Healing from plantar fasciitis can take time — sometimes up to 18 months. There are few things more frustrating than when it flares up again and again while you are doing your best to heal.
Understanding the triggers that cause a flare-up can help you avoid frustrating setbacks and painful bouts of plantar fasciitis while you are working to get back on your feet.
What Causes Plantar Fasciitis to Flare Up?
There are several common triggers that can cause your plantar fasciitis to flare up. Taking steps to avoid these 7 heel pain triggers can make your journey toward healing much more straightforward!
1. Starting a new fitness activity
Finding new ways to get in your daily exercise is a great idea, but new activities may trigger plantar fasciitis. Sometimes it is just a matter of getting used to new movements and easing yourself into a new routine, but other times it may be the activity itself that is causing a real problem.
When you decide to try a new workout, make sure that you warm up thoroughly, learn proper form, and wear supportive footwear. Avoid activities that require that you work out barefoot (like some martial arts and dance classes), and exercises that are particularly jarring to the feet.
2. Changes of intensity in activities
Even if you walk or run regularly, suddenly changing the intensity of your workouts can trigger plantar fasciitis. Sprinting when you normally jog, or power walking when you usually walk at a leisurely pace will put an added strain on your feet that your body isn’t used to. If you want to ramp up your workouts, do so slowly and make sure that you take extra preventative measures like icing and stretching your feet.
3. Weight gain (even healthy weight gain)
Weight gain is a common cause and contributing factor to plantar fasciitis. Whether you are gaining body fat, muscle mass, or healthy weight from a pregnancy, the added pounds put extra strain on your feet. This can cause plantar fasciitis for the first time, or trigger a new bout once you have already healed.
If you know that weight gain has triggered your plantar fasciitis, the first solution to consider is losing weight. If this is not possible (like with pregnancy), try to rest and elevate your feet more, and consider orthotic treatments.
4. Tight calf muscles
The feet and calves are highly connected, so when you experience problems with your calves it’s also likely to cause problems with your feet. Tight calves may be caused by exercise, excessive sitting, regular daily activity, or insufficient stretching. Make it a habit of paying attention to tightness in your calves and stretching them before and after you work out.
5. New shoes
Trying a new style of shoes can sometimes trigger plantar fasciitis if those shoes do not provide the proper support that you need. Shoes that are too flexible may cause added tension to the plantar fascia ligament, and different padding distribution may alter your footstrike as you walk or jog.
To minimize the risk, try to only buy shoes that are immediately comfortable, not ones you will need to “break-in.” If you need the added support of arch supports or plantar fascia inserts, it’s usually best to replace these inserts when you replace your old shoes. If you don’t yet have a new pair of inserts, swap your old inserts into your new shoes until you are able to replace them to ensure you have proper support at all times.
6. Old shoes
While new shoes can cause problems for plantar fasciitis, wearing worn-out shoes also poses a risk. If your shoes are showing noticeable wear on the insoles or bottom tread, it’s probably time to toss them out since they likely do not provide enough cushioning or stable support for your arch. Buy a new pair of the same style of shoes, or visit a footwear store and get the help of a fitting specialist.
Injuries like plantar fascia ligament strains and trauma can trigger a pain flare-up as well. These injuries can be caused by stepping on uneven surfaces or objects, tripping, or sustaining a blow to the foot. If you sustain an injury, take care of it immediately by icing and elevating it, and visit a doctor if you have any concerns.
Tips for Preventing Plantar Fasciitis Flare-Ups
In addition to avoiding these 7 triggers for heel pain, keep the following tips in mind to streamline your healing process!
Follow Your Doctor’s Treatment Recommendations
Closely follow your doctor’s treatment instructions, even if you notice some improvement in your pain levels. Think of your treatment plan like following a course of antibiotics: You wouldn’t stop taking the entire prescription just because you started to feel better! Following your doctor’s recommendations for the full period of time recommended can help prevent relapses caused by reinjury to the fascia.
