Lifestyle

Healing plantar fasciitis and Achilles tendonitis

Both the plantar fascia and the Achilles tendon attach to the calcaneus or heel bone. The plantar fascia is on the bottom surface of the foot and the Achilles tendon runs down the back of the ankle. If the calf muscles, the soleus and gastrocnemius, are tight the stretch of the Achilles tendon is inhibited, which can put extra tension on the plantar fascia. Tight calf muscles are one of the many factors that can lead to painful plantar fasciitis. Whether you are a weekend warrior or a world-class athlete, you will want to learn how to treat and heal your plantar fasciitis or Achilles tendonitis quickly.

Ligaments and tendons

Achilles tendon

The longest, strongest tendon in the body is the Achilles tendon. This tendon connects the two calf muscles, the gastrocnemius, and the soleus, to the heel bone. The Achilles tendon makes it possible to walk, run, jump, and climb stairs. Other tendons connect the calf muscles to the inside and outside of the foot.

Foot ligaments

The primary ligaments of the foot include the following:

Plantar fascia: The plantar fascia is the longest ligament of the foot. It runs along the sole from the heels to the toes, forming the arch, which helps maintain balance and absorbs shock. Overstretching the fascia can lead to plantar fasciitis.
Plantar calcaneonavicular ligament: The plantar calcaneonavicular ligament supports the arch of the foot and gives it elasticity. For this reason, it is sometimes called the spring ligament.
Calcaneocuboid ligament: The calcaneocuboid ligament also supports the arch.

Achilles tendonitis

Achilles tendonitis and heel spurs

The Achilles tendon attaches to the heel bone. Achilles tendonitis, or inflammation of the Achilles tendon, can result from a sudden increase in exercise, as an overuse injury in runners, or even in people who do not exercise at all. According to Mazzone et al., men over the age of 30 have the greatest risk.

Bone spurs, which are an overgrowth of bone, often form. These bone spurs rub against the Achilles tendon, causing heel pain.

People with Achilles tendonitis may experience the following symptoms:

Thickening of the tendon
Pain after exercising, with activity, or first thing in the morning
Tendon swelling
Pain where the Achilles tendon inserts into the heel bone

Risk factors for Achilles tendonitis

The following are risk factors for Achilles tendonitis:

Having a sudden increase in physical activity
Wearing poor-fitting footwear
Having excessive pronation of the foot
Having poor flexibility
Being runners, dancers, gymnasts, and tennis players

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Best ways to heal Achilles tendonitis

Injuries to ligaments and tendons are common. The following strategies may speed up the healing of Achilles tendonitis:

Icing: Ice for 20 minutes or until the skin is numb.
Non-steroidal anti-inflammatory medications (NSAIDs): Can relieve pain or inflammation. NSAIDs should not be taken for prolonged periods due to their side effects.
Stretches: Stretching the calf muscles and Achilles tendon. After raising your weight, slowly let it down to stretch the tendon.
Orthotics: An orthotic insert or wedge elevates the heel and puts less tension on the Achilles tendon.
Warm-up: A slow, gentle warm-up and appropriate training techniques can help protect the Achilles tendon from further injury.

I’ve separated my shoulder and my collarbone; I’ve messed up my knee a million times. I’ve broken my foot in several places. I’ve broken my toe a bunch, broken my nose a couple of times, and had a bunch of other annoying little injuries, like turf toe and arthritis and tendonitis. It’s part of the game. — Ronda Rousey

Plantar fasciitis

The plantar fascia runs from the heel bone to the toes. With each step, the arch of the foot drops and recoils. The plantar fascia supports the foot arch and acts as a shock absorber with each step. According to Young et al. (2001), plantar fasciitis is one of the most common causes of heel pain. The pain is usually caused by the degeneration of collagen due to repetitive microtears. Individuals with either low or high arches are predisposed to developing plantar fasciitis.

When this fascia becomes irritated or inflamed, stabbing pain right in front of the heel can result. This pain is generally worse in the morning and gradually decreases as you move around. The pain may return after long periods of standing or when you first stand up. Heel stiffness can make climbing stairs difficult. Sufferers of plantar fasciitis typically limp with their heel off the ground to decrease pain and tension on the fascia.

