Plantar fasciitis is and injury common among athletes and non-athletes.
In its simplest terms it is an inflammation of the plantar fascia,
resulting in pain throughout the foot and the arch. It is often the
cause of runner heel pain, and can be
very debilitating, lasting for months if not treated
The Plantar Fascia
The plantar fascia is a wide band of connective tissue that covers the
bottom of the foot. It extends from the heads of the five metatarsals
along the arches and inserts on the calcaneus. Because it is connective
tissue, it is considered non-contractile. The plantar fascia helps to
provide support to the muscular arches of the foot.
Inflammation of the Plantar Fascia
Inflammation of a tissue occurs when the stresses placed on that tissue
are greater than it can handle. While inflammation is a necessary part
of tissue healing, chronic inflammation can cause pain, swelling, loss
of motion, and decreased function.
Signs and symptoms include pain and discomfort along the bottom
of the foot, from the heal to the balls of the feet. One of the most
common complaints is severe pain with the first step out of bed in the
morning. Runner heel pain may also be a common symptom.
may be a feeling of tightness
throughout the arch. When
pushing on the bottom of your foot, you may feel small areas of
hardness, like little pieces of gravel or knots in the tissue. Pain and
discomfort often decreases as the tissue warms up
and stretches out, only to return with prolonged activity.
Causes of Plantar Fasciitis
One of the most common causes is poor calf
flexibility. When the calf muscles are tight, this limits the amount of
motion available to the ankle when walking. The motion of pulling your
toes towards your head is called dorsiflexion. Limited dorsiflexion
places an increased amount of stress on the arches of the foot and the
plantar fascia. This increased stress can often lead to inflammation,
pain, and discomfort.
Another common cause of plantar fasciitis can be
the biomechanics of the foot during the gait cycle. During walking or
running, the foot is required to absorb a significant amount of stress.
In order to fully understand this, lets look at the gait cycle a little
The gait cycle can be divided into several
different phases. The first phase, is called heel strike. This occurs
when you take a step and your heel makes contact with the ground. This
is the time when much of the stress needs to be absorbed. With normal
biomechanics, the foot should be in a slightly supinated position
during heel strike. Supination is a combination of motions, and simply
put is when your foot is turned in slightly, and more weight is placed
towards the outside of your foot. Supination allows for a rigid foot to
absorb the stress of heel strike
The second phase of gait is called foot flat. This
occurs when your foot is flat on the ground. In normal biomechanics,
the foot should be in a slightly pronated position. Pronation is a
combination of motions, the opposite of supination, but simply put is
when your foot is turned out slightly and more weight is placed towards
the insides of your feet. In a pronated position, the small bones and
joints of the foot are open, and they are able to absorb the stress and
shock of walking. This means that from heel strike to foot flat, the
foot is moving out of supination (the outside of your foot bearing more
weight) and moving to a pronated position.
The third phase of
gait is called push off, or toe off. This occurs as you begin to lift
your heel, rolling onto the balls of your foot and pushing yourself
forward. With normal mechanics, the foot should be in a slightly
supinated position once again. Supination causes the joints of the foot
to lock down, and creates a rigid lever to propel you forward.
The biomechanical problems occur when you spend more time in either
pronation or supination during the gait cycle. By far, over pronation
is much more common than over supination. Remember, pronation places
more weight on the inside of your foot. This means that increased
amounts of stress are being placed on the arches and soft tissues. This
increased stress can cause plantar fasciitis, and is a very common
Improper footwear is another common cause of
plantar fasciitis. Athletic shoes that do not have proper arch support
or adequate support of the heel can lead to altered biomechanics and
increased stress on the soft tissues of the foot.
Treating Plantar Fascitis
Treatment is made up of several key
ingredients. As there can be numerous causes, addressing each helps to
achieve the most effective results.
Treating the pain and discomfort of plantar fasciitis is
achieved through the use of ice and massage.
ice, especially following activities and during periods of increased
pain can help to decrease inflammation in the area, as well as reducing
pain. Ice massage
is generally very
effective in treating plantar
Massage is another excellent treatment option.
Rubbing of the plantar fascia helps to reduce some
of the "knots", and allow the tissue to return to its normal state.
With chornic plantar fasciitis, there is often a buildup of
inflammation in the area, which can be reduced through massage. Massage
also helps to increase blood flow to the area, aiding the healing
While treating the symptoms is important to
provide relief, without treating the underlying cause, your symptoms
are bound to return. So to treat the actual cause, you need to improve
flexibility and ensure you are wearing the right shoes, and account for
any biomechanical problems.
good stretching regimen for the calf muscles is
important in the treatment of plantar fasciitis. Daily stretching of
the calf can help to reduce the stress on the soft tissues of the foot.
should be performed
2 or more times a day, with each
session consisting of 4-5 stretches, held for at least 30 seconds.
is important as
well. You should
choose a shoe that is right for your activity. Good arch support, a
strong sturdy heel box, and an adequate amount of cushion are all
important in treating and preventing plantar fasciitis.
Even with great shoes, sometimes our bodies just don't
cooperate. The biomechanics of your feet, and whether you are a
pronator or supinator cannot be "fixed".
Often an insert can be placed in the shoe to help account for over
pronation. These orthotics help to bring the foot into a
more neutral position, decreasing the stress on the plantar fascia, and
limiting symptoms of plantar fasciitis, like runner heel pain and arch
soreness. There are many available
pre-made orthotics on the market for treating plantar fasciitis. Ask
your family physician or certified athletic trainer
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Plantar fasciitis can be a frustrating and chronic injury. Proper
flexibility, conditioning, biomechanics, and footwear can all play an
important role in preventing and treating this condition. Understanding
its cause, and what you can do to improve is the key to successful
treatment of plantar fasciitis.
When to Seek Treatment
If you have been suffering from foot pain for more than a few weeks, or
if you have been doing all of the above things and are still having
discomfort, you should see your family physician or certified athletic
trainer. You may be in need of a thorough biomechanical examination, as
well as plantar fasciitis treatments you cannot provide on your own.
Iontophoresis, therapeutic ultrasound, and therapeutic electrical
stimulation may be of benefit.
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