Stay Consistent with At-Home Treatments
Keep up with your regular at-home treatments like wearing plantar fasciitis inserts and stretching your feet regularly. Inconsistency won’t give you the results you need as you work to strengthen and support your plantar fascia and surrounding muscles and ligaments. Remember, your plantar fasciitis didn’t develop in a few days but rather consistently over the course of several months or even years. Applying consistent treatment over time will have the opposite effect you’re looking for!
Prevention is the key to avoiding recurring episodes of plantar fasciitis – and that includes following doctor’s orders, consistent treatments, and avoiding common heel pain triggers!
Foot cryotherapy, a relatively new procedure to treat the pain from chronic plantar fasciitis, is growing in popularity.
Initial reports show that the procedure has a great deal of potential, providing significant pain relief with a minimally invasive procedure. In one long-term study about cryosurgery for heel pain, 77% of patients reported significant pain relief in both short- and long-term check-ins (3 weeks post-procedure and 24 months post-procedure).
What should you know about foot cryotherapy? Is it safe? What is the difference between whole body cryotherapy and localized cryotherapy? Is it painful? How much does it cost? We have your answers!
What Is Foot Cryotherapy or Cryosurgery?
Cryotherapy, also known as cryosurgery or cryoultrasound, actually destroys nerve fibers (not the nerve itself). While the nerve remains intact, the inflamed nerve fibers (imagine an anemone) are destroyed. In about three weeks’ time, new fibers regenerate with healthy cells.
Cryotherapy is pretty similar to radiotherapy ablation–in which an ultrasound-guided probe uses heat to target and destroy damaged tissue. In cryotherapy, an ultrasound-guide cryoprobe uses ice and cold (more specifically nitrous oxide) to destroy damaged nerve fibers to interrupt pain signals.
Previously, cryotherapy was something of a shotgun approach. However, with advances in technology physicians are able to effectively target specific nerves with a cryoprobe.
Localized Cryotherapy Vs. Whole-Body Cryotherapy
The type of cryotherapy used to treat plantar fasciitis is also known as localized cryotherapy, since only a small part of the body (the plantar fascia) is treated, using a guided probe. However, as localized cryotherapy has grown in popularity, some health providers now offer whole-body cryotherapy.
In whole-body cryotherapy treatment sessions, a person enters a very cold, subzero vestibule (as cold as -80 degrees celsius!) for a short amount of time. While there hasn’t been much research to back the benefits of whole-body cryotherapy, supposed benefits include a rush of endorphins and reduced inflammation. But a study from 2014 cautions that icing and cold water baths appear to be equally effective (and far less expensive).
Cold Therapy Vs. Localized Foot Cryotherapy
So, is localized cryotherapy any more effective than, say, icing your feet or submerging your foot in very cold water to help reduce pain and inflammation? Yes and no.
While ice packs and cold water will certainly reduce inflammation and pain (and are fantastic for everyday use!) these home therapies won’t actually destroy inflamed nerve fibers that can be a cause of persistent pain like a cryotherapy probe.
Is Cryotherapy a Safe Procedure for Heel Pain?
Cryotherapy is generally considered very safe with minimal side effects, although you should remember that this is a newer procedure for plantar fasciitis that is still considered investigational/experimental. Cryoultrasound has been the subject of more in-depth research when it comes to neuromas and the destruction of abnormal tissue like tumors.
The good news is that while studies on cryotherapy and plantar fasciitis are still sparse, initial studies and anecdotal evidence are promising. And given the low risk of side effects and the lower cost (compared to surgery), cryosurgery shows a lot of potential.
What You Should Know About Foot Cryotherapy
The first thing you should know is that foot cryosurgery isn’t a painful procedure. You’ll feel a pinch from the needle when the local anesthetic is injected, of course, but after that, you won’t feel much more than light pressure during the procedure as a tiny incision is made and a cryoprobe is inserted into the foot.
The entire procedure will only take a few minutes, during which your doctor will guide the cryoprobe with the help of an ultrasound. A tiny, very cold ice ball on the end of the cryoprobe will destroy damaged nerve fibers, blocking pain signals and allowing for the regeneration of healthy nerve fibers.
