Plantar Fasciitis is a persistent pain located on the plantar (bottom) of the heel and the medial (inside) of the foot. The planar fascia is a fibrous, tendon like structure that extends the entire length of the bottom of the foot, beginning at the heel bone and extending to the base of the toes. During excessive activity, prolonged standing or walking, the plantar fascia can become irritated and may even tear if the area is subjected to repetitive stress. Heel contact during the gait cycle exposes the medial-plantar aspect of the heel, where the plantar fascia attaches to the heel bone.
The pain resulting from this injury is most noticeable in the morning when the first few steps are taken and subsides with prolonged walking. Likewise, during athletic activity the pain will occur in the beginning of the exercise routine and can subside as the activity continues. For some people, pain can worsen as the day goes on due to the lack of support in shoes.
Causes of Injury:
Plantar Fasciitis is more common in athletes who have a rigid high-arch, supinated foot or a flat pronated foot. In motion, the plantar fascia experiences continuous stress and excessive pulling which results in inflammation and pain.
- The most common cause is a sudden increase in the mount or
intensity of activity within a short period of time.
- Improper shoe selection can be a cause of the injury; foot and gait
type must be considered.
Pronated Foot: The plantar fascia is stretched in the pronated foot by excessive motion. Flexible shoes can cause stretching of the plantar fascia.
Over-worn shoes allow the foot to pronate more extensively and can result in an injury to the plantar fascia.
Supinated Foot: A supinated, high arch foot has a tight band like plantar fascia that is rigid during the gait cycle. Stiff soled shoes can cause stretching of the plantar fascia.
Over-worn shoes allow the foot to supinate more extensive and can result in an injury to the plantar fascia.
Short Term Treatment: In determining the proper treatment for Plantar Fasciitis, it is important that the athlete knows and eliminates the causative factors of the injury. A complete medical history analysis, pedal examination, gait analysis and x-rays to check for a heel spur are recommended.
- Do not walk barefoot.
- Complete rest or a reduction in the intensity of exercise.
- Ice application for 15 minutes several times per day.
- Massage and/or stretch the tendon by rolling the foot on a rigid object.
- Anti-inflammatory medication, such as pills or cortisone injections(only as a last resort), to alleviate severe pain in acute cases.
Long Term Treatment: In cases that are persistent, orthotic devices help correct biomechanical problems and alleviate stress and strain on the plantar fascia.
- Supinated, high arch devices require softer orthotic devices for shock absorption
- Pronated, flattened arches require a more rigid orthotic to control pronation.
- To prevent recurrence, plantar fascia and calf stretching exercises should be performed daily.
- For temporary immobilization, sleeping splints and casting may be necessary.
Most patients respond to these forms of treatment as long as they are performed on a regular basis; only a very small percentage of patients require surgery.