Plantar Fasciitis

Plantar fasciitis is an overuse condition that is caused from stretching or inflammation of the tissue that run along the sole of the foot. The plantar fascia is a collection of connective tissue originating at the bottom of the heel and progressing toward the ball of the foot. It helps maintain the arch and acts as an impact absorber. Usually a chronic condition, factors contributing to plantar fasciitis include pronated (or flat) feet, wearing shoes with inadequate arch support, and weak or inflexible muscles in the lower leg and foot.

Signs and Symptoms:

Pain along the arch or near the bottom of the heel.
Feeling of muscle tightness or weakness.
The arch may flatten out.
Inability to push off with the foot or point the foot down.
Pain and an inability to walk without limping (especially in the morning after rising from bed, or after sitting for prolonged periods).
There may be evidence of nodules (or lumps) on the underside of the foot, especially near the calcaneus (heel).

On-Site Management:

P.R.I.C.E.

PROTECT the area from further injury (i.e. orthotics)

REST the area to promote healing, it is important to take some time off from intense leg loading or running give the tissue time to heel.

ICE the area to move inflammation away, especially after any activity.

COMPRESS the area rolling your foot on a tennis ball to stretch out the connective tissue that is tight.

ELEVATE the area to promote circulation towards the heart.

Stretching the area through soft tissue massage on a hard small ball, as well as stretching the calf muscles may help relieve pain. Taping the foot into inversion and the low-dye tape job, or wearing a gel heel lift may give people some relief.

Referral:

A physician can prescribe anti-inflammatory medication or other treatments such as corticosteroid injections (be aware of the serious side effects such as tendon ruptures) or iontophoresis for short term relief.

Rehabilitation:

With guidance from a therapist, rehabilitation includes strengthening the muscles of the foot (towel curls, picking up objects with the toes, etc.), lower leg and hip. Stretching of the calf muscles and the plantar fascia itself is very important (tennis ball stretch or pull on big toe). Alteration and assessment of biomechanics when loading or running, massage and soft tissue therapy, night splints or even surgery in patients with pain for more than 6 months consistently.

Return to Activity:

Heel cushions and taping the arch for support are often useful when returning to activity. Return to activity should be guided by a therapist.

Risk Factors:

High or low arches
Unsupportive footwear
Overtraining in activities such as running, dancing
Reduced ankle dorsiflexion flexibility (pointing the toes upwards)
Excessive loading on the feet (obesity, heavy lifting)

Prevention:

A shoe with good arch support will help prevent this injury.
Proper orthotics can also be used to help runners with low arches.
Flexible calf, hamstring and gluteal muscles can also help reduce the risk of injury.

Brukner, P. and Khan, K. Brukner and Khan's Clinical Sports Medicine Brukner, P. and Khan, K. (2007) Brukner and Khan's Clinical Sports Medicine. 4th ed. North Ryde: McGraw-Hill.

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