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You wake up, and as you get out of bed and put your feet on the floor, you feel a sharp, shooting pain in your heel. What is going on? It could be a common condition called plantar fasciitis, one of the most frequent causes of foot and heel pain. It’s estimated that one in ten people will experience plantar fasciitis. The condition involves irritation of the plantar fascia – the layer of tissue that connects the base of your toes to your heel bone. Since hypothyroidism (underactive thyroid) is associated with a higher risk of plantar fasciitis, it’s helpful to be familiar with this foot condition and its diagnosis and treatment.

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Fascia is a thin layer of connective tissue, and it is located around all of your organs, muscles, and bones, holding them in place. Fascia is filled with sensitive nerves, making it highly susceptible to pain.

The plantar fascia connects the base of your toes to your heel bone and runs along the bottom of your foot, supporting your foot arch.

Various factors can create stress, tension, or irritation to the plantar fascia, leading to irritation or inflammation. When this irritation leads to chronic pain in the heel, the condition is called plantar fasciitis.  

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Plantar fasciitis often develops gradually, with slowly worsening pain in the bottom of the foot around the heel area. The pain is typically most intense when you take your first steps of the day and is known as “first-step pain.” Long periods of standing and strenuous exercise can also trigger more acute pain. Researchers report that moderate activity during the day reduces heel pain, but the pain can worsen towards the end of the day.

Tightness of the Achilles tendon – located in the back of the leg connecting calf muscles to the heel area – is also found in almost 80% of cases of Plantar Fasciitis.

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You’re at higher risk of developing Plantar Fasciitis if:

• You’re obese. Obesity is present in up to 70% of patients with Plantar Fasciitis.
• You’re between the ages of 40 and 60.
• You’re female.
• Your preferred exercise or dance routines put stress on your heel area, i.e., running long distances, ballet, and aerobic dance.
• You have flat feet and/or high arches.
• You’re on your feet or walking for extended periods throughout the day.
• You have tight Achilles tendons.
• You frequently wear high heels.
• You’re hypothyroid.

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Hypothyroidism – even mild cases of subclinical hypothyroidism – is associated with edema in the hands and feet. Edema is swelling that results from fluid accumulating in tissue. Fluid buildup around the nerves in the plantar fascia can trigger plantar fasciitis.

Tendons are also rich with receptors for thyroid hormones. When you’re hypothyroid, the tendon’s thyroid receptors may be shortchanged by a lack of sufficient thyroid hormone, increasing the risk of tendon-related medical conditions – known as tendinopathies – such as frozen shoulder, carpal tunnel syndrome, tarsal tunnel syndrome, and plantar fasciitis.

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Also, some people with hypothyroidism are overweight and sedentary, which increases the risk of plantar fasciitis and can make the resulting heel pain worse.

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Typically, plantar fasciitis is diagnosed after a medical history and a careful physical examination of your feet. The doctor will check for tenderness in your feet and evaluate the location of the pain.

In some cases, an imaging test such as an X-ray or MRI may be necessary, primarily to rule out other reasons for your heel pain such as arthritis, a stress fracture, a pinched nerve, or a visible bone spur.

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There’s good news for Plantar Fasciitis sufferers. In most cases, the condition goes away within a year, and overall, around 80% of patients improve within 12 months of treatment. 

Thyroid treatment

If you’re being treated for hypothyroidism and having symptoms of Plantar Fasciitis, an essential first step is to ensure that your thyroid treatment is optimal. Even when your thyroid test levels are “normal,” you may not have optimal thyroid function, and your thyroid may be contributing to your Plantar Fasciitis symptoms. Your thyroid doctor may be able to recommend an adjustment to your medication to improve your thyroid levels. 

More good news: some hypothyroid patients report anecdotally that optimizing their thyroid treatment improved – or even resolved – their Plantar Fasciitis symptoms.

