Plantar fasciitis is the most common cause of heel pain in runners and in sports which involve extensive running.
Plantar fasciitis is defined as the inflammation of the plantar fascia, which is the elastic support system for the
bottom of your foot. It consists of thick bands of connective tissue that originate on the front and inner side of the
calcaneus (heel bone) and fan out toward the toes connecting to bones just behind the ball of your foot. Pain
usually begins and is most prevalent in the heel or the rear portion of the arch.
Plantar fasciitis is usually caused by repetitive overstress to the plantar fascia where it connects to the calcaneus.
Pain generally occurs on the sole of the foot near the heel, but may manifest itself on the inside and outside of the
heel. Usually, this condition makes it difficult to walk after sleeping or sitting for prolonged periods. In acute
cases, the pain is most debilitating with any weight-bearing. In chronic cases, it tends to be worsened initially with
activity, but tends to decrease with continued activity. For example, plantar fasciitis is very painful during the first
couple of steps after awaking in the morning, but tends to subside significantly until it increases again by the end
of the day. The reason that this occurs is that during the night, the plantar fascia begins to heal, but not
completely. When the first step is taken in the morning, the site where the healing began becomes disrupted and
aggravated once again.
CAUSES OF INJURY
1. Shoes without adequate support for the arch
2. Playing on hard, unyielding surfaces (e.g. concrete, asphalt)
3. Abnormally flat or high arches
4. Abnormal foot pronation (arch drops too much during gait)
5. Tight calf muscles
6. Sudden increases in activity level
7. Sudden weight gain
The plantar fascia lies between the
calcaneus and the metatarsals
8. Occupations requiring prolonged standing
Most injuries to the plantar fascia are the result of multiple problems. Therefore, it often requires various methods
to completely treat the condition. Initially, as for all overuse injuries, rest or modification (cutting back) in activity
is required to allow healing to occur. Use pain as your guide. If an activity increases or maintains the heel pain
then it needs to be reduced or ceased. If the surface upon which you are active is very hard (e.g. concrete, asphalt),
then change to a softer surface (grass, turf, wood) which will provide more cushioning and less shock to your feet.
Ensure that you are wearing proper footwear. Worn out or poorly constructed shoes will cause your feet to absorb
more shock and to move inappropriately while you are walking or running. When selecting a shoe, ensure that it
feels great from the very start. Never buy shoes that you “have to break in”. Ensure that the shoe has a wide toe
box, does not bend at the toe easily, and has a firm heel counter. You may also wish to try over-the-counter shoe
inserts to support your arches, or a heel lift to decrease tension through the bottom of your foot. Remember that
shoes should be replaced every 400 - 600 miles of use, or 6 - 8 months. Just as changing the oil in a car is
important for the life of the engine, changing your shoes regularly will help maintain the health of your feet.
If you have access to a physical therapist or a certified athletic trainer, you may be able to get your arches taped.
This method decreases the stress across the plantar fascia while providing support to the arch. In some cases your
physician or physical therapist will prescribe custom-made orthotics. Custom orthotics help to correct any
underlying biomechanical abnormalities in your gait that may be the underlying cause to the plantar fasciitis.
These orthotics are custom made to fit and correct only your problems.
When plagued with plantar fasciitis, you should ice the injured area, 3 times a day to
reduce any inflammation and pain. After exercise, you should ice the affected area at least
8 minutes to help control the symptoms. To make ice cups, simply place Styrofoam cups
filled with water in the freezer. Once frozen, peel away the top lip to expose the ice and
hold the cup to apply to the affected area.
Over the counter, non-steroidal anti-inflammatories, taken as directed by the
manufacturer, will also help to reduce swelling and pain. Check with your physician to see
if this is an appropriate method of treatment, or if the NSAIDS will conflict with other
medication that you are currently taking.
Regular consistent stretching of the calf muscles and the arch of the foot can also help
plantar fasciitis. Stretching is most effective when performed 3 times for 30 seconds
(static, no bounce) before and after activity. It is possible to stretch the plantar fascia by
performing a calf stretch with a towel wedged under the toes to raise them, or, you may
loop a towel or belt around your toes while sitting with your legs outstretched and pull
back toward you until you feel a stretch under your foot. Another method is to roll a round
object under your foot such as a 16oz bottle (plastic) filled with frozen water.
After your pain resolves, you should begin to slowly strengthen the muscles around your ankle to help stabilize
the foot. In addition, you should see a physician or a physical therapist if your pain is persistent and does not remit
This article is ontributed by:
Caritas Medical Center
(Caritas Sports Medicine)
(Louisville Physical Therapy)
(Physical Therapy Specialists)
(The Hand Center)