Recovering from Cryosurgery
After the procedure, you’ll be encouraged to rest and elevate your feet, ice the injection site, and take anti-inflammatory pain relievers as needed. You should notice your pain level decrease as your foot heals, and you can typically go back to work and resume your daily activities after just one or two days. If at the end of two or three weeks, your pain level hasn’t subsided significantly, the procedure can be repeated.
The site is covered with compression bandage and patients are advised to reduce activity, ice and elevate for the remainder of the day. The bandage can be removed the following day and the patient can cover the area with a regular Band-Aid. You should keep the injection site clean and dry for at least 24 hours. Normal activity can be resumed within one or two days of the procedure and any pain that occurs is managed with NSAIDs or Tylenol. Pain continues to reduce over a two-week period; if at the end of the four-week period the reduction is not sufficient, the procedure can be repeated.
Side Effects and Benefits of Cryotherapy
Side effects of cryotherapy are generally mild. Some inflammation may flare up during healing and shouldn’t last more than a few days. Other potential side effects include bruising at the site of the injection and cryoprobe insertion or mild frostbite at the site of the probe insertion.
For some people who undergo cryosurgery, a tiny lump appears at the injection site that persists for several months after the area has healed. Typically, this lump will disappear within six months and isn’t painful.
For most people who undergo cryosurgery, the benefits outweigh these potential mild side effects. Many people experience significant or complete pain relief in the weeks and months following the surgery, particularly when cryosurgery is combined with treatments that address the root cause of plantar fasciitis.
How Much Does Cryotherapy Cost?
Cryosurgery is covered by many insurance plans, and out-of-pocket costs vary but fall somewhere in the neighborhood of $500 for most patients. Before deciding to undergo cryotherapy, make sure to talk to your doctor and insurance provider to find out your end cost.
Is Cryotherapy a Cure for Plantar Fasciitis?
While cryotherapy shows a lot of promise in reducing or eliminating pain from plantar fasciitis, new nerves that regenerate are still susceptible to damage unless the root cause of plantar fasciitis is addressed.
It’s important to determine the cause of your plantar fasciitis and take steps to prevent its return. Wearing plantar-fasciitis specific orthotic inserts that support and cushion your plantar fascia ligament, reducing the strain on your fascia, and stretching the muscles and ligaments in the arches, feet, and legs to keep them limber and strong will go a long way toward treating the root cause of your plantar fasciitis.
It was all in good fun — and hey, I didn’t feel old! But about six months later, when I started to notice that my feet hurt more often than not, I started to worry. Was this what happened on the other side of the hill?
As I finally learned from my podiatrist, I wasn’t alone. Foot pain is extremely common in mature adults. But thankfully, I wasn’t doomed to foot pain for the rest of my days either.
Walking on Broken Glass
I’d always taken a lot of pride in staying active. When I was a younger woman, I ran half marathons. As I got older, I slowed down a little but I still regularly played tennis and hiked in the foothills near my home.
I’d had sore feet before — nothing major. But I’d never experienced anything like the “walking on shards of glass” feeling that made the first steps out of bed in the morning almost unbearable. I stopped playing tennis, stopped hiking, even stopped walking to the mailbox when I could avoid it, because my feet hurt so much.
In a panic, I made an appointment with a podiatrist.
Learning I’d Lost the Spring in My Step
At the podiatrist’s office, there was good news, and there was bad news. The bad news came first: I had literally lost the “spring” in my step. After listening to my symptoms and doing some imaging to rule out a stress fracture, the doctor explained that I had a condition known as “plantar fasciitis.”
He explained that the plantar fascia is the “springy” ligament that runs from the heel to the ball of the foot, and helps absorb impact. Those “springs” can wear out as a result of injury, overuse— or the normal aging process. My doctor explained that while athletes are the ones who make news headlines when they get plantar fasciitis, the most common risk factor for the condition is age!
And that wasn’t all:
And Bunions, Too!
It turned out that plantar fasciitis wasn’t my only problem. I also had bunions (which may have been a contributing factor in my plantar fasciitis).
I’d notice that the bump where my big toes met my foot seemed to be more pronounced than my husband’s — and I could feel it rub against my shoes while I walked. Sometimes, after a tennis match, I realized they were red and inflamed. But I didn’t know that bunions could subtly change my gait over time and strain my arch as my body tried to minimize the discomfort
Okay, How Did This Happen to Me?
