Plantar fasciitis is one of the most common causes of heel pain, affecting millions of people each year. It involves the inflammation of the plantar fascia, a thick band of tissue that runs along the bottom of the foot from the heel to the toes. Whether you're an athlete, a runner, or someone who spends a lot of time on their feet, plantar fasciitis can become an annoying and painful issue.
The Anatomy: Understanding the Plantar Fascia
To fully appreciate the impact of plantar fasciitis, it’s important to understand the role of the plantar fascia in the foot.
The plantar fascia is a thick, fibrous band of connective tissue that originates at the heel (specifically from the calcaneus) and extends across the bottom of the foot to the base of the toes. It helps support the arch of the foot and plays a crucial role in absorbing the shock and stress that occurs when you walk or run.
As you move, the plantar fascia stretches and contracts, helping to propel you forward. The constant tension and movement of this tissue are essential for normal foot function. However, when the plantar fascia becomes strained or overworked, it can lead to inflammation, pain, and eventually to plantar fasciitis.
Causes:
Plantar fasciitis occurs when the plantar fascia becomes overused or strained. This can result from a variety of factors, such as:
Overuse or Repetitive Stress: Activities like running, dancing, or standing for long periods of time can place repetitive strain on the plantar fascia, especially if wearing improper footwear.
Improper Footwear: Shoes with inadequate arch support, cushioning, or poor fit can exacerbate the stress placed on the plantar fascia. High heels and shoes with little padding are common culprits.
Foot Structure and Biomechanics: Certain foot shapes and mechanics can increase the risk of plantar fasciitis. For example, individuals with flat feet, high arches, or an abnormal walking pattern (like overpronation or supination) may place extra stress on the plantar fascia.
Age and Weight: As we age, the plantar fascia loses some of its elasticity and resilience, making it more susceptible to injury. Additionally, being overweight can add extra pressure on the feet, contributing to the development of plantar fasciitis.
Tight Muscles: Tightness in the calves, hamstrings, or Achilles tendon can alter foot mechanics and increase strain on the plantar fascia.
Sudden Increase in Activity: A sudden increase in physical activity or change in routine, such as beginning a new exercise regimen or running longer distances, can lead to overstretching of the plantar fascia.
Symptoms:
The hallmark symptom of plantar fasciitis is heel pain, particularly when first getting up in the morning or after periods of rest. The pain typically occurs at the bottom of the heel, although it can also radiate along the arch of the foot. Other common symptoms include:
A stabbing or sharp pain when you take your first steps after getting out of bed or after sitting for a long period of time
Pain that decreases as you move around but returns after standing or walking for long periods
Swelling or tenderness at the bottom of the heel
Pain that worsens with activities like running, walking, or climbing stairs
Treatment:
The good news is that plantar fasciitis can often be managed and treated effectively with conservative methods, such as physical therapy. The treatment options generally focus on reducing inflammation, relieving pain, and restoring the function of the foot. Here are some common approaches:
1. Rest and Activity Modification
Avoid activities that aggravate the condition, such as running or standing for long periods.
Incorporating rest into your daily routine is essential to allow the inflammation to subside.
2. Ice Therapy
Applying ice to the affected area can help reduce swelling and pain. A common technique is rolling your foot over a frozen water bottle for 15 to 20 minutes at a time.
3. Stretching and Strengthening Exercises
Gentle stretching of the Achilles tendon, calves, and plantar fascia can help improve flexibility and reduce tension on the tissue. Stretching exercises, such as calf stretches, towel stretches, and plantar fascia stretches, can be particularly beneficial.
Strengthening exercises that target the muscles in the foot and lower leg can also help improve foot mechanics and prevent future injury.
4. Orthotics and Footwear
Supportive footwear with a cushioned sole and proper arch support can make a significant difference. Custom-made orthotics can also be prescribed by a healthcare professional to correct foot biomechanics and alleviate pressure on the plantar fascia.
Avoid wearing shoes with inadequate arch support, such as flip-flops or high heels.
5. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Over-the-counter NSAIDs like ibuprofen can help reduce pain and inflammation.
6. Night Splints
Night splints keep the foot in a dorsiflexed position (toes pointing upwards) while you sleep. This gentle stretch can help alleviate morning pain by preventing the plantar fascia from tightening overnight.
7. Physical Therapy
A physical therapist can design a tailored exercise program to address foot mechanics, strengthen key muscles, and improve flexibility. Manual therapy techniques, such as dry needling, soft tissue massage or joint mobilization, may also be helpful.
Plantar Fasciitis vs. Plantar Fasciosis
While the terms plantar fasciitis and plantar fasciosis are often used interchangeably, they actually refer to two different conditions.
Plantar Fasciitis refers to the acute inflammation of the plantar fascia. It is typically a condition caused by overstretching or overuse, and the tissue is still in the process of repair.
Plantar Fasciosis is a more chronic condition that occurs when the inflammation in the plantar fascia has persisted for a long period, often for months or years. In plantar fasciosis, the tissue has undergone degenerative changes rather than simply inflaming. The tissue may be thickened, scarred, or even torn in some areas. Unlike plantar fasciitis, there is less swelling, and the primary issue is tissue degeneration rather than acute inflammation.
Plantar fasciitis is a common and often painful condition, but with the right treatment, it is manageable. Understanding the anatomy of the foot, recognizing the causes, and implementing appropriate treatment strategies can significantly alleviate pain and promote healing. Come check us out at Precision and Performance for all your PT needs if dealing with heel pain.
Happy Running!
Dr. Noelle O’Hara, DPT