Why Plantar Fasciitis Keeps Coming Back for Some People

By Your Health Magazine Contributor

One of the most aggravating experiences for many people is when heel pain improves only to be back again weeks, months or even years later seemingly out of nowhere. Maybe after a long walk that didn’t feel all that different to ones you’ve taken pain-free before. Maybe after resuming exercise or just from being on your feet for your day job.

It’s quite puzzling because it doesn’t typically feel like you’ve “done something wrong” to cause the recurrence. You’ve followed all the advice and rested when necessary. Yet even when you do everything you’re supposed to, the pain resurfaces.

What’s so baffling is trying to do things the right way and still not getting any relief from the recurring problem. The reality of recurring plantar fasciitis is that it’s rarely the result of one thing you did or didn’t do. It’s how your foot is handling the cumulative demands of daily life.

When you know what’s silently maintaining that daily stress load you’ll find it’s much easier to understand why the cycle occurs and what actually needs to be changed to prevent it.

Understanding Why Plantar Fasciitis Becomes a Recurring Problem

Managing plantar fasciitis often calls for a multi-pronged approach, incorporating things like adjusting your activities, doing specific stretches, wearing supportive footwear, and using the insoles for plantar fasciitis. While these can decrease the stress being placed on the foot and decrease pain, recurring plantar fasciitis pain can be affected by many different parts of the foot, not just the plantar fascia ligament.

Your plantar fascia ligament runs along the bottom of your foot. This thick band of tissue acts as a shock absorber and supports the arch of your foot. Every time you walk, run, or stand your plantar fascia helps absorb the shock of your body weight.

Activities that constantly stress the plantar fascia can irritate the soft tissue and cause pain in the heel. Many people who experience heel pain from plantar fasciitis find that their pain goes away after taking a few steps to treat the condition. But for some people, the injury can come and go or return weeks or even months after symptoms improve.

Even if your plantar fasciitis pain returns, it doesn’t imply your treatment approaches were unsuccessful. It may mean that your foot is taking longer to adjust to increased activity, or there may be other issues at play.

Returning to Activity Too Quickly

Arguably, the biggest reason people experience recurrence of plantar fasciitis is that they return to their normal activities too soon. The pain seems to subside far before the foot is ready to tolerate your normal activities again. It’s easy to feel like the issue is gone once you’re able to walk around without pain or your morning heel pain isn’t quite as bad.

However, just because you’re feeling better doesn’t mean your plantar fascia can handle the same amount of activity it could previously. Jumping right back into running, long walks, the gym or even returning to a job that has you standing all day long can cause you to overload the tissue again before it has had sufficient time to adapt.

This often results in a frustrating loop of feeling better, then ramping up activity, only to experience a resurgence of pain. Recurrent plantar fasciitis is often not the result of another injury but simply the foot becoming overloaded with more activity than it’s used to handling. Gradually increasing your activity level can help prevent those pesky flare-ups.

The Underlying Cause Hasn’t Been Addressed

Part of the reason why plantar fasciitis recurs is because the cause of stress to the plantar fascia has not been corrected. Although treatments will help alleviate irritation to the plantar fascia, they may not address what caused the issue initially.

This could be due to foot biomechanics or force distribution through the foot during running and walking for some people. For others, tight calves, decreased strength throughout the lower extremity or sudden increases in training load can be contributing to excess stress on the plantar fascia. Even occupational requirements can cause recurring flare-ups if you are on your feet all day long or walking on hard surfaces.

If you find yourself repeatedly asking, “do your feet hurt even though the pain seemed to improve previously?”, it may be worth looking beyond the symptoms themselves. Finding out what is continuing to overload your plantar fascia can be key to stopping recurrent heel pain.

Everyday Habits Can Trigger New Flare-Ups

Oftentimes, these factors sneak up on you when you’ve treated your initial episode of plantar fasciitis because they slowly begin to overload the foot again. Wearing shoes with little or no support, or going barefoot for extended periods on hard surfaces (like most of us do inside our homes) can add stress through the plantar fascia without you even realizing it.

Another major cause is from increasing your daily activity too quickly. This could be from walking more miles than you are used to, returning to sport, or jumping right back into a workout routine at the gym after a long lay-off. Standing for long periods of time while at work or throughout your day can also cause problems if your feet don’t have enough variety or rest built into your day. Even large lifestyle changes such as weight gain or loss or altering your daily activities can change the forces going through your feet.

While none of these factors would typically cause an issue individually, they can add up over time and become the straw that breaks the camel’s back when your foot is still vulnerable.

Strength and Load Capacity Matter More Than Many People Realize

Slowly but surely we have come to appreciate that plantar fasciitis isn’t so much a disorder that requires rest and stretching. We now realize that the key is loading tolerance of the foot and lower limb. Loading tolerance of the foot, ankle and lower leg dictates how well an individual copes with daily activities. If the tissues aren’t up to the task, the plantar fascia will become overloaded.

Improving load tolerance is not an overnight process however. It’s a slow journey that gradually allows the tissues to become more resilient. As you build up the strength and loading tolerance of the muscles surrounding the foot, you’ll find it can often cope better with walking, standing and exercise without becoming irritated or causing symptoms to flare.

When Heel Pain May Not Be Plantar Fasciitis

When heel pain keeps flaring up even after treatment, it’s possible that plantar fasciitis isn’t the true reason. There are a few conditions that mimic plantar fasciitis pain as the symptoms are typically located around the heel and arch area.

Nerve irritation can cause sharp, burning or radiating pain. Fat pad syndrome occurs when your fat pad just doesn’t “bounce back” and cushion your heel when standing or walking. There are various tendons around the foot and ankle that can cause heel pain that can mimic plantar fasciitis but will usually improve or worsen differently.

Once again, this is why it can be critical to reassess your diagnosis if heel pain continues to bother you or if it isn’t improving as expected. It’s important to know if your pain is part of a larger foot and ankle condition versus purely plantar fascia-related so you know what to expect from non-surgical treatment options for heel pain.

What Can Help Reduce the Risk of Recurrence?

Decreasing the chance of recurrence is typically more dependent on load management of the foot post initial symptoms rather than any one treatment.

When you start walking, running, or returning to work that puts constant pressure on your feet, it’s crucial to gradually ramp up your activity. Wearing shoes that provide support and cushioning can also help reduce load through your feet during daily activities.

Foot, ankle, and lower-leg strengthening exercises can help increase your tolerance to load over time. Continued load management can assist with avoiding peaks of load that your tissue may not be able to tolerate. Additionally, treating flare-ups when they first occur can help avoid a minor flare-up turning into a prolonged episode.

For some people, having a few simple, quick-relief exercises on hand can also be useful for managing early symptoms before they escalate, particularly during periods of increased activity or workload.

Breaking the Cycle of Recurring Heel Pain

The most common cause of recurring plantar fasciitis is multifactorial. It’s seldom a single root cause, but rather a mix of strains and pressures accumulating, influenced by everything from foot strain and shoe selection to how active you are and your body’s resilience.

Importantly, we should recognize that recurrent plantar fasciitis doesn’t automatically imply a lack of success with treatment. Quite often, feeling better straight away is a positive sign that the treatment is working, even if some of the underlying causes are still present.

Helpfully, the main change in mindset is usually stopping to think about heel pain as something that needs to be “fixed once and for all” and starting to look at what factors are contributing to your pain.

Once these are understood and addressed, future recurrence can be minimized, allowing for longer-lasting recovery.