My podiatrist reassured me that aging feet are simply at higher risk for different conditions that cause foot pain — including plantar fasciitis.
The doctor reassured me that while the bunions and my active lifestyle might have played a role in my plantar fasciitis diagnosis, age was likely the main contributing factor. I had no idea that the aging process flattens and widens the feet, making it harder for the plantar fascia (that spring in my step) to absorb impact, and wearing down the heel’s natural fatty cushioning.
Older adults also deal with changes in circulation (which may slow healing when we overuse or injure our feet), and changes in the strength of skin and tissue that make injuries from rubbing or pressure more common (hello, bunions!).
Finding Answers for Foot Pain
My doctor was quick to reassure me that foot pain wasn’t a life sentence. I was also relieved to learn that most people with a diagnosis of plantar fasciitis recover within a few months — without surgery.
I left the podiatrist’s office with a prescription for rest, stretching exercises for my plantar fascia, and instructions to ice my feet whenever they felt inflamed or painful. My doctor also recommended orthotic inserts that I could slip into almost any pair of shoes I already owned, to help support my injured arch and make walking much less painful.
I was given strict instructions to stop wearing shoes that rubbed against my feet while I walked, or were too tight in the toes.
Getting My Spring Back!
I’m happy to say that while I might be “over the hill,” I’m back to hiking in the hills without foot pain! It took a few months. And I’m more vigilant about giving my feet a good rest after a long hike than I was before. But it’s safe to say I have the spring back in my step.
Those orthotic inserts my podiatrist recommended were a lifesaver. In the short term, they took the pressure off my arch and relieved that “walking on broken glass” sensation. And in the long term, combined with stretching to improve my strength and flexibility, and better-fitting shoes, my arch actually was able to heal and recover.
I’ve also added the following tools into my daily and weekly routine. After learning what it’s like to be knocked off my feet, I’m doing everything I can to keep them healthy:
- Orthotic inserts: My doctor recommended fascia bar inserts because they are more effective than regular cushioning and arch support
- Compression socks: These socks help improve my blood circulation, important for older adults
- Massage ball: This little ball helps roll out painful muscle knots and scar tissue, as well as improving circulation in my feet
- Ice therapy slippers: Since I ice my feet regularly, I wanted an upgrade from the ziploc bag! These slippers stay in place, with no mess, and strap right to your feet.
Gout is a type of arthritis caused by a buildup of uric acid and characterized by foot pain, swelling, redness, and difficulty walking is typically localized in the big toe. However, some types of gout may be localized in the heel, making it difficult to distinguish from plantar fasciitis.
Let’s explore the connection between gout and heel pain, as well as symptoms that can help you tell the difference between plantar fasciitis and gout
The Connection Between Heel Pain and Gout
While it’s fairly rare for gout pain to appear in the heel (instead of near the big toe), it does happen!
Gout that leads to foot pain develops when there are high levels of uric acid in the body. And high levels of uric acid are most likely to develop under the following conditions:
- Diet: A diet that is heavily focused on red meat, sugar (particularly fructose), and alcohol (beer, in particular) can increase levels of uric acid and gout.
- Increase in body fat: As your body increases its stores of body fat, uric acid levels rise, and your kidneys may struggle to eliminate the excess.
- Medications: Some medications, including hypertension, may increase uric acid in the body. Studies show that Thiazide diuretics (which treat hypertension) are key culprits.
- Untreated medical conditions: High blood pressure, metabolic syndrome, diabetes, and kidney disease can all contribute to higher than usual levels of uric acid in the body, and gout.
- Genetics and gender: There is a genetic link to gout. If you have a family history of gout, you may be especially susceptible. Younger men are more likely to get gout than women; however, postmenopausal women have an increased risk as well.
How Can High Uric Acid Cause Heel Pain?
So, why does gout show up in the feet (as opposed to other body parts)? Uric acid is very sensitive to cooler temperatures. As it circulates throughout the body and reaches the feet (furthest from the heart and typically the coolest), the liquid uric acid crystalizes, leading to pain in the joints of the big toe or joint of the heel (where the heel bone meets the ankle bone).
