What causes plantar fasciitis to flare up and what does it feel like?

Where is the plantar fascia?

The plantar fascia is a thick fibrous band of fascia under your foot. It runs from your heel bone to the ball of your foot.

Its main job is to support your foot’s arch and prevent it from flattening out when you place weight through your leg. The small muscles inside the foot, as well as the ones that run along your inner ankle (tibialis posterior, tibialis anterior), share this job and are meant to prevent the plantar fascia from being overloaded.

What causes plantar fasciitis to flare up?

Plantar fasciitis is an overload injury that develops when the force that goes through your foot is too high for the plantar fascia to cope with. This overload can happen gradually over several days or during one event that loads your feet more than what they are used to.

Activities that can increase the force through your feet and aggravate plantar fasciitis include:

• Running, walking or standing a lot in unsupportive shoes
• Running, walking or standing on hard surfaces like concrete
• Carrying a heavy object or gaining weight
• Increasing your running or walking volumes too suddenly
• If the muscles in your feet or legs are weak
• If the muscles along the back of your legs are excessively tight (glutes, hamstrings, calves)

What does plantar fasciitis pain feel like?

This is an important question, because there are several other conditions (back pain, tarsal tunnel syndrome, tib post tendinopathy etc.) that can feel very similar but require totally different treatment.

Plantar fasciitis pain typically feels like this:

• It’s mainly located on the inner part of the arch, right where the plantar fascia attaches to the heel bone.
• It’s usually not associated with any tingling, pins and needles, or numbness – if you have those symptoms it’s likely something else.
• You may notice some puffiness or swelling in the area of the inner arch, under the foot, but it will not cause swelling around your ankle or on top of your foot.
• It usually doesn’t hurt while you’re sleeping/lying in bed.
• The first few steps in the morning will likely be the most painful and stiff and people often have to hobble around until it’s warmed up a bit.
• If you sit still for long periods in the day, you may again find that your foot is very stiff and painful when you start walking.
• Standing still in one spot can be very uncomfortable.
• Discomfort with walking and running can vary depending on how aggravated your plantar fascia is. In mild cases you may find that it hurts a bit to start with, but then actually warms up and feels OK, just to hurt more afterwards. In severe cases you’ll likely find that the more you walk or run, the worse the pain gets.

I’ve seen plenty of patients who have been misdiagnosed with having plantar fasciitis, when they actually have a different condition. If you feel that your symptoms don’t quite fit the above description, it may be worth reading this article where we discuss how you can differentiate between plantar fasciitis and conditions that create very similar symptoms.

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Can plantar fasciitis go away on its own?

It depends on what you mean with ‘on its own’. If you mean, ‘Will it go away if I continue to run and walk as much as I like and push through pain?’ then no, it will likely just get worse.

You will have to do certain things (like reduce your time on your feet or wear supportive shoes etc.) to allow your plantar fascia to settle down, but as long as you catch it early, you usually don’t require any fancy treatments. The body is very good at healing itself as long as you create the right environment. We discuss how to effectively treat plantar fasciitis at home in this article.

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