The pain of plantar fasciitis

Written by Megan Gaudry. 

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The views and information provided by Aspire Health & Rehabilitation, and Megan Gaudry, in the form of blogs, videos, photos and reviews are not in any way to be substituted as a Medical consultation, and are for education purposes only.

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Like many others, I suffer from plantar foot pain or plantar fasciitis (pain on the bottom of the foot), for me, it usually associated with prolonged standing without rest, returning to running after a period of time, or even increased duration or intensity in my current running program. Being flat-footed, also doesn't help, and I will discuss why. 

I find this condition very annoying, just like shin splints. However just like shin splints, its all about management and addressing (or being aware of) the contributing factors that result in plantar fasciitis.

Insertional site of the plantar fascia. Image by Lucien Monfils (Wikimedia Commons).

The plantar fascia is actually a thick, fibrous band of connective tissue which originates at the heel bone and runs along the bottom of the foot in a fan-like manner, attaching to the bottom of each of the toe. The plantar fascia takes on a number of critical functions during weight-bearing activities such as running and walking. It stabilizes the metatarsal joints of the foot (the joints associated with the long bones of the foot) during impact with the ground, acts as a shock absorber and helps to maintain the longitudinal arch of the foot, particularly during the 'take off' phase of gait.

Plantar fasciitis is an overuse condition of this fascia, particulalry at its attachment to the heel. It is a common running related injury, affecting 10% of runners, however overall, accounts for 11-15% of all foot complains requiring professional treatment. The condition affects the plantar fascia of the foot, which arises from the heel (or calcaneus) and attaches onto the toes. This provides static support to the longitudinal arch and dynamic shock absorption of the foot.

Plantar fascia- showing a fibrous band of connective tissue. Image by Ryxi10 (Wikimedia Commons).

Causes of plantar foot pain, or plantar fasciitis, include:

• Long-distance walking or running.
  
• Low arch/flat foot individuals, there is an increased strain on the origin of the plantar fascia at the heel, as the plantar fascia attempts to maintain a stable foot arch during gait such as standing, walking and running.
  
• For those that have a high arch, there may be excessive strain at the heel area, because your foot lacks the ability to shock absorb and adapt to the ground.
  
• Inappropriate or non-supportive footwear. This is self-explanatory, and can result in many injuries not just plantar fasciitis.
  
• Reduced dorsiflexion movement of the ankle has also been shown to be an important risk factor, and to improve this range of movement for those with restrictions, check out our previous blog "Are your ankles limiting your movement?" for some great information, quick assessment and exercises on how to improve your range and get more out of your movement such as squatting.
  
• Obesity and work-related weight bearing.
  
• Tightness in structures such as the calf, hamstrings and gluteal regions.

For those that haven't experienced plantar fasciitis, it is a gradual onset of pain, tenderness and tightness that is felt in the medial aspect of the heel/ arch. It is usually worse in the morning, and may decrease with activity, often aching after activity has ceased. Periods of inactivity through the day is generally followed by increase in pain as activity is recommended. As the condition worsens, pain can become more severe, and present during any weight-bearing activities.

Stretching has been shown to be the only preventative strategy, apart from addressing biomechanical aspects such as flat feet with taping, exercises and orthotics; as more research is focused on the treatment and management of the condition.

Plantar fasciitis is reversible, or more so 'manageable' to prevent reoccurrence. In fact, 85-90% of cases can be successful managed  with conservative treatment. This can involve;

• Avoidance of aggravating activity
  
• Ice therapy after use- ensure you are constantly moving the ice to avoid ice burn.
  

• Fascial release with ball (i.e. golf ball or lacrosse ball) or frozen bottle; or foam roller for gluteals and hamstrings.

Using a hard ball, such as a lacrosse ball will hurt when you first start using it, however after a few minutes it will feel better.

Using a frozen bottle of water for relief and fascial release. To avoid ice burn, make sure you are continually moving you foot.

Using massage stick on the calf muscles, can also use on the hamstrings.

• Stretching of plantar fascia, gastrocnemius and soles. You can also stretch the plantar fascia manually with your hands, I actually prefer this way.

Plantar fascia stretching on wall

• Taping- both Rigid and Rocktape variations are shown. If you are allergic to taping, consult your treating practitioner as to the possible use of underwrap. Arch taping is another option for those with flat feet, I felt this had helped prior to my first pair of orthotics.
  

• Strengthening based exercises- strengthening of intrinsic foot muscles of the foot are designed to improve longitudinal arch support and in turn will prevent excessive loading through your plantar fascia. Keep in mind, many allied health professionals have their own view on foot intrinsic exercises, so consult your treating practitioner as to what they recommend.
  

• Silicone gel heel pad- these can be picked up from the chemist or a shoe store, maybe even shops like K-mart. These are great for shock absorption.
• Footwear with well supported arches and midsoles- Trying to hang onto your shoes for as long as possible, may actually be doing you more harm. Especially runners, or those on their feet all day, you should be looking at replacing them more often.
• Night splints or Strasbourg sock
• Biomechanical correction with orthosis- as mentioned in the blog about shin splints, their are off-the-shelf orthotics and custom-made orthotics.

If you have other treatment and or preventative ideas for Plantar Fasciitis, I would love to hear about them, please contact me via the CONTACT US section of this page.

Yours in health,

Megan

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References used in this article

• Brukner, P., & Khan, K. (2009). Clinical Sports Medicine (3rd Ed). Mc Graw Hill, pg 648-651.
  
• La Porta, G,. & La Fata, P. (2005). Pathologic conditions of the plantar fascia. Clin Podiatr Med Surg, 22: 1-9.
  
• Lee, S., McKeon P,. Hertel J. (2009). Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis. Phys There Sport, 10:12-18. 
  
• Lafuente, A., O’Mullony, I., & Escribá, M. (2007). Plantar fasciitis. Evidence-based review of treatment. Reumatol Clin., 3:159-165.
  
• BMJ Best Practice. (2014). Plantar Fasciitis. BMJ Publishing Group Limited. http://bestpractice.bmj.com.ezproxy1.library.usyd.edu.au/best-practice/monograph/487.html
  
• Di Giovanni, B., Moore, A., Zlotnicki, J.,  & Pinne, S. (2012). Preferred management of recalcitrant plantar fasciitis among orthopaedic foot and ankle surgeon. Foot Ankle Int, 33; 507.
  
• Garrett, T., & and Neiber, P. (2013). The effectiveness of a gastrocnemius–soleus stretching program as a therapeutic treatment of plantar fasciitis. Journal of Sport Rehabilitation, 22; 308-312
  

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* All photos (except those of Wikimedia Commons) used in this blog are a product of Aspire Health and Rehabilitation (2014) and cannot be reproduced without permission.