Uric acid levels rise when your body breaks down “purines.” Purines are found in foods like red meat and alcohol, as well as in certain medications and naturally in the human body (especially as fat stores increase).
Most of the time, your body is able to manage uric acid levels effectively, simply dumping the uric acid into your kidneys where it is excreted as urine. However, when uric acid levels get high enough, your kidneys may struggle to keep up, and uric acid may stay in your bloodstream where it causes inflammation, pain, and swelling as it crystallizes in the joints of the foot.
Is My Heel Pain Gout or Plantar Fasciitis?
Heel pain can be confusing at times. While the most common cause of heel pain is plantar fasciitis, other less common ailments like gout can mimic similar symptoms! Use this helpful symptom guide to determine whether you’re dealing with plantar fasciitis or gout:
Symptoms of Heel Pain from Plantar Fasciitis
The hallmark symptoms of plantar fasciitis include the following:
- Heel pain that’s most intense first thing in the morning (when the plantar fascia hasn’t “warmed up” yet through movement).
- Pain that improves somewhat with stretching and low-impact physical activity
- Sharp or dull pain, accompanied by redness or swelling
- Pain that coincides with weight gain
- Difficulty walking or standing on the affected foot (plantar fasciitis can happen in both feet, though more rarely!)
- Pain that improves through the use of orthotics that help properly realign and cushion the plantar fascia
Symptoms of Heel Pain Due to Uric Acid
Anyone can get gout, although it’s most common in individuals with the risk factors we covered earlier (like heavy alcohol use, or a diet that includes a lot of red meat.) The symptoms of gout in the heel are subtly different from those of plantar fasciitis in the heel:
- Redness, swelling and tenderness that is most pronounced where the heel meets the ankle. You are also likely to notice symptoms at the base of the big toe.
- Often, gout symptoms will flare-up in the middle of the night (when that uric acid settles and cools during this period of low activity)
- During a flare-up, your heel will feel so hot and painful to the touch that even wearing socks is excruciating
- Pain that is less intense but lingers after a “gout attack” flare-up of pain
- Increasing difficulty moving the joint
As a general rule of thumb, pain from plantar fasciitis will improve with rest, while pain from gout will flare up during long periods of inactivity and rest.
Treating Heel Pain from Gout
Thankfully, most cases of heel pain from gout can be successfully resolved with minimal medical intervention and changes to diet and lifestyle.
NSAIDs (non-steroidal anti-inflammatory drugs) like Tylenol and Ibuprofen can help relieve pain from a gout attack, as well as reduce pain and swelling in the heel.
Colchicine is another common medication prescribed to treat pain from gout, however, it can cause severe side effects like nausea and diarrhea. Your doctor will likely recommend the minimal dose needed.
Corticosteroids are used in rare cases when NSAIDs or Colchicine can’t be taken since these drugs have serious side effects including high blood pressure and high blood sugar.
If you have ongoing gout attacks, or severe ongoing gout symptoms your doctor may also consider prescribing medication that limits the amount of uric acid your body produces.
Limit foods that increase uric acid production: These foods include alcohol, red meat, seafood, organ meats, fructose sugars, and other foods high in purines.
Exercise and manage weight when possible: As possible, maintain a healthy weight to keep the body’s own production of uric acid down.
Drink coffee: While scientists don’t understand the link completely, some studies have shown that drinking coffee can help lower your levels of uric acid!
Add more vitamin C to your diet: Taking at least 500 mg of vitamin C each day (and eating foods rich in vitamin C) has been shown to make a measurable, positive impact on uric acid levels in the body!
Have you suffered from heel pain that turned out to be gout? Tell us about your experience in the comments below!
No matter where heel pain strikes (front, middle, back, or everywhere!), the biggest question on your mind is likely, “How can I make it stop?” However, the location of your heel pain reveals important clues about its underlying cause!
Inner heel pain can present as achy, bruise-like, or sharp and intense. By understanding your unique symptoms and honing in on the why your inner heel hurts, you can take more effective steps toward treatment. Let’s get to the bottom of your inner heel pain:
Why Does My Inner Heel Hurt?
