If you feel pain in your heel as you take those first few steps after getting out of bed in the morning, chances are you have a condition called “plantar fasciitis.” That pain may go away in a few minutes after your muscles warm up, but it returns when you get up after sitting for a long period.

Plantar fasciitis, also known as “plantar fasciosis” (because it has been determined by some professionals to be a degeneration of the tissue rather than an inflammation), is a common and painful foot problem. It occurs as a result of a minor tear in the plantar fascia — the strong ligament that runs along the bottom of your foot from the heel bone to the toes.

Plantar fasciitis can cause discomfort and limit your activities. It can be relieved through treatment, and it can be prevented.

Plantar fasciitis can strike anyone, from long-distance runners to executives to nurses — anyone who spends long periods on their feet.

The condition may develop slowly over a long period or it may strike suddenly after intense activity, says Hartley Miltchin, a podiatrist with Accent on Feet in Toronto. A common cause is an imbalance in the way you walk, causing the foot to “overpronate” or roll inward, putting pressure on the plantar fascia ligament. This overpronation causes your foot to lengthen slightly, adding tension to the plantar fascia, which cannot stretch in the way a muscle does. The ligament eventually begins to tear away from the point at which it connects to the heel bone, resulting in inflammation and heel pain.

Overpronation is a hereditary condition that’s common to people with rigid body types. These people are more likely to overpronate than those whose bodies are naturally more flexible, such as ballet dancers and gymnasts. An overpronation problem often goes unnoticed and, if it’s not corrected, Miltchin says, all those years of walking with the imbalance can result in a foot problem such as plantar fasciitis.

The condition is more common among people who are middle-aged and older, Miltchin says. As we get older, the plantar fascia has been tugging and pulling for more years. So, if you are at risk and you overdo something — such as walking or running — the plantar fascia can tear.

For example, Miltchin says, a golfer who normally uses a cart decides to walk the course and wakes up the next morning with heel pain. Or, he says, you might return from a tour of Europe during which you did a lot of walking, and wake up with the pain.

“What [such patients] are telling me,” Miltchin says, “is that the band has been pulling for a very long time and they did something that caused it to tear away from the bone a little bit. Then, you get the swelling and the pain.”

Plantar fasciitis is a challenge to treat because of its location. “If there were a tear on the hand from a pulled muscle or ligament, you would put it in a sling for a week and it would heal,” Miltchin says. “But because the foot is farthest from the heart, the blood flow isn’t great. And we put all our body weight on it, so it doesn’t heal by itself.”

People most susceptible to plantar fasciitis are those who are overweight, wear improper shoes — such as high heels or those that lack cushioning or arch support — and people with flat feet or high arches, says Karim Riskallah, a chiropractor with Infinity Health Centre in Toronto. “You don’t inherit plantar fasciitis,” Riskallah says. “You inherit the biomechanics that cause it.”

Although surgery may be required for extreme cases, the most common treatment is prescription orthotics — shaped insoles that fit into your shoes and help to correct the overpronation and relieve the tension in your plantar fascia, allowing the tear to heal. Orthotics can be customized to the shape of your foot.

An array of other treatments are available. To relieve pain while the patient is waiting for the orthotics to be made, Miltchin often uses treatments such as ultrasound therapy, laser therapy or electromagnetic therapy combined with laser therapy. He also uses radial sound wave therapy, a method of treatment he introduced in Canada, which brings energy into the tear area and encourages the development of new blood vessels and cells to hasten healing of the tear.

Miltchin claims this new therapy has effectively eliminated the need for surgery among his patients in the past seven years.

Riskallah uses orthotics, exercises and “deep fascial or muscle work” to the plantar fascia ligament to treat plantar fasciitis.

Whatever therapy is used, healing generally takes at least 12 to 16 weeks.

If plantar fasciitis is left untreated, it can lead to other problems, such as bunions, heel spurs, knee problems and back pain.

The best treatment, of course, is prevention. If your calf is tight and you don’t have much range of motion in your ankle, Riskallah says, acupuncture to the calf and stretches to release the tightness will help prevent plantar fasciitis from developing.

Have your feet checked by a podiatrist, Miltchin advises, who can adjust any imbalance with orthotics to prevent tugging on the plantar fascia.  IE