treatment. Some of the components we might incorporate into your plantar fasciitis treatment plan include:

  • Rest. Taking time away from high-impact activities or, even better, replacing them with low-impact ones (cycling, swimming) will allow your body to more fully repair the damaged tissue.
  • Ice. An appropriate icing regimen will both relieve inflammation in the fascia and reduce pain.
  • Stretches. Keeping the soft tissues in your lower limbs flexible can help relieve painful symptoms, and also prevent the condition from becoming a recurrent issue.
  • Medication. We may recommend or prescribe certain pain relievers (including ibuprofen and naproxen), or use corticosteroid injections to provide relief.
  • Orthotic devices. Whether we prescribe custom orthotics or recommend certain heel cups or cushioning inserts, these devices can more equitably distribute pressure and take it away from your fascia.

orthotics

The vast majority of cases benefit from conservative care. Severe conditions may require surgical intervention. In these instances, we might detach the plantar fascia from its connected point on the heel bone. (Naturally, we will discuss this together in greater depth if this is our recommended course of action.)

As is the case for virtually any medical issue, the best course of action is to prevent plantar fasciitis from developing in the first place. Now, it is difficult (or even impossible) to completely reduce all injury risk, but there are measures you can use to make it less likely.

Wearing proper footwear that fits appropriately is a great starting point. So too is easing into new physical activities and not suddenly ramping up intensity or duration for existing ones (without preparing your body first). Even better is to follow a simple, easy stretching regimen on a regular basis. Some stretches you should use include:

  • Eccentric heel drop. Start by facing a set of stairs and then step up on the bottom stair. Standing on the edge—with only your toes and balls of feet being on the stair, and your heels hanging over the edge—slowly lower both heels down and hold for 10 seconds. Then raise them back up to the starting position. Repeat this 10-15 times.
  • Calf stretches. Stand about an arm’s length in front of a wall and place your palms on it. Take a step forward with your right leg. Keeping your left knee straight and heel on the ground, bend your right leg slowly until you can feel a gentle stretch in your left calf. Hold the position for 20-30 seconds, release, and then switch legs and repeat.
  • Toe stretch. For this stretch, start by sitting in a chair and raising your right leg so the foot rests on the thigh of your left leg. Grab your right foot’s big toe and gently pull it back toward you until you feel a stretch. Once you do, hold the position for 20-30 seconds, and then release. Switch legs and stretch your other one.
  • Remember, even the best preventative action plan cannot completely eliminate all injury risk. Following the right measures can definitely lower it, though!
In the event you do find yourself dreading the thought of getting out of bed and walking around in the morning, we’re here for you. For more information, or to request an appointment with Foot & Ankle Associates of Florida, call 407-339-7759 or 352-589-9550 (if calling from Lake County).
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