The most common causes of heel pain deep within the heel are trapped nerves, plantar fasciitis, fat pad syndrome, and stress fractures.
Trapped Nerves in the Heel
Sometimes, nerves in the heel can become “entrapped,” or squeezed/constricted because of injury to the foot, trauma, or simply overuse. There are several key nerves that run along the inside of the heel and connect to the posterior tibial nerve. These nerves include the medial plantar nerve medial calcaneal nerve, the lateral plantar nerve, and the nerve to the abductor digiti minimi.
- Pain may feel tingling, numb, or burning
- You may notice tenderness to the touch along the inner heel. The exact location of the pain will depend on which nerve is entrapped.
- Symptoms may flare up when you walk or participate in physical activities, and improve somewhat with rest
- Pain from an entrapped nerve is usually felt in just one foot
If your inner heel pain is caused by an entrapped nerve, your doctor will likely recommend rest from activities that aggravate pain, icing, stretching, and anti-inflammatory medication as needed. If these more conservative treatment methods do not work, your doctor may recommend surgery to decompress the entrapped nerve.
Heel Pad Syndrome
A thin, atrophied heel pad can result in a painful condition known as Heel Pad Syndrome. This condition can be caused by aging, weight gain, repetitive impact on hard surfaces, or unsupportive, uncushioned footwear.
- Bruise-like pain deep in the heel as the fat pad is no longer able to cushion the heel effectively
- Pain that can be recreated by firm pressure on the bottom of the heel
- Pain that gets worse when you walk on hard surfaces
- Heel Pad Syndrome is often closely linked with plantar fasciitis
Treatments for Heel Pad Syndrome involve lots of rest and better support and cushioning for the heel. Your doctor will likely recommend icing, anti-inflammatory medicines as needed, taping, and orthotic inserts that cushion the heel, support the foot, and reduce pain while walking.
Stress Fractures on the Heel
A stress fracture on the heel is a very thin crack in the heel bone that can be caused by repetitive stress or impact to the heel, or a sudden blow to the heel. The risk for stress fractures is elevated in high impact sports, for people with osteoporosis or with low vitamin D levels, or for individuals who increase the intensity of their workouts significantly without warming up.
- Pain may come on gradually or onset suddenly and is typically sharp and intense
- Pain that gets worse the longer you stay on your feet and gets worse if you stretch
- Pain that is located in one very specific spot on the heel
- Swelling, redness, and tenderness to the touch
It’s important to see a doctor and treat suspected stress fractures right away, to avoid further damage or a complete break in the bone. Your doctor may recommend an Ace Bandage or KT tape to help stabilize the foot, and may also recommend crutches, a cast, and complete rest from the foot while you heal. Icing and anti-inflammatories can help with pain while you heal.
Plantar fasciitis is caused by damage to the plantar fascia ligament, which runs from the heel to the ball of the foot. This damage, combined with inflammation in the heel can lead to intense pain in the heel. Risk factors for plantar fasciitis include weight gain, wearing unsupportive shoes, intense exercise without proper warmup, and jobs that require a lot of standing and walking.
- Pain that is worst in the morning, with the first few steps out of bed
- Pain that gets slightly better with movement and improves with stretching
- Stiff, aching heels
- Swelling, pain, and inflammation in the heels
- Pain may be dull, or sharp and needling
Thankfully, most cases of plantar fasciitis can be treated at home with rest, stretches to improve flexibility, and orthotic inserts that realign the plantar fascia and cushion the heel. Icing, anti-inflammatory medication, and dietary changes to lose weight when possible can also help speed up healing.
What to Do if You Have Inner Heel Pain
If you have inner heel pain, the most important thing you can do is hone in on your unique symptoms and educate yourself — while you rest from any activities that seem to be exacerbating the pain!
This information will help you communicate effectively with your doctor, determine the source of your inner heel pain, and form an effective and actionable plan for treatment.
In general, most cases of inner heel pain can be resolved with conservative treatment rather than invasive medical procedures like surgery. Unless your heel pain is very severe, or you suspect a fracture, try conservative treatment methods first! In most cases, you’ll be back on your feet in a relatively short amount of time.