Who’s at risk for plantar fasciitis?

Factors which may increase your risk for plantar fasciitis include the following:

Running: Long-distance running can leave to microtears due to repetitive stress.
Obesity: Puts extra stress on the fascia.
Foot mechanics: A high arch or low arch, a discrepancy in leg length, or abnormal walking patterns can stress the fascia.
Tightness: Tight Achilles tendon or calf muscles puts additional stress on the heel and plantar fascia.
Standing: Occupations in which you are required to stand for long periods.
Age: The elderly, due to poor intrinsic foot muscle strength and decreased healing capacity.
Shoes: High-heels, unsupportive shoes or thin soles can put added stress on the fascia.
Muscle weakness: Weak calf or intrinsic foot muscles can lead to increased stretching of the fascia with each step.

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Plantar fasciitis and heel spurs

The plantar fascia may become torn or inflamed if too much pressure is put on it when running and jumping. Like Achilles tendinitis, overuse, tight calf muscles, and a sudden increase in activity can lead to inflammation. Bone spurs on the heel bone can result. According to the American Academy of Orthopedic Surgeons, one out of ten people have bone spurs, but only 5% have pain. Therefore the pain can be treated without removing the spur.

Best ways to treat plantar fasciitis

The following are suggested ways to treat plantar fasciitis.

Icing the area: Icing the area for 20 minutes or rolling the foot over a frozen bottle of water may decrease inflammation and pain.
Stretches: Stretching the calf muscles by pushing against a wall or allowing the heel to hang over the edge of a step stretches both the Achilles tendon and the plantar fascia. Stepping on a towel and then pulling the edges of the towel upward can stretch the plantar fascia. Picking up marbles with the toes may also help.
Splints: Wearing night splints to stretch the calf and foot while you sleep by keeping the foot in a neutral position.
Supportive shoes or inserts: Orthotics can decrease the impact on the heel and reduce the inflammation to help heal plantar fasciitis.
Non-steroidal anti-inflammatory medications (NSAIDs): Can relieve pain or inflammation. NSAIDs should not be taken for prolonged periods due to their side effects.
Corticosteroid injections: Injecting corticosteroids along with a local anesthetic may provide short term pain relief.
Extracorporeal shock-wave therapy: Uses pressure waves to stimulate healing and inhibit pain receptors.
Surgery: A surgical solution is considered in a small group of carefully selected patients who have persistent, severe symptoms despite using a nonsurgical treatment for 6-12 months.
Iontophoresis: The use of electrical impulses to drive topical corticosteroids into the soft tissue. A physical therapist or athletic trainer administers this treatment at least two to three times per week.

According to Buchbinder, studies comparing methods for how to treat plantar fasciitis have demonstrated inconsistent results. Plantar fasciitis is considered to be a self-limiting condition. In more than 80% of patients, the symptoms will resolve within a year.

Do athletes need to stop their sports?

Most physical therapists do not feel that athletes need to stop participating in their sport while waiting for plantar fasciitis to heal. Substitution of lower impact sports may be recommended.

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Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References:

Young CC, Rutherford DS, Niedfeldt MW. Treatment of plantar fasciitis [published correction appears in Am Fam Physician 2001 Aug 15;64(4):570]. Am Fam Physician. 2001;63(3):467-478. https://www.aafp.org/afp/2001/0201/p467.html
Buchbinder, R. (2004). Plantar Fasciitis. N Engl J Med 2004; 350:2159-2166 https://pubmed.ncbi.nlm.nih.gov/15152061/
OrthoInfo – AAOS. (2020). Plantar Fasciitis and Bone Spurs. Retrieved from https://orthoinfo.aaos.org/en/diseases–conditions/plantar-fasciitis-and-bone-spurs/
Mazzone, M. & McCue, T. (2002). Common conditions of the Achilles tendon. Am Fam Physician.; 65(9):1805-1811. https://pubmed.ncbi.nlm.nih.gov/12018803/

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