If you’ve been diagnosed with Plantar Fasciitis and have any symptoms of hypothyroidism such as fatigue, weight gain, hair loss, or brain fog, it’s vital to get a thyroid screening. A complete thyroid evaluation can determine whether an undiagnosed thyroid condition may trigger or worsen your Plantar Fasciitis. Your doctor can order a thyroid blood test panel, or you can start by ordering a Paloma Health Complete Thyroid Blood Test Kit.

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Optimizing your thyroid levels with thyroid hormone replacement medication is usually the first step in minimizing symptoms.

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At-home care for plantar fasciitis

Here are some things you can do on your own to help speed the healing of Plantar Fasciitis and reduce foot pain, including:

• Over-the-counter pain and anti-inflammatory medications -- nonsteroidal anti-inflammatory drugs (NSAIDs) – like ibuprofen (Advil, Motrin) and naproxen sodium (Aleve) can be helpful for heel pain and reducing inflammation in your feet.
• Rest your feet to help reduce irritation and inflammation.
• Ice your feet to help reduce inflammation.
• Tape your feet to help prevent worsening strain on the plantar fascia.
• Wear night splints to help lengthen and stretch the plantar fascia while sleeping.
• Get over-the-counter or custom orthotic shoe inserts and/or heel cups to support your arch or heel.
• Don’t go barefoot or wear worn-out shoes and avoid high heels
• Choose exercise that has less impact on heels, like swimming or cycling, and avoid stressful activities like running or jumping on hard surfaces. Make sure you stretch your ankles, feet, and calves before and after exercise.
• Maintain a healthy weight, or work to lose weight if you’re overweight.

The importance of stretching for plantar fasciitis

One of the most effective things you can do is have a regular leg and foot stretching regimen for your Plantar Fascia. In particular, stretching your calf muscles is very important. To perform a calf stretch, you stand against a wall, palms to the wall, and alternate lowering each heel to the floor.

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You can also use a simple device called a foot roller. The action of rolling the foam tube back and forth with your foot can help stretch and strengthen your Plantar Fascia.

Medical treatments for plantar fasciitis

Experts recommend you try self-care and more conservative treatments before pursuing more invasive therapies. But if self-care approaches don’t work, there are several treatments your doctor can recommend for Plantar Fasciitis, including:

Steroid injection

When your heel pain doesn’t respond to over-the-counter medications or is unusually severe, your doctor can give you a steroid injection into the heel area. The injection typically provides some pain relief for around a month.

Physical therapy

Physical therapy may be recommended for chronic Plantar Fasciitis that isn’t responding to medication and self-care. A physical therapist can work with you to provide massage and exercises that stretch and strengthen your ankles, lower leg, Achilles tendon, and the Plantar Fascia itself.

Procedures

Other procedures may be recommended when your Plantar Fasciitis doesn’t respond to medications and physical therapy, though it’s not common. These can include platelet-rich plasma injections into the heel, extracorporeal shock wave therapy, and ultrasonic tissue repair.

Surgery

Typically, surgery to detach the plantar fascia from the heel bone is only recommended if Plantar Fasciitis symptoms interfere significantly with your daily life for more than six to twelve months.

A note from Paloma Health

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Whether you’re looking for or already have a diagnosis of hypothyroidism, optimal testing, management, and care of your hypothyroidism is essential and may help you more quickly resolve plantar fasciitis. 

The Paloma Health at-home thyroid test kit can make thyroid screening and testing easy and affordable, right from home. 

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Your at-home thyroid test kit has everything you need for sample collection and analysis of TSH, free T3, free T4, and TPO antibodies. You even have the option to add on reverse T3 and/or vitamin D.

Your thyroid test kit is sent directly to your address, requires an easy finger prick, and is then sent back to the lab with pre-paid shipping. Your thyroid lab results are released to your secure online dashboard within days, similar to the wait time for in-person lab results, without the inconvenience. 

You also can schedule a virtual visit with one of our top thyroid doctors. Paloma Health’s doctors will recommend thyroid hormone replacement medications to safely normalize your thyroid function and reduce your symptoms if you require hypothyroidism treatment.