PLANTAR FASCIITIS

Plantar fasciitis is characterized by stiffness, inflammation and gradual degeneration of the plantar fascia (fibrous connective tissue) on the plantar (bottom) aspect of the foot.  A less common cause is associated with a bone spur of the heel. 

WHAT CAUSES PLANTAR FASCIITIS?

•  There are a number of factors that can contribute to plantar fasciitis including:
•  Repetitive impact resulting in micro trauma or stress to the heel tissues that may cause inflammation or calcification of the fascia
•  Inflexibility of the calf muscles
•  Flat (planus) or high (cavus) arched feet
•  Unhealthy foot pronation
•  Limited ankle range of motion
•  Excessive body weight
•  Poor footwear
•  Irritation of the small nerve that runs under the foot where the fascia attaches to the heel bone

In our office we most commonly have patients with repetitive micro trauma to the plantar fascia resulting in adhesion and scar tissue formation.

SIGNS AND SYMPTOMS:

This injury can manifest in several ways.  The most common signs and symptoms include:

•  Pain and tenderness on the sole of the foot usually localized at the heel bone when standing or walking
• Pain following your activity
• Pain associated with the first few steps taken in the morning when getting out of bed or after prolonged sitting

DIFFERENTIAL DIAGNOSIS:

Many conditions can resemble and can coexist along with plantar fasciitis, such as:

• Strain of the Flexor hallucis longus
• Achilles tendonopathy (inflammation and gradual degeneration of the Achilles tendon)
•  Ankle sprains (damage to the ankle ligaments)
• Referred nerve pain from the low back

SELF MANAGEMENT:

There are several ways that you can prevent development and recurrence of plantar fasciitis including:

•   Stretch and warm-up prior to activity (including foam rolling/lacrosse ball)
•   Use a frozen water bottle to roll along the base of your foot
•  Maintain appropriate strength/conditioning (glute and lower extremity)
• Maintain healthy body weight
• Avoid activities that put a constant strain on the foot
•  Wear appropriate footwear
•  Night splints
• Correction of gait abnormalities

CONSERVATIVE MANAGEMENT:

Similar to any foot-related injury, treatment interventions will vary based on the individual and are commonly multifaceted.  More complicated cases may require several of the following interventions in order to achieve positive clinical outcomes:

• Active Release Techniques©(ART) and/or Graston Technique^© to help elongate the tissue and breakdown any scar tissue or adhesion formation
• Functional Rehabilitation to strengthen the kinetic chain
• Joint mobilization to improve ankle and tarsal (bones of the foot) mobility
•  Passive modalities (low volt therapy, ultrasound)
• Night splints/Kinesio Taping^©
•  Orthotics (custom/over the counter)
• Gait analysis and gait training
• Appropriate footwear

Plantar fasciitis can quickly become a chronic condition if ignored for too long.  If you are experiencing symptoms of plantar fasciitis for greater than 1-2 weeks and self-management does not change your symptoms, you should have your condition evaluated.  The longer you wait, the longer it takes to resolve.   If a condition does not resolve with self-management and conservative care, higher intervention therapies may be necessary.  

The intent of this article is to provide a brief overview of plantar fasciitis.  In no way does it describe all causes or treatment options or intended for self-diagnosis.  If you are questioning your pain, please follow-up a licensed health care provider.