Hello, I'm Roberta Bass, a women's health physiotherapist, a Pilates instructor and women's health specialist. And welcome back to Making Sense of Women's Health.
Today we're going to be talking about plantar fasciitis. Now this is a common and often persistent cause of heel pain. Whether it's first thing in the morning, after long walks or just from standing too long, plantar fasciitis can really get in the way of your daily movement. But with the right understanding and a few changes, you don't have to let it slow you down.
But what is plantar fasciitis? It is an inflammation or irritation of the plantar fascia, which is a thick band of tissue that runs along the sole of the foot and it connects your heels to your toes. Its job is just to support the foot and help absorb shock as you move. But when it's overloaded or irritated it can become inflamed and this can cause sharp stabbing or aching pain around the heel or into the foot along the arch. The most classic symptom is this sharp heel pain first thing in the morning when taking your first steps out of bed.
And often the pain will improve slightly as we get moving. But it can then worsen again if you've been on your feet for a long time, if you're walking any distance, or if you then rest, sit down and then get up again. This is because it tightens up when we're not on it. And then that first few steps stretch out this inflamed structure and then causes pain.
It can affect one foot or sometimes if you're unlucky it can be in both and it often builds up gradually though sometimes it can start quite suddenly after a change in activity or footwear. Plantar fasciitis is usually caused by a combination of overuse, mechanical stress and reduced tissue resilience and some of the most common reasons I see people with this condition is a sudden increase in walking or running often if they've been away on holiday or they've started like the couch to 5k because they're not used to that kind of activity or if they've been stood up for a long time particularly on hard floors or wearing unsupportive footwear. So particularly when people are going on holiday walking lots and they're wearing flip-flops that give you no support or really flat shoes and they come back from holiday and their feet are really painful.
Having tightness in the calf or Achilles tendon can increase the tension through the plantar fascia and reduced foot strength or poor arch support can also cause the condition. And in some women, so particularly the women that I see, hormonal changes during perimenopause or pregnancy can affect the health of the connective tissue.
So lower estrogen levels can reduce the collagen production and this in turn causes decreased tissue elasticity, making structures like the plantar fascia more prone to irritation or injury, especially then if it's combined with other changes in activity, footwear or body mechanics. Also weight gain. So this again is common during pregnancy certainly and often in because of our metabolic changes and our lifestyle shifts and this increases the load onto the foot that then can cause irritation, particularly if we're then combining it with increase in activity, hormonal changes and everything else that we've spoken about.
So what can you do to ease the symptoms? These are all things that you can try yourself at home. So certainly wearing some more supportive footwear to avoid walking barefoot, particularly on hard floors because every time you take a step you are stretching through that irritated connective tissue and particularly on hard floors you're going to get more impact and irritation. Ideally choosing shoes with a good arch support, some cushioning in the heel, a small heel drop so not completely flat and ideally a firm but flexible sole.
If you need to, can add in insoles with a bit of an arch support and some cushioning in the heel and that can be effective and can provide some relief as well, particularly if it's like in the early stages or if you're on your feet a lot. But using insoles in the correct footwear is most effective when you're also combining it with other strategies such as stretching and strengthening rather than on their own.
So speaking of stretching, we mentioned that having tight calves and Achilles can be a major contributor. So trying to do some daily stretches of the calves and of the plantar fascia can be really helpful. So doing a calf stretch where you put your toes up against the wall can stretch both the calf and the plantar fascia. Rolling the arch of your foot over a cold water bottle or ice bottle or a golf ball can be really helpful to help stretch out the structures but also getting the blood circulating to the area. Doing some toe stretches and some towel scrunches. So you put your foot on top of a towel, tea towel, normal towel, and then scrunch up the toes. So you're trying to move the towel. It can be really helpful to activate the small little muscles in the foot. And that then strengthens up the arches. With the stretches, you're aiming for 20 to 30 seconds for each side, I would do it both sides, even if it's only one side you're getting the problem, just so that you're balancing it out. And you want to be doing them two or three times in one session, and then repeat that a few times a day.
Using ice can be really helpful. So we mentioned about the bottle. So actually, if you put a bottle of water in the freezer, so you've got an ice bottle, then using that to roll over can be really helpful. An ice pack itself, but certainly having it so you're rolling the foot back and forth can be really effective to calm inflammation, particularly if you've been out and about. Obviously make sure it's not too cold that you're going to cause freeze burns, but doing that for 10 to 15 minutes can be really helpful.
Try and avoid prolonged walking or standing without having a break and sitting down, but at the same time don't do nothing. So still keep moving, doing gentle movement because that helps the circulation flowing and helps to keep those tissues mobile. So it might be that instead of cutting out activities and exercise altogether, you might switch it for a lower impact option. So instead of running, maybe try swimming or cycling or going for something like Pilates or a chair based strength work, that allows you to keep active but without aggravating your heel.
And I often work with women to adapt their routines in a way that supports their healing, especially those who don't want to lose progress with their fitness or their weight goals. There's nothing worse than if you've been working towards something to then stop all the exercise completely. There's no need for that, we just need to do some tweaks and adjust it slightly.
Longer term recovery does depend on improving the strength and resilience of the tissues. So doing those simple foot strengthening exercises like the toe curls, coming up and doing heel raises and balance work can improve the arch control and reduce recurrence of plantar fasciitis. And it's often things I build into my Pilates programs and the physio plans, we need to have that foot control. So certainly my Pilates classes are not just about the core, we do do a lot of balance and proprioception work as well.
So when do you need to get help? So doing all these things at home is great, and they may well help to settle things. If your symptoms have lasted more than a few weeks or they're getting worse, it is time to go and get some help. So you should speak to a physio or the GP if your pain is waking you up at night time, if you're getting numbness or tingling. This is a sign it may not be the plantar fascia that's causing your pain. It may actually be one of the nerves that runs down into the foot.
If you are having pain up into the calf or the ankle, then it might be that other structures are involved as well. Or if you're finding it hard to walk or function day to day, then you really need to get some help because it may be that it's not plantar fascia and it's a different condition such as the nerve irritation or stress fracture. Or it might be you've got plantar fascia problems and something else as well. So getting the right diagnosis is key because you can be treating the plantar fascia for a long time. But if it's not actually the plantar fascia that's causing your pain, then you're not going to get anywhere.
So going to see a physio or similar professional can help you understand the cause of your symptoms and then build a progressive rehab plan, modify your exercise so it's safer and get back to the activities that you love. So it might be including some hands-on treatment, it might be some taping, it might be strengthening or maybe just even advice and reassurance, but you don't have to put up with it.
The longer you put up with it the more chronic it becomes and then the more difficult it is to treat. And if you are struggling with heel pain or not sure what's causing your foot discomfort then I would love to help. I am a women's health physio but I also can see MSK conditions as well, particularly as this may be related also to hormonal changes. So you can book a physio assessment with me or even if you want to go down the Pilates route, I do offer that one-to-one as well.
And we can do this in person at the clinic or I can assess you online just to give you a clear action plan. We will look at your foot biomechanics, we'll look at your movement and we'll make sure that it is the plantar fascia that is causing the problems. So if you want my help, then just visit the website and book in or go to your local physio that you normally go to or anybody local to you and make sure that you are not just putting up with the pain.
And often it is related to hormonal changes if you are perimenopausal or you've just had a baby so it's worth looking at the bigger picture as well not just the foot. But for now thank you so much for tuning in to Making Sense of Women's Health. If you found the episode helpful as ever if you could share it or leave a review that'd be really helpful.
I'll be back next week with another episode.
Until then, take care and see you next time.