Plantar Fasciitis - Care Guide

Plantar fasciitis is a relatively common running related cause of severe foot pain. It is an acute inflammation of the band of tissue that supports the arch and it may affect anyone but especially strikes runners and other physically active people. Plantar is medical nomenclature for the bottom of the foot and the plantar fascia is a rope-like band of tissue with almost no elastic properties that stretches along the bottom of the foot. The pain usually results from inflammation of the plantar fascia tissue. If the arch is overstressed the fascia will not stretch, instead it will pull away from the attachment site at the calcaneus (heel bone) where the arch meets the heel.

The plantar fascia becomes less resilient with age and may be damaged by frequent or intense physical activity. One common misconception is that a bone spur in the heel causes the pain. A spur may be noted on an x-ray, but plantar fasciitis is strictly a soft tissue inflammation.

Plantar Fasciitis Symptoms

The onset of this problem is often associated with foot pain at the bottom of your heel. The classic symptoms of Plantar Fasciitis may be acute in the morning and when you first stand after sitting for an extended period of time, or at the beginning of a run. During the initial stages the pain subsides after warming up but in the chronic cases the pain can progress beyond the initial steps of a run to a constant ache or sharp pain. The condition often tends to improve gradually over the course of the day. Towards the evening, a dull ache replaces the pain, which may subside with adequate rest. The typical physical symptoms can include a mild swelling in the affected region, tenderness and redness at the bottom of the heel.

Plantar Fasciitis Causes

The most common cause of Plantar Fasciitis is abnormal pronation of the foot, causing biomechanical misalignment. Vigorous participation in sports such as running, tennis, and aerobics (dance, step, etc.) puts particular stress on the foot and causing damage to the plantar fascia. Another cause of plantar fasciitis is tight calf muscles. If there is not enough motion in the ankle joint due to a lack of flexibility then there will be extra strain on the fascia which may lead to this injury. Foot type and how the foot functions can also play a significant role in this injury.

The two extreme foot types, flat feet and high arched feet, are commonly implicated in fasciitis. Plantar fasciitis can also result from a bony spur projecting from the underside of the heel that makes walking painful. Spurs under the sole (plantar area) typically cause localized tenderness and pain that is made worse by stepping down on the heel. Additional factors that may contribute to the development of plantar fasciitis are obesity, inactivity, excessive periods of walking or standing on hard surfaces, and also badly worn shoes with insufficient arch support.

Plantar Fasciitis Treatment

A conservative approach to treatment is often beneficial. Treatment options have historically included rest, physical therapy, ice, heat, heel cups, pads, splints, stretching exercises for the heels, shoe modification, orthoses, nonsteroidal anti-inflammatory medications, injections, and surgery. However, treating Plantar Fasciitis can be a process involving several months, or in some cases, even a couple of years. The average timeframe for treatment has been about 9 months.

Of all the treatment options, the most consistently positive results have come from Achilles stretching programs, both active and passive, using night splints. Exercises to stretch and strengthen the Achilles tendon are an effective means of decreasing hyperpronation, thus reducing pain. In chronic cases people may benefit from the use of a night splint. It is a device worn on the foot and leg that holds the foot in a stretched position while you sleep. The best night splints are adjustable to provide a better stretch as muscle flexibility improves. In severe cases, a podiatrist should be consulted to help identify appropriate insoles or arch supports for your feet. In certain cases, a short cast up to the knee may be recommended.

Taping the foot to support the fascia and reduce the traction forces that are causing the inflammation is another excellent treatment tool. If the foot feels better when it is taped then this helps to confirm the diagnosis of plantar fasciitis. Ice plays an important part in the treatment of most injuries. It will help to reduce the inflammation to the area, which in turn can reduce the pain. One excellent way to ice the bottom of the foot is to freeze a water bottle and roll your foot over it for at least fifteen minutes per day, preferably at the end of the day.

Though some physicians may advise steroid injections, it should be understood that they are very painful and may not suit everyone. In extreme cases, surgical procedures may become necessary to bring in lasting relief.

Over 95% of the time plantar fasciitis improves or resolves with conservative therapy. If the symptoms are not improving then there may be something else causing the pain such as a stress fracture, nerve pain, or bursitis. In these cases further testing including an MRI, bone scan, or CT scan should be considered. In the event that plantar fasciitis is a confirmed diagnosis and pain is still present after a year or so of conservative treatment only then should surgery be considered.

Plantar Fasciitis Prevention

You can do many things to decrease your chances of developing plantar fasciitis. The following steps will help prevent plantar fasciitis or help keep the condition from getting worse if you already have it:

• Take care of your feet. Wear shoes with good arch support and heel cushioning. If your work requires you to stand on hard surfaces, stand on a thick rubber mat to reduce stress on your feet.
• Stretching exercises can help maintain the stability of the plantar fascia and reduce the chances of injury. Do exercises to stretch the Achilles tendon at the back of the heel. This is especially important before sports, but it is helpful for non-athletes as well.
• Maintain a normal body weight since it is another way to avoid undue stress and damage to the plantar fascia.
• Establish good exercise habits. If you are physically active, always wear well-fitting shoes and avoid sudden drastic increases in exercise intensity. Increase your exercise levels gradually.
• If you run, alternate running with other sports that will not cause heel pain.
• Put on supportive shoes as soon as you get out of bed. Going barefoot or wearing slippers puts stress on your feet.