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It can take a long time to heal plantar fasciitis (sometimes up to 18 months), so there is nothing more frustrating than when it flares up again and again.

What Causes Plantar Fasciitis to Flare Up?

The best way to prevent plantar fasciitis from flaring up is by closely following your doctor’s treatment instructions and keeping up with your regular remedies. Take preventative measures like wearing plantar fasciitis inserts and stretching your feet regularly, and avoid these 7 heel pain triggers:

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, 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. Brian Hamzavi, MS, MD; and David A Forsh, MD have found that “weekend warriors,” or people who spend most of the week working at a more sedentary job and then play hard on the weekends with lots of physical activity are especially vulnerable to plantar fascia injuries and flare-ups.

If you tend to participate in physical activity in spurts, make sure that you take extra preventative measures like icing and stretching your feet before and after the activity. If you’re starting a new workout regimen, ramp up the intensity slowly instead of diving in.

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 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. One study that included 228 patients with plantar fasciitis who lost a significant amount of weight through bariatric surgery showed that an amazing 90% recovered from plantar fasciitis.

If weight loss is not possible (like with pregnancy or different health conditions), try to rest and elevate your feet more, and consider orthotic treatments to take the pressure off your arches.

4. Tight calf muscles

The muscles in the calves (specifically the gastrocnemius and soleus muscles) are directly connected with tendons and ligaments in the foot, including the plantar fascia ligament.

Many podiatrists recommend stretching out the muscles in your calves as a way to improve plantar fasciitis, since improving strength and range of motion in these connected muscles can in turn help stabilize and support your arch. Lisa M. Schoene, DPM, ATC, FACFAS, says, “Calf stretching both with the knee straight and with the knee bent [is] an important part of the treatment protocol [for plantar fasciitis].”

5. New shoes

Trying a new style of shoes will sometimes trigger plantar fasciitis if they 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 that 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 them with your new shoes. If you don’t yet have a new pair, 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. Check the tread and integrity of your shoes every few months, and replace when needed.

Christopher Corwin, DPM, says, “Wearing appropriate shoes is the first step in alleviating the pain associated with plantar fasciitis.” This is especially important if you spend a lot of time on your feet at work, or if you participate in high impact exercises like jogging or basketball. The more time you spend in a given pair of shoes, the more quickly those shoes will wear out.

7. Injury

Most people intuitively understand that injuries, strains, or trauma to the plantar fascia ligament can cause a flare-up of pain. However, it’s less commonly understood that an injury to the tendons in the leg, ankle, or foot can trigger a flare-up of plantar fasciitis. For example, several studies have documented that tightness or injury to the Achilles tendon is strongly correlated to the function of the plantar fascia.

Injuries to the foot, ankle, or leg can be caused by stepping on uneven surfaces or objects, tripping, playing sports, exercising, 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 or if the injury is severe.

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!