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Plantar Fasciitis: A Detailed Look

I have had pain in my heel as a result of changes in my training regimen for approximately three months. I have been told that this is plantar fasciitis. What exactly is it, and how do I treat it?

Answer, provided by William R. Olson, DPM, Past President, AAPSM

Q: How can I treat plantar fasciitis?

A: : The plantar fascia is a strong, connective tissue that runs along the bottom of the foot connecting the heel to the base of the toes. This thick, fibrous band of tissue, along with the muscle and bones, forms the arch of the foot. Once the fascia becomes irritated, it becomes inflamed and painful.

Think of the arch of the foot as a hunting bow and the plantar fascia as the bow string. If you put pressure on the top of the bow or arch, it will tighten the plantar fascia and cause it to stretch. Weak foot muscles can lead to pressure on the arch. The shape of the arch, such as being flat footed or running in old shoes which do not properly support your feet, can stress the plantar fascia. The Achilles tendon also attaches to the plantar fascia. If the calf muscles that attach to the Achilles tendon are tight, the ankle becomes less flexible, and the plantar fascia also tightens.

Frequently, the pain is noticed after getting up in the morning or after standing after long periods of sitting. This is because the fascia has an opportunity to tighten during the night or during periods of rest and is traumatically stretched upon initial weightbearing. Over the course of the day, however, with increased activity, the pain may again worsen despite the fact that it frequently loosens up after the first few steps. The location of the pain may vary as well. While plantar fasciitis frequently is noticed under the heel, it may extend along the entire course of the fascia or at any point along the length of the fascia.

The primary goals in the management of plantar fasciitis are to 1) reduce the inflammation, 2) protect the plantar fascia from further trauma, and 3) stretch and strengthen the ankle, foot and calf muscles.

Inflammation is best managed through icing. This can be done either with an ice cup (fill a paper cup with water and freeze; when ready to use, peel off the top part of the cup and apply to the painful area), or an ice pack to be used for no longer than 15 minutes. It is also effective to use bags of frozen vegetables (corn or peas usually work best), as these will wrap around the heel and contour to the arch. It is most effective if you can ice several times a day.

Protection of the plantar fascia can be achieved through taping and use of shoe inserts. Occasionally, over-the-counter inserts can be effective in reducing strain along the plantar fascia; however, if improvement of symptoms is not noted within the first few days of using over-the-counter inserts, you can assume that the pre-determined shape of that insert does not correspond well to your particular foot type, and consultation with a podiatrist is recommended for evaluation for the possible fabrication of functional foot orthoses.

Stretching and strengthening of the muscles of the ankle and foot will not only help in your recovery, but will also help to prevent the pain from recurring. The morning before you get out of bed, pull your feet towards you and stretch out your calves to help decrease the pain of that first step. Also, keep a pair of slippers or shoes by your bed that have a slightly elevated heel so that the fascia is gradually stretched out. As discussed earlier, calf muscles (gastrocnemius and soleus) need to be flexible. This is achieved by slowly leaning forward while facing a wall, with the knee straight and the heel on the ground until you feel a pull in the back of your upper calf. After holding this stretch for 30-60 seconds, allow your knee to bend, and feel the stretch in your lower calf. This should be repeated 3-5 times per day. Remember that proper stretching is gentle and should not be painful. These exercises need to be done on a consistent basis to be most beneficial. If your symptoms have not improved over the course of 2-3 weeks, further evaluation by your podiatrist is recommended.

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