Posted: March 19, 2012
Plantar fasciitis is an injury that is extremely common, and one we see in the clinic on a daily basis. Ask around to friends, family, and running buddies and chances are, at least one or two people you know have had it at some point! Fortunately, if caught early, this injury can resolve itself with a few simple interventions. However, if allowed to become a chronic issue, it can be notoriously difficult to get rid of. As with any injury, understanding what causes plantar fasciitis is key to determining the best treatment course of action.
‘Plantar’, meaning bottom, and ‘itis’, meaning inflammation, translates to represent inflammation of the tissues of the bottom of the foot. Specifically, plantar fasciitis refers to inflammation of a very important group of connective tissue: the plantar fascia. The fascia originates on the heel bone (calcaneus) and runs towards the front of the foot, inserting just behind the ball of the foot (metatarsal heads). Because of its strength, it absorbs force and maintains the integrity of the arch. It also generates a spring-like response during propulsion when we walk and run. All in all, the plantar fascia is a very important piece of tissue. That’s why it can be so problematic when it becomes inflamed.
There are a few mechanisms that cause plantar fascia strain and inflammation. Overpronation at the midfoot or arch of the foot causes stretching and collapsing of the plantar fascia. This motion pulls the fascia from its insertion point. In addition, if the foot joints or fascia are tight and restricted during movement, the fascia cannot do its job as a shock absorber and the fascia undergoes more strain that it is capable of withstanding. Both of these conditions can cause micro tearing of the tissue, which becomes painful when standing, walking, or doing activity. Why did this problem develop? Though faulty biomechanics are the major cause, footwear that is worn out or the wrong support category can be the another major culprit. Tight muscles and tendons, specifically the calves and/or the intrinsic muscles of the feet can also be a factor. Starting a new exercise program, increasing distance or intensity can also cause abnormal stress.
One of the hallmark symptoms of plantar fasciitis is morning pain with the first steps out of bed. After the tissue is stressed and micro tearing develops, the body heals itself while we sleep and the foot is relaxed. When you get out of bed in the morning and put your feet down, the healing tissue is stressed again and all the good work your body has done is undone with a few steps. Often times the first steps will be very painful, then dissipate, returning later on as you stand, walk, or exercise throughout your day. Patients may have pain in the heel, through the arch or both, that generally follows this pattern. It is common to get caught in this cycle of healing and tearing each and every day.
Treating plantar fasciitis can start with easy interventions and progress to more complicated options and symptoms dictate. A morning warmup routine to ready the foot for walking and daily activity can stop the heal-tear cycle. Calf and foot stretching, as well as manual therapy can be very beneficial to increase flexibility of the tissues involved. Orthotics or over-the-counter insoles contour the arch and cup the heel to reduce biomechanical causes. Replacing your shoes and making sure you have the right type of footwear for your needs is integral as well. Lastly, let pain be your guide when determining the right level of activity for your injury.