Plantar fasciitis is an inflammation of the band of tissue located along
the bottom of the foot. It extends from the calcaneus (heel bone) to the
base of the toes and functions to support the arch of the foot.
This seemingly minor injury affects both novice and elite athletes, as well
as people who spend a lot of time on their feet. It can cause significant
pain and disability if left untreated. Plantar fasciitis can occur from
overtraining, contact with hard or irregular surfaces while running, and
from structural or biomechanical abnormalities affecting the foot and leg.
In general, both high-arched feet and pronated feet are prone to this
injury.
Pronation is a rolling in or flattening of the arch that occurs during
walking or running. Pronation helps provide shock absorption for the foot
and leg; but when it becomes excessive, it can be responsible for many
lower extremity injuries, including plantar fasciitis.
A high-arched foot can also develop plantar fasciitis; however, the
mechanism of injury in these cases is usually increased stress to the arch
due to a relatively inelastic plantar fascia.
Plantar fasciitis is the result of repeated stress or microtrauma to the
plantar fascia where it inserts into the heel. Over time, this microtrauma
will cause small tears in this tissue, leading to heel and/or arch pain. At
first, the pain will occur when taking the first few steps after getting
out of bed in the morning. This pain is often described as feeling like a
""""stone bruise"""" and will usually go away after walking for a little while.
As the injury becomes more severe, the pain may be present anytime one
stands or walks.
Over a long period of time, the chronic inflammation that results from this
repeated stress may cause a bone spur to form on the bottom of the heel.
This is commonly known as a heel spur. In most cases, however, it is not
the spur that is causing the pain, but rather the pulling on the fascia.
Rarely is surgery indicated for this problem. There are also other
conditions that can affect the heel, such as stress fractures and bursitis,
that can cause pain similar to plantar fasciitis.
Plantar fasciitis can almost always be treated by conservative means. The
first step is to reduce the inflammation in the heel and arch area. This is
accomplished by rest, ice application, and the use of an arch strapping to
take the stress off the plantar fascia. Depending on the severity of the
symptoms, oral anti-inflammatories or injection therapy may be recommended.
During this period of recovery, it is not necessary to stop all of your
fitness activities. The use of alternate training, such as cycling,
swimming, or running in a pool with a flotation device, can allow you to
maintain your current level of fitness.
It may take up to four weeks for the pain and inflammation to subside.
During that time, it is important to determine why the injury occurred so
that steps can be taken to avoid recurrence.
When an overuse injury occurs due to overzealous training, the best
approach to avoid re-injury is to adjust your training schedule
appropriately. In many cases, you will recuperate from an injury only to
have a recurrence in a few months. In these situations, the cause is often
related to some type of biomechanical or structural abnormality in your
lower extremity.
One of the most frequent causes of overuse injuries of the lower extremity,
including plantar fasciitis, is tightness in the calf and Achilles tendon.
The Achilles tendon is made up of two muscle groups, the gastrocnemius and
soleus, which join together two-thirds of the way down the leg to form the
strongest tendon in your body. A tight Achilles tendon prevents the ankle
from bending up properly to a degree necessary for walking or running. The
lack of this motion causes the arch of the foot to collapse in or pronate
to make up for this lack of motion. A leg length difference, tight
hamstrings, and certain foot structures can also cause excessive pronation
to occur. As the foot over pronates, it also causes the arch to stretch,
resulting in the microtrauma previously discussed.
An important part of the long-term treatment of plantar fasciitis is to
develop flexibility in the calf area. Many different stretches have been
suggested for this part of the body; however, foot placement and proper
technique are essential in achieving good results. Devices such as the
Foot-Flex can also aid in correct positioning of the foot and leg to
stretch the calf and arch. Stretching is a gradual process and should be
performed slowly and on a regular basis to be effective.
When abnormal foot structure and or biomechanics are contributing to your
injury, your doctor may recommend the use of prescription orthotics to be
worn in your shoes. This should be only be done after a thorough
examination and a walking and running evaluation.
Orthotics are custom made shoe inserts that help to correct imbalances in
the foot and leg. They accomplish this by realigning the feet in a
""""neutral"""" position to allow the bones, muscles, and tendons to function
more efficiently.
Orthotics devices are constructed from various materials and are designed
to your specific needs, depending on your injury and the type of activities
in which you participate. They are not the answer to every problem, but
when indicated, they can be extremely effective in the treatment and
prevention of many injuries.
The best prevention for overuse injuries such as plantar fasciitis is to
evaluate your training schedule so that you increase your activity
gradually. Also, take the time to stretch everyday, even when you do not
workout, and warm up correctly before activity.
Many minor injuries will resolve in a few days with rest and ice. However,
anytime you sustain an injury that persists for longer than a week, gets
worse, or recurs, you should see a sports-oriented physician for a thorough
examination and appropriate treatment.
Perry Julien, D.P.M., is a podiatrist specializing in the medical and
surgical treatment of foot and ankle problems at the Atlanta Foot and Ankle
Center in Atlanta, GA.
